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PubMed2000

Interpreting clinical evidence of malingering: a Bayesian perspective.

Customary ways of reporting on or testifying about malingering have shortcomings. Stating an opinion "with reasonable medical certainty" tells fact-finders little about how much confidence the opinion deserves; stating that an individual's behavior is similar to that of known malingerers does not convey the information that fact-finders really need to know, which is the likelihood that the evaluee in question is a malingerer, given the evaluator's findings. Mossman and Hart (Mossman D, Hart KJ: Presenting evidence of malingering to courts: insights from decision theory. Behav. Sci. Law 14:271-91, 1996) recommend that mental health professionals address this problem by using Bayes' theorem to interpret test data from evaluations. However, these authors do not discuss the use of evidence obtained during interviews and from other clinical contexts, nor do they describe a method for quantifying imprecision in Bayesian probabilities. This article provides examples of how forensic evaluators might use a Bayesian perspective to interpret clinical indicia of malingering observed during evaluations of adjudicatory competence. The article discusses sources of imprecision in Bayesian posterior probabilities, describes a method for characterizing that imprecision using confidence intervals, and then presents several sample calculations that illustrate how interview findings change the likelihood of malingering. The article also discusses the implications of the Bayesian approach for forensic evaluations and for future research on malingered incompetence.

Bayes Theorem↗

PubMed1982

Defining malingering.

Malingering, also called shamming illness or goldbricking, is the false and fraudulent simulation or exaggeration of physical or mental disease or defect, performed in order to obtain money or drugs or to evade duty or criminal responsibility, or for other reasons that may be readily understood by an objective observer from the individual's circumstances, rather than from learning the individual's psychology. Malingering is seen in apparently normal children, students, test subjects, spouses, and adults. It is not a mental disorder. Malingering may coexist with the antisocial personality disorder, with various factitious disorders, such as the Ganser Syndrome and the Munchausen Syndrome, with the hysterias and with traumatic neuroses and other mental disorders. A review of definitions and a medicolegal discussion are presented. Malingering is an act, which is distinguished from a legal or mental status. Failure to distinguish act from status accounts for the wide disparities in definitions of malingering.

Factitious Disorders↗

PubMed1996

The distinction of malingering and mental illness in black forensic cases.

The ability of twenty items to separate malingering from mental illness is tested. The items were obtained from the literature and clinical experience. The study used an experimental, cross-sectional design which compared fifty malingering African patients and a control group of fifty African State Presidents' Detainees. The chi-square test and the Fisher's exact test were used to assess statistical significance. The effectiveness of these items was assessed by calculating their sensitivity, specificity, false positives and negatives and positive and negative predictive values. Seventeen items showed statistical significance. Eleven items had high positive predictive values mostly above 90% with four items scoring 100%. These diagnosed malingering effectively. Another six items had high negative predictive values mainly above 90%. These diagnosed mental illness directly and excluded malingering effectively. The study proved that seventeen items can scientifically and effectively separate mental illness from malingering.

Black or African American↗

PubMed1998

Evaluation of posturography in the detection of malingering subjects.

OBJECTIVE: This study aimed to test the performance of proposed methods for detecting malingering subjects on computerized dynamic posturography using one subject group in three situations (normal, malingering, vestibular weakness). STUDY DESIGN: The study design was a prospective, blinded study. SETTING: The study was conducted at a university hospital. PATIENTS: Volunteer subjects aged 20-59 years of age participated. INTERVENTIONS: Computerized dynamic posturography was performed under three situations: best effort, faking vestibular weakness, and transient induced vestibular weakness with bilateral simultaneous caloric irrigation. MAIN OUTCOME MEASURES: Measured was identification of situation (normal, malingering, induced vestibular weakness) by each of three detection methods: blinded clinical scoring, a set of formulae, and a set of variables (the latter two methods proposed previously by other investigators). RESULTS: Each method performed well. In three-way discrimination, the formulae and clinical scoring each correctly identified approximately 75% of trials. In two-way discrimination (malingering vs. induced vestibular weakness), the best combination of variables slightly outperformed clinical scoring (0.93 vs. 0.88 ROC [receiver operating characteristic] curve area). CONCLUSIONS: Computerized dynamic posturography can distinguish malingering in normal subjects from trials performed with best effort or after binaural simultaneous caloric irrigation. The accuracy of blinded clinical scoring was comparable to that of two objective detection methods.

Adult↗

PubMed2002

Feigning not equal malingering: a case study.

Researchers and scholars assert that feigning should not be equated with malingering. Some practicing clinicians doing the everyday work of forensic assessment may view this as merely an academic distinction. This case study illustrates that a high level of certainty about feigning must not be considered indicative of malingering. The case also contrasts two models for assessing malingering and highlights the need for forensic examiners to present assessment-of-malingering data clearly and cautiously.

Adult↗

PubMed1998

P300 correlates of simulated malingered amnesia in a matching-to-sample task: topographic analyses of deception versus truthtelling responses.

Two experiments using a P300-enhanced Forced Choice Procedure (P3FCP) investigated simulated amnesia in a matching-to-sample task. In Experiment 1, successful manipulation of subjects towards different behavioral hit rates (75-80% vs. 85-90%) did not adversely affect the diagnostic sensitivity of match-mismatch Pz-P300 amplitude analyses, allowing detection of 69% of simulators. P300 amplitudes of simulators (Malinger group) were as large as those of truth-tellers (truth group, a control), indicating no dual task-related (Malingering) reduction across different behavioral hit rates. Experiment 2 found no main effect of oddball type, match vs. mismatch, on P300 (P3) amplitude with a mismatch-rare variant of the P3FCP. This study also revealed larger Pz-P3s in the Malingering (vs. Truth-telling) condition. Subsequent topographic analyses suggested different Truth and Malinger scaled P3 amplitude topographies in both these sets of P3FCP data and in those from a previous autobiographical memory paradigm. Further analysis yielded preliminary evidence for a common deception-related P3 amplitude topography across different paradigms/conditions.

Adult↗

PubMed1999

The detection of malingered psychosis.

The detection of malingered psychosis is sometimes quite difficult. The decision that an individual is malingering is made by assembling all of the clues from a thorough evaluation of a person's past and current functioning with corroboration from clinical records and other people. Identifying malingered psychosis will prevent unnecessary hospital admissions and is critical in forensic assessments. Indeed, clinicians bear considerable responsibility to assist society in differentiating true psychosis from malingered madness.

Delusions↗

PubMed1998

Assessment of malingering with simulation designs: threats to external validity.

Comprehensive forensic evaluations are predicated on the accurate appraisal of response styles that may affect evaluatees' clinical presentation and experts' conclusions associated with psycholegal issues. In the assessment of malingering, forensic experts often rely heavily on standardized measures that have been validated exclusively via analogue research. While such research augments internal validity, the threats to external validity are readily apparent. As the first study of these threats, type of incentive (positive versus negative), context (a familiar versus unfamiliar scenario), and relevance to the participants was investigated systematically with a between-subjects factorial design. A sample of 231 undergraduates was asked to either (a) feign major depression and given an easily understood description of this disorder or (b) serve as controls responding honestly. They were administered a brief measure of psychopathology (Hopkins Symptom Checklist; Derogatis, Lipman, Rickels, Uhlenhuth, & Covi, 1974) and a recent screen for malingering (Screening Inventory of Malingered Symptoms or SIMS; Smith, 1992) in 1 of 18 experimental conditions. Results suggested that incentive had a main effect on the SIMS. More specifically, simulators under negative incentives appeared more focused in their feigning; they produced more bogus depressed symptoms, but fewer symptoms unrelated to depression. Interactions were also observed between context and incentive, and context and relevance. Implications of these results are explored for both analogue research on malingering and current forensic practice.

Adult↗

PubMed2002

[Neuropsychological assessment of malingering].

Current problems and neuropsychological assessment strategies of malingering detection (assessment of negative response bias or non-optimal test behaviour) are reviewed. First, the paper discusses major conceptual problems inherent in the definition of malingering, factitious disorders, and somatoform disorders. Traditional and modern test approaches and diagnostic procedures are reviewed. Two case vignettes illustrate the application of particular strategies for malingering assessment. In German speaking countries, malingering research has not yet aroused profound interest comparable to that in English speaking countries. Diagnostic standards and instruments still have to be refined.

Humans↗

PubMed1999

Using intraindividual variability to detect malingering in cognitive performance.

The utility of measures for detecting malingering was evaluated using a simulation design in which half the participants were encouraged to do their best and half were asked to feign head injury. Particular attention was focused on the utility of repeated assessment (intraindividual variability) in discriminating the groups. Participants were tested on three occasions on measures commonly used to detect malingering including a specific symptom validity test (SVT). The results indicated that multiple measures of malingering obtained in single assessment (occasion one) discriminated the groups effectively. In addition, however, intraindividual variability in performance, particularly of indicators from the SVT, provided unique information beyond level of performance. The results suggest that response inconsistency across testing sessions may be a clinically useful measure for the detection of malingering.

Adult↗

PubMed1998

Effects of coaching on detection of malingering on the California Verbal Learning Test.

The diagnostic accuracy of California Verbal Learning Test (CVLT) indices to detect malingered head injury was examined using a simulation paradigm that included naive malingerers, malingerers provided with information about head injury, and normal controls (N = 90). The application of diagnostic cutoff scores for Recognition Discriminability and Recognition Hits derived from populations of individuals with bona fide head injury and individuals suspected of malingering (Millis et al., 1995) proved highly sensitive and modestly specific in detecting feigned head injury among both simulation groups. Results of analyses of variance and logistic regression support previous findings that malingerers overestimate memory impairment associated with mild head injury; however, they indicate that exposure to a simple instructional set may render insensitive many indices of malingering. In contrast, indices based on more subtle principles of learning theory hold promise in the detection of malingering, even in the presence of an instructional set.

Adolescent↗

PubMed1999

Use of the Wisconsin Card Sorting Test in the detection of malingering in student simulator and patient samples.

We analyzed the ability of the Wisconsin Card Sorting Test to distinguish between 41 malingering and 31 normal undergraduates, and 17 probable malingering and 16 brain injured patients. A logistic regression consisting of number of categories (CAT) and failure to maintain set (FMS) distinguished malingering and normal undergraduates with 70.7% sensitivity, 87.1% specificity, and 77.8% overall classification, and distinguished patients suspected of malingering from brain injured controls with 82.4% sensitivity, 93. 3% specificity, and 87.5% overall classification.

Adult↗

PubMed2003

Using the WMS-III faces subtest to detect malingered memory impairment.

The current study evaluated the utility of the WMS-III Faces I subtest (Faces) for the assessment of malingering. Thirty nonlitigating traumatic brain injury patients and 30 control participants were administered Faces under standard administration and instructed malingering conditions. Although the two groups obtained similar scores when taking the test under standard instructions, both groups produced significantly lower performances when instructed to malinger, indicating that Faces is sensitive to malingering, but less sensitive to traumatic brain injury. The total raw score provided stronger classification accuracy than an empirically weighted combination of the five easiest items (i.e., floor effect items). A raw score cutoff of 31 yielded the maximum classification accuracy with 93.3% sensitivity and 80.0% specificity.

Adult↗

PubMed1993

Effects of sophistication and motivation on the detection of malingered memory performance using a computerized forced-choice task.

The present study employed a computerized forced-choice recognition memory task, the Multi-Digit Memory Test (MDMT), to examine the effects of instructional set (i.e., dissimulation information provided subjects) and motivation (i.e., monetary incentive) on simulated malingering behavior in a group of 119 university undergraduate students and 33 patients sustaining varying severity of closed-head injury. For the nonpatient groups, a significant effect of instructional set was revealed. Motivational incentive, however, did not affect forced-choice performance. Overall, significant performance differences emerged between all groups with nonmalingering students performing nearly perfectly, the brain-injured patients performing well above chance levels, sophisticated student malingers performing at chance, and naive student malingers performing well below chance levels. These results suggest the MDMT may offer a clinically useful and convenient addition to a neuropsychological assessment when there is suspicion of feigned memory problems. These data also support the use of naive and sophisticated malingering subjects in further analog studies addressing this topic.

Adult↗

PubMed2000

An investigation of the relationship between psychopathic traits and malingering on the psychopathic personality inventory.

This study employed a repeated-measures simulation design to examine (a) the specific effects of malingering on a recently developed measure of psychopathy, the Psychopathic Personality Inventory (PPI), and (b) the broader association between psychopathic traits and dissimulation. One hundred and forty-three participants completed the PPI twice (both under standard instructions and with instructions to feign psychosis), and also completed post-test questionnaires assessing their attitudes toward engaging in malingering across several hypothetical settings. When attempting to feign psychosis, participants produced elevated scores on a validity scale designed to identify deviant responding, and use of a cross-validated cutoff score with this scale produced high sensitivity and specificity rates across the honest and malingering conditions. Furthermore, PPI scores (in the honest condition) were significantly correlated with a willingness to engage in dissimulation across various hypothetical forensic/correctional scenarios. Results are discussed in terms of the "fakability" of the PPI, as well as the relationship between psychopathic personality features and malingering more generally.

Adult↗

PubMed2001

The detection of malingered posttraumatic stress disorder with MMPI-2 fake bad indices.

This investigation explored the effect of posttraumatic stress disorder (PTSD) simulation on Minnesota Multiphasic Personality Inventory-2 (MMPI-2) responses, to detect malingered from genuine PTSD. Sixty-four adult PTSD outpatients at a child sexual abuse (CSA) survivor treatment program were compared with 85 adult college students instructed and trained to malinger PTSD. MMPI-2 overreporting indices examined were F, F-Fb, F-K, F(p), Ds2, O-S, OT, and FBS. A stepwise discriminant analysis identified F(p), F-K, and O-S as the best malingering predictors. A predictive discriminant analysis yielded good hit rates for the model, with impressive cross-validation results. Cutoff scores were assessed for the model's predictors. Clinical implications for detecting malingered PTSD using the MMPI-2 are discussed.

Adult↗

PubMed1998

Validation of reliable digits for detection of malingering.

This study is a cross validation of the previous work by Greffenstein, Baker, and Gola (1994) and Greiffenstein, Gola, and Baker (1995) on the Reliable Digits (RD) method of detecting possible malingering. This study consisted of 47 mild brain-injured litigating and 49 mild brain-injured non-litigating participants. The result of this study was that only 4.1% of the non-litigating participants were classified as malingering by RD, while 48.9% of the litigating participants were classified as malingering by RD. Comparing litigating participants' performance on a forced choice task with their RD revealed that 77.8% (7/9) who failed the forced choice task also failed RD. RD classified more litigating patients as malingering than did the forced choice task and none of the non-litigating participants failed forced choice. These findings underscore the previous recommendations of Greiffenstein et al. (1994, 1995), that it is important to assess motivation on specific neuropsychological tests and that motivation on neuropsychological tests is not an all or none phenomenon.

Adult↗

PubMed1996

Can psychosis be malingered on the Rorschach? An empirical study.

Can psychosis be faked on the Rorschach? We examined this question by comparing 2 groups of subjects with a high incentive to malinger, persons accused of serious crimes. All subjects were administered both the Minnesota Multiphasic Personality Inventory (MMPI) and the Rorschach and were assigned to honest (N = 35) and malingered (N = 13) groups on the basis of MMPI validity scales. The Rorschach protocols of these 2 groups were compared to assess how successfully malingerers could deliberately produce records that appeared psychotic on empirically derived Rorschach indices of psychosis. Despite an attempt to portray themselves as psychotic on the MMPI, subjects in the malingered group did not differ from honest responders on Rorschach variables that distinguish psychotic from nonpsychotic patients, but did differ in the number of dramatic responses produced. Our data suggest that the combination of the MMPI and Rorschach provides a powerful psychometric technique for detecting deliberate malingering of psychosis.

Adolescent↗