Yes, some of the PTSD (post traumatic stress disorder) symptoms can be faked. However, the physical symptoms of PTSD are difficult to fake, as the physical symptoms are outside your voluntary control. The physical symptoms are manifestations of the activation of the sympathetic nervous system and the release of adrenaline, noradrenaline, and cortisol, which is the fight or flight response.
Sadly, there are people who fake having PTSD for personal gain, to obtain disability benefits from the military, Social Security, or the employer. This takes away from those people who actually have PTSD and are genuinely disabled by it. But because psychiatry has no biological markers to confirm clinical diagnoses like PTSD, there are some people who can fake the symptoms and be labelled with PTSD, and possibly even get disability from this misdiagnosis. How does this happen with a psychiatric assessment? These misdiagnoses occur all the time, as many of the symptoms for the DSM checklists can be obtained from the patient’s own words and clinical history.
In PTSD, there are three main categories of symptoms: re-experiencing of the traumatic event, avoidance of reminders of the trauma, and hyperarousal symptoms. It is easy to fake the re-experiencing and avoidant symptoms, as these symptoms can come from the patient’s own account of them from their clinical history, fabricated or not:
- You can fake having nightmares and flashbacks of the feigned traumatic event
- You can fake avoiding situations which remind you of the feigned trauma
- You can fake having an emotional detachment
- You can fake being emotionally numb
- You can fake having depression, worry, or guilt
- You can fake having anhedonia and losing interest in things
What you can’t fake are hyperarousal symptoms, as these are manifestations of the fight or flight response, which is caused by the activation of the sympathetic nervous system and release of stress hormones:
- You can’t fake being easily startled
- You can’t fake being on edge
- You can’t fake being hypervigilant for danger
- You can’t fake sleep problems, especially when you are referred for sleep studies in a sleep lab to confirm your sleep disturbance
- You can’t fake the increased heart beat, and the increased blood pressure that comes with activation of the fight or flight response
- You can’t fake the dilated pupils when you are on guard
So to summarize, not all of the symptoms of PTSD can be faked, but many can. It takes a skilled psychiatrist to figure out who actually has PTSD, and who may be faking it. The best way to confirm symptoms is to get collateral information from family, friends, and co-workers to see if they observe any of the symptoms that the patient is reporting. A thorough psychiatrist will also get vitals, do a physical exam, and may refer the patient for sleep studies, just to observe for any objective evidence of PTSD.
When there is the potential for personal gain, like getting disability, psychiatrists should not make the diagnosis of PTSD by the patient’s own words alone. Such is the state of modern psychiatry, where patients can go into a psychiatric assessment, deliberately feign symptoms, and walk out with a diagnosis.