Psychology: A Critical Review on PSTD

A Critical Review by cheryl yow

Chapter 2: Post-traumatic stress disorder. Offprint 2.
Brief report 2: The ability of naïve participants
to report symptoms of post-traumatic stress disorder.
Burges and McMillan, 2001



The abstract displays the main elements of this article
in a concise and readable manner. The research’s objective
was to find out whether successful faking of DSM-IV criteria
B-D on the PTSD symptoms checklist is due to previous
knowledge of PTSD or the leading nature of symptoms
checklists or combination. A between-groups design was
employed and naïve participants needed to self-generate
PTSD symptoms from a vignette. Then they were randomly
assigned to groups and asked to complete either a standard
symptom checklist or a checklist with PTSD bogus symptoms.
Results revealed less than 1% of self-generated symptoms
tallied with DSM-IV criteria B-D for PTSD whereas 94% of
participants fulfilled the criteria of the standard checklist and
90% on the modified checklist.34% of participants incorrectly
identified 38% of faked symptoms. The conclusion also
confirmed the significance of the findings without
overemphasising -that in spite of poor understanding
of PTSD, 94% of participants were able to successfully
realized diagnostic criteria with a standard checklist due to
‘guessing’.



The introduction explains the rationale behind the research:
the capability to fabricate PSTD symptoms. 19 of 22 survivors
seeking personal injury claims after the sinking of Aleutian
Enterprise were diagnosed with PSTD, however, when
re-interviewed by the inquiry only 4 were diagnosed with PSTD.
This highlights the possibility of diagnostic inaccuracy as
PTSD includes symptoms that are similar with other stress
disorders. People can falsify these symptoms to seek financial
compensation in the legal setting. In the self report,
symptoms are matched against a checklist and a criterion score,
thus it is easy to guess the symptoms. Clinicians were advised
to use psychometric assessments to substantiate self-report.
However, psychometric evaluation may not be effective in
discerning genuine from faked symptoms. 52 percent of
uninstructed participants were found to be able to fabricate
PTSD using Minnesota Multiphasic Personality inventory (MMPI)
(Lees-Haley,1989). Other appraisals, like the MS-PTSD measure,
was found to be ineffective in distinguishing between PTSD
cases and the impostors (Dalton et al., 1989; Frueh &
Kinder, 1994).



A previous study by Lees-Haley and Dunn (1994) examined the
capability of naïve undergraduates faking the symptoms of
generalized anxiety disorder, mild brain injury, major
depression and PSTD. Results showed high score of 97%.
However their study did not point out whether the
undergraduates’ success in faking responses is due to
preceding knowledge about the symptoms or the leading
characteristic of the checklists or a combination and the
undergraduates also did not represent the general
population in general intelligence, socio-economic group
or age. Thus, this present study endeavoured to expand
Lees-Haley and Dunn’s (1994) study by using a widely
used PTSD checklist and mock items in investigating the
ability of naïve participants to replicate PTSD symptoms.



The relevant literature and background were adequately
explained. Even by incorporating psychometric assessments to
substantiate the ineffective, subjective self-reports, PTSD
symptoms can easily be fabricated. The assessment of other
literature reviews led to the aim and the research question
at the end of the introduction: The researchers sought to
investigate whether the reason for easy fabrication of
symptoms is due to preceding knowledge of the symptoms
or it is the inherent leading cues exist in the symptoms
themselves or both. The research question is explicitly and
clearly stated. Supporting evidences from other studies were
precisely and fairly summarised and their appropriate
references were clearly cited. The rationale was well
developed and sufficient information were given in a direct,
readable manner.



The method section started with 136 participants being
recruited from night-classes at a college. A demographic
questionnaire was used to ascertain if the sample accurately
represented the general population. To assess general
intelligence, the Spot the Word test (Baddeley, Wilson,
& Nimmo-Smith,1992) was used. Participants self-generated
PSTD symptoms from a vignette of PTSD knowledge task. Then
they were assigned randomly to 2 groups to complete either
the Post-traumatic Symptoms Scale-Self report
(PSS-SR, a checklist of 17 DSM.IV symptoms of PTSD)
or a modified PSS-IR which includes 16 fake symptoms.


Participants in this between-groups design has been randomly
assigned to avoid bias. Exclusion of participants that were
clearly not naïve participants was stated. In this article a
few instruments were used: a demographic questionnaire to
ascertain the accurately represented general population, the
Spot the Word test to assess intelligence, the vignette and
lastly the Post-traumatic Symptoms Scale-Self report. All
instruments have been clearly named and stated. The
questionnaires and method used is validated and
appropriately employed to assess how easily PTSD can be
fabricated. However, it is not clear when the participants
were recruited, who recruited them, where did they
completed the tasks and who scored the questionnaires. The
exact number of males and females participants is not known.
The age range is not mentioned, it is not clear if they do
cover fully the general population as participants from night
classes may be below 55 years, thus exclusion of age was not
explicitly stated.




The results of all tests and questionnaires were succinctly
stated. From the vignette, only 1out of 134 participants
correctly guessed the PSTD criteria B-D. The accurate guesses
were hyperarousal (22%), re-experience (19%) and
avoidance/numbing symptoms (3%). When using symptoms
checklists, more than 90% attained the criteria for PTSD
diagnosis. Unrelated t tests showed no distinct differences
between groups in identifying the number of PTSD symptoms
or the number of participants attaining DSM-IV criteria for
PTSD (p> .05). Some participants incorrectly associated
all 16 fake symptoms and 50% incorrectly identified 5 fake
symptoms.



There were no significant differences between the
participant’s ages, sex and years of education or IQ test.
Pearson’s product moment correlation discerned the difference
between demographic variables showed an assumed
relatedness between years of education and IQ
( r=34; p<.001). Correlations between demographic variables,
the two PTSD knowledge variables (number of symptoms guessed
and number of symptoms guessed correctly) and the two
symptoms checklist variables ( number of PTSD symptoms
correctly checked and number of fake symptoms incorrectly
checked) revealed three distinctive outcome: in the vignette,
participants inclined to guess more accurate symptoms
( r+.50; p<.001) and on symptoms checklist they
inaccurately checked more bogus symptoms. Those who
accurately checked many PTSD symptoms also inclined to
check as many fake symptoms inaccurately. The correlation
between number of symptoms presumed accurately and
number of symptoms checked accurately was low.There
were no distinctive differences between those who claimed
to have witnessed a traumatic event and those who did not.
No distinctivedifferences found between sex of considered
male or female assault victims or between sex of participants
and sex of role-play victim. (t test, p.05)



The relevant descriptive statistics were succinctly described
and the findings seem significant however no tables were
displayed. There are many figures here but these data was not
summarised in a way that is fluid and readable.



In the discussion section, the authors have explained clearly
how the results linked to the experimental aim stated in the
introduction. The findings were related to the literature
outlined in the introduction. It built on the previous
study of Lees-Haley and Dunn (1994) who examined the
capability of naïve undergraduates faking the symptoms of
generalized anxiety disorder including PSTD. The purpose of
this study was partly a research and also partly implemented
C. Burges’ Doctorate in Clinical psychology at the University
of Surrey. The intended audience are the clinicians who
highly depended on unreliable self-report in diagnosing PTSD
patients. More females were employed because of the given
epidemiology of PTSD. Results suggested that participants
were actually ignorant about the experiences and symptoms
of PTSD although 40% of them have witnessed a traumatic
event.



On symptoms checklist, the results differs significantly
as compared to the result of the vignette - the results of
94% is similar to Lees-Haley and Dunn (1994)where 99% of
untutored undergraduates fulfilled DSM-IV criteria. In
interpreting the results three possible reasonable opinions
were given: Firstly, participants were not really ignorant
of PTSD, they were just able to recognise symptoms better
in a recognition model (symptom checklist) than in the
recalled model (vignette). However, if memory recognition
is triggered by symptom checklist than it does not explain
why participants with more prior knowledge of PTSD
were not able to distinguish the genuine and fake symptoms
better than those without experience. Secondly, the format
of the checklists might influence the participants, hence
they ticked questions without much discernment. Thirdly,
participants might just be guided by their general sense
of what they expected a PTSD patient would experience.
Evidence also showed that those who ‘guessed’ more correct
symptoms on the PTSD knowledge task and the symptom
checklist ( PSS-SR) also intuitively inaccurately
recognized more fake symptoms on the modified checklist.
This suggests face validity- which means at first sight they
seem to be appropriate indicators of PTSD. The results were
objectively and explicitly interpreted. Results indicated
that traditional symptoms checklists ( PSS-SR) can be easily
‘faked’ by naïve participants. Research on MS-PTSD scale and
the MMPI ( Dalton et.al., 1989; Frueh & Kinder, 1994;
Lees-Haley, 1989; Perconte & Goreczny, 1990) showed
similar results.


This study also proves that symptom checklists can also be
 faked even when fake symptoms are included. Confounding
variables and limitation of the study has been acknowledged
and clearly stated: the exclusion of diagnosed PTSD patients
as this would help to establish more detailed and precise
symptoms of the modified checklist. The authors also
suggested that any future direction of this study
should consider a balance of the ‘real’ and ‘fake’
symptoms which is not the case here ( ‘real’ 82%, ‘bogus’ 38%).
It is also essential that the ‘fake’ items that not symptoms
of PTSD yet they should not be strikingly unrelated that
render them ‘fake.



The discussion was written objectively and the ideas were
presented in a coherent, logical and systematic manner. The
empirical evidence has clearly supported that it is easy to
replicate PTSD symptoms and this is not due to prior
knowledge rather it is due to the weakness in the symptoms
checklist.

(1658 words)



Reference

C. Burges, Department of psychology, University of Surrey,UK,
T.M. McMillan, Department of Psychology, University of Surrey
and department of Psychological medicine, university of
galsglow, Gartnavel Royal Galsgow, UK. The ability of naïve
participants to report symptoms of post-traumatic stress
disorder. British Journal of Clinical psychology,
2001, vol. 40, pp.209-14.



Tutor Comment:
Cheryl,
you have written a very good critical review
of a journal article. You started very interestingly
with a critic of the abstract section. It is very well
written giving readers a good idea of how the abstract
of the journal article is like.

Next, you went on with a good critic of the introduction.
It is very clearly written and the comment given shows
an in-depth understanding of the introduction. From there,
you went on to give a good critic of the method section
and also the result section. Your discussion section is also
very well written however, you can further improve on it by
stating if future direction of research is discussed here.

Overall this has been a well written critical review.
However you can further improve on it by giving an
introduction to your critical review. In this introduction,
you can write on the title of the journal article you are
reviewing. After that, give brief comments on why you choose
the journal article, and why it is of interest to you.

Total: 75 marks

Warmest Regards
Boon Yeow