Seattle University Collaborative Projects - International Academy of ...

Malingering in Psychological/ Psychiatric Injury: Detection Strategies andCautionsGerald Young, York University (gyoung@glendon.yorku.ca)Problematic presentations and performances in psychological/psychiatric injury evaluations arecommon, but there are many reasons for them, including varying response biases other thanmalingering. Psychological injury concerns PTSD, mTBI, and chronic pain, in particular, afterevents at claim. This presentation will focus on PTSD. First, controversies related to PTSD arepresented. Second, the issue of malingered PTSD is discussed, in civilian populations.Malingering can be detected, but incontrovertible evidence is needed. The literature is repletewith conceptual and empirical difficulties. Even the definition used varies, with some sourcesincluding even mild exaggeration as part of malingering. Prevalence or base rate estimates varywidely because of this inconsistency and others. Recommended detection strategies consideredmost effective in the literature range from the clinical interview to psychometric testing.Moreover, which tests to use vary between different sources. This presentation concludes withresearch recommendations, including on the definition of malingering (DSM-IV based) and howto survey it to get an appropriate base rate estimate; it presents a “diagnostic” model ofmalingering that includes inconsistencies/discrepancies and psychometric test data. At thepractice level, the presentation examines assessment strategies, appropriate tests to use, and howto integrate the data gathered.The Impact of PTSD on Performance and Decision-Making in EmergencyService Workers: Implications for Forensic AssessmentCheryl Regehr, University of Toronto (cheryl.regehr@utoronto.ca)Research has identified alarming levels of traumatic stress symptoms in individuals working inemergency services. Yet the impact of these symptoms on performance and hence public safetyremains uncertain. This presentation discusses a program of research that has examined theeffects of prior critical incident exposure and current post-traumatic symptoms on theperformance and decision-making during an acutely stressful event among police officers,emergency communicators, paramedics and child welfare workers. Four studies using simulationmethods involving video simulators, human-patient simulators, and/or standardized patients,examined the performance of emergency workers in typical workplace situations related to theirindividual profession. Exposure to critical incidents in the workplace and current level oftraumatic stress symptoms were assessed prior to participation in the scenarios. Subjectivepsychological stress and physiological stress responses were measured before, during and afterparticipation in the scenarios. Results regarding performance and decision making varied bysituation. PTSD symptom levels did not affect performance in emergency situations requiringfrequently practiced skills, while complex clinical judgment was correlated with PTSD. Thus,295