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PubMed2002

Specificity of the MMPI-2 Fake Bad Scale as a marker for personal injury malingering.

Psychologists who evaluate patients in medicolegal contexts should utilize objective assessment data with empirically established sensitivity and specificity for identifying negative response bias. The purpose of this study was to investigate the specificity of the Fake Bad Scale for identifying negative response bias in personal injury claimants. The cutoff scores proposed by Lees-Haley and colleagues were applied a federal prison, medical outpatients, and patients from to inmate volunteers from substance abuse unit. Half of the inmates were given instructions to malinger psychopathology to affect the adjudication process, and the remaining inmates and all of the hospital patients were given standard instructions. The original cutoff scores correctly identified the majority of inmates instructed to malinger psychopathology, but these scores resulted in unacceptably high rates of false positive classifications. The revised cutoff scores resulted in fewer false positives, i.e., 8%-24%.

Adult↗

PubMed2004

Malingered ADHD in adolescents diagnosed with conduct disorder: a brief note.

This brief note cautions clinicians about the possibility of adolescents with Conduct Disorder malingering the symptoms of Attention Deficit Hyperactivity Disorder (ADHD) to obtain medication. Presented are some guidelines to consider when the diagnosis of ADHD is indicated in forensic settings with adolescents such as the need for a comprehensive assessment and the importance of exploring the possibility of malingering.

Adolescent↗

PubMed1996

An exploratory stepwise discriminant function analysis of malingered and nondistorted responses to the Neuropsychological Symptom Inventory.

Clinicians are often asked to evaluate a patient's potential for malingering during a neuropsychological examination. This problem is particularly crucial when financial gain may hinge on the results of the assessment. Response distortion may occur even when a head injury has been verified by radiological means (e.g., MRI). Research in the identification of malingering has yet to produce results that are effective in the clinical setting. The present study addressed several shortcomings of past research with the use of a self-report symptom inventory. The responses of 242 subjects told to distort symptomology were compared to 128 nonmalingerers. A discriminant function analysis of these data produced a 90% hit rate overall with 2.3% false positives. The results were discussed in terms of clinical utility.

Cognition Disorders↗

PubMed1976

[Invalidation of a girl after 7 years of succesfull malingering of a wound (author's transl)].

Provocation of wounds by malingering is one of the most typical artefacts in surgery. In this paper the succesful maintaining of a wound in a girl for over 7 years is demonstrated. In this time the girl underwent 25 surgical operations and was invalidated at the age of 18 years. In patients with non-healing wounds, which cannot be explained by the rules of general pathology, doctors are well advised to think of the possibilities of malingering at an early time.

Adolescent↗

PubMed2000

Malingering and symptom magnification: a case report illustrating the limitations of clinical judgement.

Malingering and symptom embellishment are of concern to specialists in pain medicine. Valid criteria to identify malingering individuals suffering chronic pain do not exist. We present a case of a patient on worker's compensation identified as a malingerer by six different physicians who had evaluated the patient for her chronic complaints. Ultimately, she was found to have a lesion that explained all of her subjective complaints. Physicians should exercise caution in labeling patients suffering intractable pain as malingerers.

Accidental Falls↗

PubMed2001

Malingering assessment: evaluation of validity of performance.

Consideration of symptom exaggeration or overt malingering is of particular importance in assessment of alleged mild head trauma and other mild or questionable personal injury situations. Validity is the extent to which tests assess what they were designed to measure. The determination of invalidity is part of the overall neuropsychological interpretation process. In neuropsychology a line of validity assessment research has developed, leading to three general approaches to validity and/or malingering assessment: (a) symptom validity measures, (b) invalid patterns of performance on clinical neuropsychological measures, and (c) concomitant extra-test behavioral information or observations. In each case some aspect of behavior is compared to an external standard or to other intra-subject behavior. Inconsistencies and discrepant comparisons are cause for validity concerns. These approaches are described and recommendations are provided based on the extant literature. However, validity assessment is difficult and at times ambiguous in part because real and feigned deficits are not mutually exclusive. In some clinical situations the most that can be said about an invalid performance is that it is not indicative of the true neurobehavioral capabilities of the person being evaluated, and is not consistent with the presumed etiologic event.

Humans↗

PubMed2002

A comparison of simulation and known groups in the detection of malingering on the MMPI-2.

Three groups of 30 inmates, one instructed to respond honestly, one to fake being mentally ill, and one to fake schizophrenia after being educated to its symptoms, were administered the MMPI-2. These simulation groups were compared to two forensic evaluation groups of 30 pretrial defendants, one believed to be mentally ill and one suspected of malingering based on their psychiatric history, in order to compare the results of simulation with those of the forensic context. The results demonstrated that those instructed to feign psychiatric disorder and those suspected of malingering in the forensic context scored significantly higher on all MMPI-2 validity indicators than did those with a history of psychiatric treatment and those instructed to respond honestly, yet did not differ from each other. These findings suggest that the results of simulation designs are comparable to those obtained from forensic subjects. The F(p) Scale failed to add incrementally to F in discriminating the two defendant groups.

Adult↗

PubMed2003

A validation of multiple malingering detection methods in a large clinical sample.

The purpose of this study is to further previous research that has shown that common neuropsychological tests can do "double duty" as test of motivation/malingering. Using a large clinical sample of 796 participants, it was found that the nine neuropsychological tests (when used together) were able to correctly identify litigant and nonlitigating groups. Failure on any two of the malingering tests suggested motivational/malingering issues. The groups consisted of mild, moderate, and severe traumatic brain-injured patients; chronic pain, depressed, community controls, and "malingering actors." Institutionalized and noninstitutionalized patient performance were also examined. This method showed 83% sensitivity and 100% specificity. A 0% false positive rate was found, suggesting good reliability especially in litigating settings. A group of patients for whom this method of motivational assessment might not be appropriate was also identified.

Adolescent↗

PubMedDate not supplied

[Relationship between malingered psychometric profiles and personality styles in prisoners].

INTRODUCTION: One of the most typical clinical problems is the assessment of malingering in the field of forensic and penitentiary psychiatry. OBJECTIVE: The purpose of this research was to find associations between different personality types and psychometric response styles. MATERIAL AND METHODS. SUBJECTS: participants consisted of 41 imprisoned male offenders. Instruments and data collection: the psychometric tools used were the Millon Clinical Multiaxial Inventory (MCMI-II) and the Minnesota Multiphasic Personality Inventory (MMPI-2). STATISTICS: data were analyzed with the Statistical Package for the Social Sciences (SPSS, version 10.0). A p < 0.05 significance level was proposed. RESULTS: There is significant correlation between personality types and styles of responses in the inventories. CONCLUSIONS: The greatest relationships were found between personality types shaping cluster B of DSM-IV-TR and validity indexes that measure malingering as response style.

Adult↗

PubMed2006

Simple real-time computerized tasks for detection of malingering among murderers with schizophrenia.

It is our contention that computer-based two-alternative forced choice techniques can be useful tools for the detection of patients with schizophrenia who feign acute psychotic symptoms and cognitive impairment as opposed to patients with schizophrenia with a true active psychosis. In our experiment, Visual Simple and Choice Reaction Time tasks were used. Reaction time in milliseconds was recorded and accuracy rate was obtained for all subjects' responses. Both types of task were administered to 27 patients with schizophrenia suspected of having committed murder. Patients with schizophrenia who were clinically assessed as malingerers achieved significantly fewer correct results, were significantly slower and less consistent in their reaction time. Congruence of performance between the Simple and Choice tasks was an additional parameter for the accurate diagnosis of malingering. The four parameters of both tests (accuracy of response, reaction time, standard deviation of reaction time and task congruency) are simple and constitute a user-friendly means for the detection of malingering in forensic practice. Another advantage of this procedure is that the software automatically measures and evaluates all the parameters.

Adult↗

PubMed1991

Iatrogenesis and malingering of multiple personality disorder in the forensic evaluation of homicide defendants.

In this article I have addressed the possibility of iatrogenesis and/or malingering of MPD in 19 individuals who were charged with homicide. Due to the fragmentary nature of most of these case reports, it is not possible to state definitively who had genuine MPD and who did not. There is a strong possibility that a substantial proportion were malingering, however, because of their rather atypical presentations. Data from other sources suggest that the use of hypnosis in individuals accused of homicide may iatrogenically produce MPD-like phenomena when coupled with the defendant's desire to escape criminal responsibility. Finally, I have offered guidelines for the forensic evaluation of homicide defendants in whom MPD is suspected. Although hypnosis should generally be avoided in such defendants if it is used, rather strict guidelines should be followed. Clinicians using hypnosis with such individuals should be forewarned that such use will be strongly challenged in court and could pose an extreme threat to the defense position.

Diagnosis, Differential↗

PubMed1989

Malingering.

Malingering adds to the cost of medicine. Unnecessary tests, exhaustive evaluations, and repeated referrals are part of the cost. In noneconomic terms, malingering erodes trust and confidence in the physician-patient relationship. This article explores means whereby the physician can detect the malingerer. Once the physician is convinced of the disingenuous nature of the symptoms, intervention is indicated. Suggestions for confronting the malingerer are reviewed.

Diagnosis, Differential↗

PubMed1988

Malingering vs. the factitious personality in chiropractic practice.

This article details how to identify and treat the malingering patient, which we feel is seen more often than was originally thought in chiropractic practice. A historical perspective of a malingering vs. a factitious personality is examined. The factitious patient is reviewed in detail with special attention to the classic case of Munchausen syndrome. An extensive treatment plan is discussed, including short- and long-term care. The common characteristics, objective tests and studies are reviewed. We theorize that due to our increasing involvement in Workers' Compensation and personal injury cases our attention should be focused more closely on the possibility of these types of patients entering our office.

Chiropractic↗

PubMed1984

Malingering and associated syndromes.

Malingering is the false and fraudulent simulation or exaggeration of physical and/or psychological symptoms. It is not a mental disorder, but rather a behavior pattern that may coexist with objectively diagnosed disease. Whatever form it takes, malingering is defined as conscious, voluntary, goal-directed behavior; the presence of a clearly definable goal differentiates malingerers from those with other forms of factitious illness.

Humans↗

PubMed1981

Speech discrimination scores at low sensation levels as a possible index of malingering.

Persons referred to the clinic for hearing evaluation, aged 17--35 yrs, who during the evaluation yielded inconsistent pure-tone and speech data and were suspected of malingering, were given a monosyllabic Hebraic PB test at 5, 10, 15, and 20 db re their admitted SRT. Group performances were compared at every presentation level to those of normal-hearing young adults. Both groups performed better as levels increased, but the suspected malingerers yielded SDSs at 5, 10, and 15 db significantly higher than controls by 20.8, 12.5, and 5.2 percentage points, respectively. The higher SDSs at low sensation levels (SLs) yielded by the suspected malingerers were assumed to be due to the exaggerated SRTs admitted by them. Furthermore, the performance - vs - level curve of the normals corresponded to that in the literature for English material, while the curve of the suspected malingerers was, in contrast, essentially different. It was concluded that with careful standardization and wide clinical and experimental use, collecting SDSs at low SLs re admitted SRT might produce a potentially valuable additional tool for uncovering malingering.

Adolescent↗

PubMed1994

Medical observations of malingering in Iraqi enemy prisoners of war during Operation Desert Storm.

The authors, who were at the Al Khanjar enemy prisoner of war (EPW) collection point along the Saudi Arabian-Kuwaiti frontier during Operation Desert Storm, furnish two accounts of malingering and deliberate, manipulative attempts at "conning the doctors" by Iraqi EPWs of the Republican Guard Corps. To some extent, malingering and conning of the doctors with faked illness or complaint expended time and other valuable resources that could have been directed toward EPW patient care and treatment with genuine medical bases.

Adult↗

PubMed1993

Rule-Out and Rule-In scales for the M test for malingering: a cross-validation.

Previous research found the M test to have limited utility for the screening of malingering. Subsequently, Rogers et al. attempted to improve the test's discriminative ability by developing an alternative scoring procedure-Rule-In and Rule-Out scales. These scales showed promising results as a brief screener for malingering with hit rates as high as 95 percent. The present study cross-validated their proposed decision rules, but found lower rates of classification accuracy. The most conservative decision rule (i.e., to maximize detection of malingerers) only identified 72.7 percent of the malingerers with a false positive rate of 50.8 percent.

Adult↗

PubMed1998

Malingering uncommon psychiatric symptoms among defendants charged under California's "three strikes and you're out" law.

This paper describes an epidemic of uncommon psychiatric symptoms among nine criminal defendants charged under California's new "Three Strikes and You're Out" law. The defendants were facing a minimum sentence of 25 years to life in prison. The defendants exhibited the following uncommon psychiatric symptoms: coprophagia (eating feces), eating cockroaches and many reported seeing little green men. The defendants, all of whom we believe were malingering, were evaluated by the authors for competency to stand trial. Thus far, eight of the nine defendants were found competent to stand trial; only one defendant was found incompetent to stand trial. The authors created a database which included information on the defendants from court documents and from our interview with the defendants. We summarized the data and outcomes of the case. Also included is a brief review of the "Three Strikes Law" and a paradigm for how we ruled out relevant psychiatric diagnoses before we arrived at our opinion of malingering.

Adult↗