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Trauma Symptom Inventory-2 (TSI-2) Validity Scores (ATR)

I’m a psychologist and I like testing. I appreciate the judicious use of test scores. However, I also get very irritated when they’re misused by professionals who should know better. This seems to happen in some VA Compensation and Pension examinations, for example. Psychologists will incorrectly interpret validity scale scores and use them as a sole basis to discount everything in the examination and in their supporting medical records (including from a provider who has been treating them for their mental health concerns for a long time). The validity scores on psychological testing are not magical x-ray machines that can tell if a Veteran is lying.

From time to time I will write about validity scores on this blog, in a general way, so people involved in disability claims can have a more clear understanding. These are involved in popular psychological tests including the MMPI-2, MMPI-2-RF, PAI, and MCMI-IV. I own all of the manuals and have access to the research related to them. I will write about some of those tests in the future, but since I just worked on a claim with a Veteran that involved validity scales on the Trauma Symptom Inventory (TSI), and it was fresh in my mind, I thought I would start there. If you want to be sure to hear the news when I write other articles please subscribe to my Nexus Letter News email list here:

VA examiners sometimes over-rely on validity scales; scales that the examiners themselves don’t fully understand. For example, if there is an elevated ATR validity scale on the TSI-2 there is a potential that the examinee engaged in malingering. However, the scale by itself alone in the absence of other information to support a hypothesis about malingering or other issues does not tell us that much. It could be a reflection of significant impairment.

I will offer some quotes from the TSI-2 manual for administering and interpreting the test to assist you in understanding the validity scales and what they can and can’t tell us. I’m not going to give you an extensive literature review related to Veterans or the TSI-2 because this is frankly just an educational blog post. I am not divulging any extensive information or test questions that could invalidate the test. The Trauma Symptom Inventory, second edition (TSI-2) manual, by John Briere, Ph.D., (page 14) describes the Atypical Response (ATR) scale (a validity scale). Per the manual, “the ATR scale evaluates the tendency of the respondent to overendorse trauma-related symptoms on the TSI-2.” Malingering could potentially be a concern. However, one of the potential reasons for “a very high score on this scale” was specifically noted to be “very high levels of distress.” The TSI-2 manual, on page 14, describes one potential interpretation of a “very high” score on the ATR as resulting from “very high levels of distress.” Dr. Briere goes on to write about the ATR scale, on pg. 14, that “although overendorsement may reflect malingering or factitious disorder, it also may arise from a tendency to experience and/or report symptoms as being more intense than others do or an attempt to present oneself as needing clinical assistance (e.g., a “cry for help”). Some individuals with substantial child abuse or trauma histories have elevated scores on infrequency or “fake bad” scales as a result of the atypical or extensive symptomatology sometimes associated with posttraumatic disturbance.” On page 14 of the TSI-2 manual Dr. Briere writes “invalidity here refers to excessive symptom endorsement only. It does not support specific conclusions as to whether unusually high item response rates are due to malingering, a “cry for help,” random responding, or some other factor. Further, an invalid ATR score should not be interpreted as information on whether the respondent has or has not been traumatized or whether he or she is suffering major posttraumatic symptoms.” On page 28 of the TSI-2 manual, Dr. Briere noted that “trauma survivors often have elevated scores on “fake bad” invalidity scales, seemingly without intention to malinger.” On page 38 Dr. Briere describes the process, in one study, of comparing two research groups: a “PTSD simulation group and a genuinely distressed group. The PTSD simulation group consisted of 75 participants (47 women, 28 men) enrolled in introductory psychology courses. Students were at least 18 years of age and attended college at one of two medium-sized universities in the midwestern or western United States…” It was noted that the “genuine posttraumatic distress group was similarly recruited from introductory psychology courses…” In a 2010 article in the Journal of Anxiety Disorders, “Evaluation of the Atypical Response scale of the Trauma Symptom Inventory-2 in detecting simulated posttraumatic stress disorder” by Matt J. Graya, Jon D. Elhaib, and John Briere; the TSI-2 ATR scale was noted to be derived after the authors trained 75 undergraduates to “simulate” PTSD and then compared them to other undergraduates (not combat veterans) who were identified as having PTSD. The ATR was noted to only correctly classify 75% of the “distressed individuals.”  This evidence of course supports that no examiner should ever discount what a Veteran is saying solely on the basis of one test score.

Validity scales should always be considered, however, they shouldn’t be considered the word of God. The scientific evidence behind some validity scales is far less than ideal. In addition, there are many potential explanations for an elevated score. If you have questions, or if you need a medical opinion, please feel free to reach out to me. My e-mail is: [email protected] My cell phone is: (330)495-8809.

Thank you for reading,

Todd Finnerty, Psy.D.