Tuesday, April 24, 2012

Army Wants PTSD Clinicians to Stop Screening for Fakers

After a spate of controversies over inaccurate PTSD diagnosis techniques, the Army has released new guidelines meant to prevent doctors from screening for "malingerers," who are faking their symptoms. Photo: U.S. Air Force
In a big reversal, the Army has issued a stern new set of guidelines to doctors tasked with diagnosing post-traumatic stress disorder (PTSD) among returning soldiers. Stop spending so much time trying to spot patients who are faking symptoms, the new guidelines instruct. Chances are, they’re actually ailing.
The 17-page document has yet to be made public but was described in some detail by the Seattle Times. In it, the Army Surgeon General’s Office specifically points out — and discredits — a handful of screening tests for PTSD that are widely used by military clinicians to diagnose a condition estimated to afflict at least 200,000 Iraq and Afghanistan veterans.
The Army Surgeon General finds great fault with a dense personality test popular with clinicians that ostensibly weeds out “malingerers,” as PTSD fakers are known.
But the results of what’s known as the Minnesota Multiphasic Personality Test are flawed, according to the report. PTSD sufferers often exhibit anxiety, insomnia, flashbacks and depression — all of which, some doctors believe, can be discounted under the test. The test devotes a large swath of questions to catching apparent exaggerations of symptom severity, seemingly inconsistent answers, or reported symptoms that don’t mesh with the typical signs associated with an illness.
“The report rejects the view that a patient’s response to hundreds of written test questions can determine if a soldier is faking symptoms,” the Seattle Times summarized. Where PTSD is concerned, that’s especially true. The condition is accompanied by symptoms that can differ markedly between patients: Some are hyperactive, others are lethargic; some exhibit frenetic rage while others are simply sullen and depressed.
“And,” the Times continued, “[the report] declares that poor test results ‘does not equate to malingering.’”
Those tests were the standard of care at Madigan Army Medical Center — which is a big deal. Located in Tacoma, Washington, Madigan isn’t just one of the military’s largest medical installations. It’s home to a forensic psychiatry team tasked with deciding whether soldiers diagnosed with PTSD were sick enough to qualify for medical retirement. In March, the Army launched an investigation of the Madigan team after Madigan’s screening procedures allegedly reversed 300 of the PTSD diagnoses among soldiers being evaluated.
The reversals resulted in some soldiers being diagnosed with “personality disorders” and others left with no diagnosis at all. Madigan allegedly used the tests to save money by limiting the number of patients who’d qualify for retirement. “We have to ensure we are not just ‘rubber stamping’ a soldier with the diagnosis of PTSD,” reads a memo from an unnamed Madigan psychiatrist that leaked last month. “We have to be good stewards of the tax-payer dollars.”
The Surgeon General’s attempts at strengthening its PTSD diagnostic tactics might come as a relief to veterans. But they might also be more than a little too late. Shortly after the scandal at Madigan emerged, subsequent reports of similar shoddy diagnostics at Walter Reed, Fort Carson and Fort Bragg trickled out as well, including more allegations of soldiers being pinned as malingerers by military docs.
“Leading off, trying to say it’s isolated, doesn’t really pass the common-sense test,” Patrick Bellon, executive director of Veteran’s for Common Sense, told Stars and Stripes earlier this month. “Clearly, something is not right.”