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PubMed1994

Qualitative and quantitative characteristics of malingered and other invalid WAIS-R and clinical memory data.

To further the understanding of malingering and other compromises to data validity on standard neuropsychological tasks, the present study evaluated WAIS-R and clinical memory data produced by two groups from a mildly head-injured sample: Malingerers (MPs; n = 12) were identified via below chance forced-choice testing; "QVs" (n = 10) provided implausible neuropsychological performances but were not clearly malingering. A low level of performance characterized the data of the MPs and QVs: Full Scale IQ and Performance IQ were significantly lower for MPs and QVs than for matched controls, and obtained IQ for MPs and QVs averaged 18 points below estimated IQ. On the California Verbal Learning Test, total words recalled and recognition memory were significantly lower for MPs and QVs than for controls. In contrast, qualitative analyses, such as approximate answers, bizarre responses, "scatter" on the WAIS-R, inconsistency in performance across similar tasks, clustering, and intrusions on memory measures, generally yielded negative findings.

Adult↗
PubMed1997

A partial cross-validation of a Halstead-Reitan Battery malingering formula.

Using the Halstead-Reitan Battery profiles of 796 people, a formula for the detection of malingering was partially cross-validated to assess the false positive rate. Subjects included normals, psychiatric cases, and persons with all major types of brain disorder. The formula incorrectly designated 32% of the sample as fakers (i.e., as false positives). Of the 120 head-trauma cases, 39 (32%) obtained Fake scores, whereas 81 (67%) were correctly assessed as not malingering. The correlation of the results of the formula and the severity of the profile (as measured by the Average Impairment Rating) was 67, p < .0001.

Adolescent↗
PubMed1997

Memory performance after head injury: contributions of malingering, litigation status, psychological factors, and medication use.

Impaired memory test performance can reflect a host of factors, such as head injury/postconcussive syndrome, involvement in litigation, malingering behavior, psychological distress, and medication use. Such factors are important in interpreting memory test performances in patients referred in the context of litigation. We examined memory test performance in mild head-injured patients in litigation, mild to moderate head-injured patients not in litigation, severely head-injured patients not in litigation, depressed patients, and patients with somatization disorders. Findings showed that several memory tests were useful in distinguishing probable malingerers from the other groups. There was a complex interaction among malingering status, psychological status, and medication use in the prediction of memory test results. Although nonneurological factors were related to memory impairment, litigation status alone was not predictive of memory performance. The results emphasize the need to consider nonneurological factors in the interpretation of poor memory performance in patients seen for forensic evaluation.

Adult↗
PubMed2003

Evaluation of malingering cut-off scores for the Rey 15-Item Test: a brain injury case study series.

PRIMARY OBJECTIVE: To evaluate the utility of prescribed malingering cut-off scores by examining the Rey Fifteen-Item Test (FIT) responses of persons with severe brain injury. RESEARCH DESIGN: Series of five case studies. METHODS AND PROCEDURES: The FIT was administered along with standardized neuropsychological and neurobehavioural measures. MAIN OUTCOMES AND RESULTS: Using the standardized scoring protocol, all five patients obtained perfect (15/15 correct) scores on the FIT. All patients exhibited significant impairment on other neuropsychological indices, included measures of memory and attention. CONCLUSIONS: Results lend support to the use of higher cut-off scores to identify malingering. Further large-scale research is recommended to ascertain the reliability of FIT scoring procedures, determine cut-off scores for various diagnostic groups and develope age and education adjustments. Implications for use of the FIT in clinical and forensic settings are also discussed.

Adult↗
PubMed2005

The Rey 15-item memory test for malingering: a meta-analysis.

BACKGROUND: The Rey 15-Item Memory Test (RMT) is frequently used to detect malingering. Many objections to the test have been raised. Nevertheless, the test is still widely used. OBJECTIVE: To provide a meta-analysis of the available studies using the RMT and provide an overall assessment of the sensitivity and specificity of the test, based on the cumulative data. RESULTS: The results show that, excluding patients with mental retardation, the RMT has a low sensitivity but an excellent specificity. CONCLUSIONS: These results provide the basis for the ongoing use of the test, given that it is acceptable to miss some cases of malingering with such a screening test, but one does not want to have many false positives.

Brain Injuries↗
PubMed2006

Estimating the predictive value of the Test of Memory Malingering: an illustrative example for clinicians.

Recent years have witnessed an explosion in the amount of research literature dedicated to the identification of symptom exaggeration and/or malingering in neuropsychological assessments. Additionally, there is now a growing literature devoted to estimating the base rates of symptom exaggeration/malingering in a range of populations and settings. However, very little literature has been devoted to estimating the positive predictive value (PPV) or negative predictive value (NPV) of these assessment devices and/or strategies. The current project was conducted to provide an illustrative example of how to use the research literature to calculate both PPV and NPV in everyday clinical practice. When the Word Memory Test (WMT) was used as the "gold standard" to which the Test of Memory Malingering (TOMM) was compared, the TOMM achieved very high PPV (.98) and acceptable NPV (.78). How to incorporate the strategy used into clinical practice is discussed.

Female↗
PubMedDate not supplied

Psychometric perspectives on detection of malingering of pain: use of the Minnesota Multiphasic Personality Inventory-2.

Self-report plays a primary but not exclusive role in pain assessment. As is true of all self-reported experiences, under certain circumstances, the report of chronic pain can be distorted and misrepresented. There are unique challenges associated with the detection and assessment of malingering or self-report distortion in the evaluation of chronic pain. The current paper provides a rationale for the use of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) in the comprehensive assessment of chronic pain with an emphasis on the advantage the MMPI-2 provides in the detection of response bias or malingering. A critical review of available MMPI-2 validity scales is presented, and recommendations for use of these scales in the evaluation of patients with chronic pain are made.

Chronic Disease↗
PubMed1986

Evoked potentials in hysteria and malingering.

Evoked potentials are often helpful in confirming the nonorganic nature of sensory symptoms in hysteria and malingering. In a retrospective analysis, such cases were found to comprise approximately 1% of referrals to a university hospital laboratory. However, the diagnostic usefulness of electrophysiologic tests is limited in some clinical settings: normal responses may be encountered in subjects with certain organic deficits, and "abnormal" responses can sometimes be produced voluntarily by normal subjects. In malingering--as opposed to hysteria--the role of the technologist in monitoring patient compliance with the test procedure is particularly important. Like other laboratory investigations, evoked potential findings must be interpreted within the context of each clinical situation, and with full appreciation of the sensitivities and specificities of the tests.

Adult↗
PubMed2005

A new set of criteria for evaluating malingering in work-related vestibular injury.

OBJECTIVE: To develop and use a set of criteria using computerized dynamic posturography results to detect aphysiologic behavior in patients with complaints of imbalance, and to compare the efficacy of this system with present quantitative techniques and with subjective methods of evaluating malingerers. STUDY DESIGN: Prospective study of two groups of sequentially referred patients complaining of dizziness and/or imbalance. SETTING: A tertiary and quaternary care ambulatory referral center. PATIENTS: Two groups of patients were studied. One was a group of patients who had suffered work-related head trauma and had subsequent complaints of dizziness and/or imbalance. The other was a group of patients referred for dizziness and/or imbalance who had no history of head trauma, work-related injury, or litigation procedures. INTERVENTIONS: Standard vestibular assessment including computerized dynamic posturography was carried out on all patients. MAIN OUTCOME MEASURES: All patients in both groups were scored for aphysiologic behavior using a quantified formula that has been used to detect malingerers, an analysis criterion using different aspects of computerized dynamic posturography performance that has been used for some time, and our newly developed nine-point scoring method. Results of all three methods were compared to determine the effectiveness of each one in detecting malingering behavior. RESULTS: Our nine-point protocol was effective in assessing patients in a consistent manner. Assessment using the quantitative formula in the literature raised suspicions of malingering in many patients with no known ulterior motives, some of whom had documented vestibular disease. Our criteria also evaluate other aspects of performance not evaluated by the presently used techniques. CONCLUSION: Our newly developed criteria are effective at evaluating the medicolegal patients from both the quantitative and qualitative viewpoints, and provide a more thorough assessment than has previously been available.

Adult↗
PubMed2006

Detecting malingering of Ganser-like symptoms with tests: a case study.

A middle-aged man presented with Ganser symptoms. He had been involved in a car crash and was seeking disability insurance benefits. Extensive testing with malinger instruments revealed that he performed below chance on simple memory tests and endorsed a variety of nonexistent symptoms. With this in mind, the authors collected collateral information which showed that the patient was involved in high level sports activities that were difficult to reconcile with the severe cognitive dysfunctions that he claimed to suffer from. The case demonstrates that Ganser-like symptoms deserve close scrutiny, preferably with malinger tests.

Accidents, Traffic↗
PubMed2002

Detecting malingered neurocognitive dysfunction using the reliable digit span in traumatic brain injury.

This study assessed the effectiveness of Greiffenstein's Reliable Digit Span (RDS) score for the detection of malingered neurocognitive dysfunction. Participants were 54 traumatic brain injury patients referred for neuropsychological evaluation. Twenty-four met the Slick, Sherman, and Iverson criteria for at least probable malingered neurocognitive dysfunction. The control group was composed of 30 patients without external incentive and who thus did not meet the Slick criteria. All patients completed the digit span test as part of either the WAIS-R or WAIS-III. The RDS scores were calculated, and sensitivity, specificity, and predictive power were examined for several cutoffs. Classification accuracy for the RDS was excellent. Issues related to the clinical application of this technique are discussed.

Adult↗
PubMed2003

Detection of feigned mental disorders: a meta-analysis of the MMPI-2 and malingering.

The validity of test data from multiscale inventories is dependent on self-reports that may be easily distorted by malingering. In examining the Minnesota Multiphasic Personality Inventory-2's (MMPI-2) role in the assessment of feigning, this review provides a conceptual analysis of the detection strategies underlying the MMPI-2 validity scales. The conceptual analysis is augmented by comprehensive meta-analysis of 65 MMPI-2 feigning studies plus 11 MMPI-2 diagnostic studies. For the rare-symptoms strategy, Fp (Cohen's d = 2.02) appears especially effective across diagnostic groups; its cut scores evidence greater consistency than most validity indicators. The data supported the F as an effective scale but questioned the routine use of Fb. Among the specialized scales, Ds appeared especially useful because of its sophisticated strategy, consistent cut score, and minimalfalse-positives. General guidelines are offeredfor specific MMPI-2 validity scales in the assessment of malingering with specific diagnoses.

Factitious Disorders↗
PubMed2005

Utility of the trauma symptom inventory's atypical response scale in detecting malingered post-traumatic stress disorder.

The authors examined the Trauma Symptom Inventory's (TSI) ability to discriminate 88 student post-traumatic stress disorder (PTSD) simulators screened for genuine PTSD from 48 clinical PTSD-diagnosed outpatients. Results demonstrated between-group differences on several TSI clinical scales and the Atypical Response (ATR) validity scale. Discriminant function analysis using ATR revealed 75% correct patient classification but only 48% correct simulator classification, with an overall correct classification rate of 59% (positive predictive power [PPP] = .71; negative predictive power [NPP] = .51). Individual ATR cutoff scores did not yield impressive classification results, with the optimal cutoff (T score = 61) correctly classifying only 61% of simulators and patients (PPP = .66, NPP = .54). Although ATR was not developed as a malingered PTSD screen, instead serving as a general validity screen, caution is recommended in its current clinical use for detecting malingered PTSD.

Adolescent↗
PubMed2000

Assessment of malingering in chronic pain patients using neuropsychological tests.

Validity checks into neuropsychological tests have been successful at detecting malingering in litigant patients with mild brain injury in recent years. This study expanded on these findings and examined whether 6 neuropsychological tests could be used to detect malingering in litigant (n = 55) and nonlitigant (n = 53) patients claiming cognitive deficits due to chronic pain. Encouraging findings were found. When patients were matched on age, gender, racial or ethnic background, years of education, and time postinjury, almost one third (29%) of patients in the litigant group failed 2 or more validity checks in these 6 neuropsychological tests versus none (0%) of the patients in the nonlitigant group. This result challenges the validity of some litigant patients who complain of cognitive deficits due to chronic pain. Furthermore, the findings suggest that neuropsychological assessments can be used as part of the assessment of chronic pain complainants. Further investigation of the validity markers in these 6 neuropsychological tests is recommended.

Adult↗
PubMed1988

A psychometric study of stereotypes: assessment of malingering in a criminal forensic group.

This research investigates the validity of the stereotype of insanity defendants as malingerers by analyzing the proportions of insanity defendants who exaggerate psychopathology at the pre- and postacquittal stages of the legal process and by assessing the severity of psychopathology among preacquittal defendants. We administered the Minnesota Multiphasic Personality Inventory (MMPI) to 49 insanity defendants evaluated for fitness to stand trial and/or sanity at the time of the alleged crime and to 52 subjects previously found not guilty by reason of insanity. Results indicated: (a) Contrary to the stereotype, a minority (14% to 41%) of insanity defendants clearly malingered, whereas 22% to 39% showed evidence of minimizing psychopathology. (b) Eighty-one percent of these subjects had MMPI profiles suggestive of psychosis, but relatively few showed evidence of primarily antisocial behavior. Thus, the malingering stereotype may be application to only a minority of insanity defendants and is specifically inapplicable to a substantial proportion who minimized psychopathology or showed evidence of psychosis consistent with the claim of insanity.

Adult↗
PubMed1998

An investigation of malingering posttraumatic stress disorder on the Personality Assessment Inventory.

Utilizing the Personality Assessment Inventory (PAI; Morey, 1991), this study aimed to isolate a pattern of responding that is indicative of an attempt to malinger posttraumatic stress disorder (PTSD). The PAI profiles of 116 male participants were examined. Profiles of a group of 29 alcohol-abusing veterans with a primary Axis I (American Psychiatric Association, 1994) diagnosis of PTSD and a group of 30 alcohol-abusing veterans with no other diagnoses were compared to those of 27 undergraduate men instructed to feign PTSD. Control data were obtained from another group of 30 undergraduates. The student malingerers produced PAI profiles that were significantly different from the veterans with PTSD. Seven scales distinguished the malingerers from the veterans with an actual diagnosis of PTSD. Malingerers tended to overexaggerate pathology, inflating their scores on many clinical scales greater than the mean of the PTSD sample. Malingerers also scored higher on Morey's (1993) 8-item Malingering Index than either group of veterans and the controls. Only 2 scales reliably differentiated alcohol-abusing veterans with PTSD from those without the disorder. The implications of these findings in the diagnosis of PTSD are discussed.

Adult↗
PubMed1996

Order effects in the administration of a forced-choice procedure for detection of malingering in disability claimants' evaluations.

100 disability claimants of the Social Security Administration referred for neuropsychological evaluation and 40 undergraduate college students asked to simulate brain damage were administered a measure for the detection of malingering, an abbreviated version of the Hiscock Forced-choice Procedure, and other neuropsychological tests. Half of each group was administered the Hiscock Procedure at the beginning of the battery; the other half was administered this test last. For both groups, the results indicated poorer performance on the earlier administration of the abbreviated Hiscock Forced-choice Procedure. Formal measures for detection of malingering should be an integral and early part of any neuropsychological evaluation in which the subject has a financial incentive to perform poorly.

Adult↗
PubMed1999

Prevalence of malingering in suicidal psychiatric inpatients: a replication.

The MMPI-2, L, F, and K validity scales were administered to 21 (42%) suicide attempters and 29 (58%) ideators who had been hospitalized as being at risk for committing suicide. These inpatients were also asked to rate anonymously how much they had "exaggerated on purpose or lied about being suicidal to a staff member" during their current hospitalizations. The three MMPI-2 validity scores of the inpatients were not associated with self-reported malingering, and 6 (12%) of the inpatients reported malingering. This rate was comparable to the 10% rate which had previously been found by Rissmiller, et al. in 1998.

Adult↗