Symptom overreporting in combat veterans evaluated for PTSD: differentiation on the basis of compensation seeking...

We examined the role of compensation-seeking status on response patterns to self-report inventories of acute psychopathology and psychological distress in a group of 165 combat veterans evaluated for posttraumatic stress disorder (PTSD) at a Department of Veteran Affairs (VA) Medical Center. Veterans completed the Minnesota Multiphasic Personality Inventory-Revised, Beck Depression Inventory, Mississippi Scale for Combat-Related PTSD, a fixed-response format version of the Dissociative Experiences Scale, and Impact of Events Scale as part of a standard assessment battery. Results showed that compensation-seeking veterans endorsed dramatically higher levels of psychopathology across measures and produced sharply elevated "fake-bad" validity indices as compared to non-compensation-seeking veterans. Differences between the two groups on most scales and indices exceeded effect sizes of 1.0, even when effects of income, global assessment of functioning, and clinician-rated severity of PTSD were controlled for. It is suggested that the availability of VA disability compensation for combat-related PTSD impedes accurate initial assessment of veterans presenting for treatment and may impair estimation of long-term therapeutic outcome in this population.