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PubMed2006

Classification accuracy of the Portland Digit Recognition Test in traumatic brain injury: results of a known-groups analysis.

The present study used a known-groups design to examine the accuracy of the Portland Digit Recognition Test (PDRT) in the detection of malingering in traumatic brain injury (TBI). Data were derived from 262 TBI patients who were classified as not malingering, possibly malingering, and malingering based on the Slick, Sherman, and Iverson (1999) criteria. The original PDRT cutoffs detected between 20 and 50% of malingering TBI patients with a false positive error rate of 5% or less. When the false positive error rate was held at 5%, across all item sets, sensitivity was as high as 70%. The results show that the original PDRT cutoffs are conservative and that higher scores detect more MND patients without causing the false positive error rate to become unacceptably high. Clinical application and future research needs are discussed.

Adult↗
PubMed1998

Operating characteristics of six response distortion indicators for the personality assessment inventory.

The characteristics of six different indicators of response distortion on the Personality Assessment Inventory (PAI; Morey, 1991) were evaluated by having college students complete the PAI under positive impression management, malingering, and honest responding conditions. The six indicators were the PAI Positive Impression (PIM) and Negative Impression (NIM) scales, the Malingering and Defensiveness Indexes, and two discriminant functions, one developed by Cashel and the other by Rogers. Protocols of students asked to malinger were compared with those of actual clinical patients, while protocols of students asked to manage their impression in a positive direction were compared with those of students asked to respond honestly. Comparisons between groups were accomplished through the examination of effect sizes and receiver operating characteristic (ROC) curves. All six indicators demonstrated the ability to distinguish between actual and feigned responding. The Rogers function was particularly effective in identifying malingering. The Cashel function was less effective than other measures in identifying positive impression management, although it appears to also have promise as an indicator of malingering.

Adult↗
PubMed2002

The predictive capacity of the MMPI-2 and PAI validity scales and indexes to detect coached and uncoached feigning.

The objective of this study was to examine the relative effectiveness of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Personality Assessment Inventory (PAI) validity scales and indexes to detect malingering. Research participants were either informed (coached) or not informed (uncoached) about the presence and operating characteristics of the validity scales and instructed to fake bad on both the MMPI-2 and PAI. The validity scale and index scores produced by these research participants were then compared to those scores from a bona fide sample of psychiatric patients (n = 75). Coaching had no effect on the ability of the research participants to feign more successfully than those participants who received no coaching. For the MMPI-2, the Psychopathology F scale, or F(p), proved to be the best at distinguishing psychiatric patients from research participants instructed to malinger, although the other F scales (i.e., F and Fb) were also effective. For the PAI, the Rogers Discriminant Function index (RDF) was clearly superior to the other PAI fake-bad validity indicators; neither the Negative Impression Management scale nor Malingering Index were effective at detecting malingered profiles in this study. Overall, RDF proved to be marginally superior to F and F(p) in distinguishing MMPI-2 and PAI protocols produced by research participants asked to malinger and psychiatric patients. Both the RDF and the F and F(p) scales, however, were able to increase the predictive capability of one another.

Adult↗
PubMed1993

The validity of the M test in a residential forensic facility.

The validity of the M Test as a screening measure for malingering was assessed in a residential forensic treatment center. Clinically, malingering was recognized by the treatment staff as a significant problem among incompetent to proceed (ITP) defendants in this setting. A total of 79 ITP defendants completed the M Test under standard instructions. To assess the predictive validity of the M Test, its sensitivity and specificity were determined using three separate measures of malingering status. Using the original scoring procedure, the results provided estimates of sensitivity of 11, 31, and 29 percent and estimates of specificity of 67, 70, and 69 percent, respectively, for the three malingering status measures. A revised scoring procedure improved the sensitivity estimates to the statistically significant level of 86 percent for the malingering status measure that was defined as feigned or grossly exaggerated psychotic symptoms. The pattern of correlations between the M Test scales and a variety of other clinical measures suggested that, in this forensic treatment setting, the subject's pattern of responses to the M Test was primarily determined by the severity of cognitive impairment of that subject.

Adult↗
PubMed2000

Have we forgotten the base rate problem? Methodological issues in the detection of distortion.

The search for valid and reliable methods of detecting malingering and distortion has become an increasingly important task for forensic psychologists and neuropsychologists. This report highlights several important methodological issues commonly observed in research on the prediction of malingering. The choice of indices for determining optimal cutoff scores on the utility of existing measures, the impact of base rates of malingering on the accuracy of prediction models, the incremental accuracy of combining multiple measures, and the relationship of test validity to the interpretation of data are described with regard to the prediction of malingering on neuropsychological tests. These methodological concerns are discussed in reference to several recent publications assessing the utility of various methods for the detection of malingering.

Journal Article↗
PubMed2000

Detection of feigned recognition memory impairment using the old/new effect of the event-related potential.

Twenty-four undergraduate university students with no known neurological disorders completed the Recognition Memory Test (Warrington, A., 1984. Recognition Memory Test manual. Windsor, Berkshire: NFER-Nelson.) while event-related potentials (ERPs) were recorded. Twelve subjects were instructed to feign a recognition memory deficit (malingering group), while the remainder served as controls. The malingerers performed poorly on the test compared to the control group. The 'old/new effect', an ERP measure thought to reflect recognition memory processes, did not differ between the groups, indicating recognition of previously learned material in the malingering group despite poor test performance. The study also revealed a second, early, old/new effect, maximal at left frontal sites in the malingering relative to the control group, suggesting task-related processing differences between the two groups. These effects appear to be of potential value in the detection of malingering of cognitive impairment in the clinical situation.

Adult↗
PubMed2005

Differential diagnosis of stuttering for forensic purposes.

PURPOSE: This case study demonstrates the application of an assessment protocol for differential diagnosis of psychogenic stuttering, neurogenic stuttering, developmental stuttering, and malingering. METHOD: A male in his late 30s, accused of armed robbery, was evaluated for stuttering at the request of his defense attorney. The speech assessment included 4 main sections: collection of speech samples, observation in multiple speaking conditions, evaluation of communication attitudes, and consideration of case history and background information. RESULTS: The defendant stuttered severely in all speaking conditions. He demonstrated typical stuttering loci and consistency, but no adaptation. Communication attitudes were typical of people who stutter, but steady, direct eye contact was atypical. His statements about his speech conflicted with reports of outside witnesses. CONCLUSIONS: Characteristics were consistent with developmental stuttering and partial malingering. Both psychogenic and neurogenic forms of stuttering were suspected, but mixed results were largely unsupportive. Valuable protocol elements included speech sampling under multiple speaking conditions, careful examination of case history information, and indirect tests of malingering. Further knowledge and research are warranted to improve processes of differential diagnoses among subtypes of developmental, psychogenic, and neurogenic forms of stuttering as well as malingering.

Adult↗
PubMed1997

[Examination strategies in simulation and functional vision disorders].

The diagnosis of malingering and functional visual loss should be proven by specific tests-after the exclusion of differential diagnoses such as optical disturbances, amblyopia, early stages of macula and optic nerve disease and cortical lesions. Malingering and functional visual loss are based on different causes and pathogenetic mechanisms. However, they produce the same symptoms and can therefore be examined by the same methods. The strategy consists of three parts: 1) check the reproducibility of the results, 2) specific procedures: provocation of reflectory responses, deception, measurement of the same function with different methods and objective methods and 3) proof. In alleged bilateral blindness the provocation of reflexes and deceptive strategies are especially useful, in alleged bilateral reduction of visual acuity deceptive methods (related to the size of the optotype), the examination of central vision by other methods (equivalents to visual acuity) and objective methods are applied. In alleged monolateral blindness or reduction of visual acuity the binocular tests are valuable. Additionally, methods to provoke reflexes, especially pupil reaction, are used as well as the measure of equivalents to visual acuity. In alleged concentric constriction of the visual fields three strategies are mainly used: 1) check if visual field size is in accordance with the visual angle, 2) different methods to examine the isopters and 3) different perimetric methods. In case of an alleged hemianopic field defect the following methods are of special value: 1) binocular examination, 2) reading ability, 3) different perimetric methods and 4) half-field stimulation. After finishing the specific tests the diagnosis of malingering or functional visual loss should be unambiguous and the existing function should be determined. Strategies for further management are shown--dependent on the pathogenesis: the aim is to avoid repetition and to set the right course for the future. In case of malingering the reliable expert's report is helpful. In case of functional visual loss it is important to avoid unnecessary examinations and to offer specific aids.

Blindness↗
PubMed1999

Identifying simulators of cognitive deficit through combined use of neuropsychological test performance and event-related potentials.

Event-related potential (ERP) methods for identifying malingering of cognitive deficit assume that elements of brain/cognitive functioning are not under a person's direct control, whereas neuropsychological methods assume that malingered cognitive deficit will present differently than true impairment in terms of level or pattern of errors on tests of cognitive function. Two studies were conducted to examine the combined use of neuropsychological and ERP methods for identifying malingering because of the potential independence of these approaches. All normal control participants performing at their best level (n = 25) were correctly classified by both ERP and neuropsychological methods. All participants simulating cognitive deficit (n = 35) were correctly classified on the basis of a positive outcome on either the neuropsychological or the ERP method. Results suggest that the neuropsychological and psychophysiological measures of malingering that were studied contribute non-redundant information in the classification of simulators.

Adolescent↗
PubMed1990

Prospects for faking believable memory deficits on neuropsychological tests and the use of incentives in simulation research.

The vulnerability of several neuropsychological memory tests--the Wechsler Memory Scale--Revised, Complex Figure Test, Auditory Verbal Learning Test, and Rey Memory Test--to faked deficits was evaluated. Subjects were randomly assigned to one of three conditions: Control (n = 28), Malingering with a financial incentive (n = 30), and Malingering without a financial incentive (n = 28). Overall, the performance of the Malingering Groups was not significantly different from one another, but both groups were significantly poorer than Controls. Discriminant functions with a reduced set of predictors correctly classified about 75% of cases in both the Control and the combined Malingering Groups on cross-validation. The results suggest that neuropsychological memory tests are vulnerable to faked deficits, and that recognition tasks are disproportionately affected. The use of incentives in simulation research is also discussed.

Adult↗
PubMed2003

Use of the TOMM in a criminal court forensic assessment setting.

Use of the Test of Memory Malingering (TOMM) in a criminal court forensic assessment setting was examined. Results indicated that those initially suspected of cognitive malingering and, thus, administered the TOMM, differed from others in this setting in ways that are consistent with descriptions of suspected cognitive malingerers in the existing literature. These defendants' TOMM scores were also consistent with those reported in samples characterized by relatively high base rates of cognitive malingering. Defendants whose TOMM scores met the recommended criteria for detecting malingering (n = 29) were more likely to report a previous head injury, to be viewed as only marginally cooperative or uncooperative during the course of the evaluation, and to be diagnosed with antisocial personality disorder than those who did not generate suspicious TOMM scores.

Adult↗
PubMed1991

Validity of the M Test: simulation-design and natural-group approaches.

The utility of the M Test (Beaber, Marston, Michelli, & Mills, (1985) as a screening measure for malingering was assessed using simulation-design (subjects asked to fake mental illness) and natural-group (forensic assessment cases suspected of malingering) approaches. A total of 318 subjects from community, clinical, and correctional settings completed the M Test under instructions to respond honestly or to simulate a major mental disorder. A factor analysis of the M Test items supported the original rationally based scale assignment, and the scales were found to have adequate internal reliability. To examine the predictive validity of the M Test, results revealed that sensitivity using the cutting scores suggested by Beaber et al. (1985) was much higher for simulating subjects (79.8%) than for the suspected malingerers (40.0%). The findings emphasize the danger of exclusive reliance on simulation studies for validating measures of malingering. It was concluded that, in its present form, the M Test does not constitute a good screening measure for assessing malingering.

Adult↗
PubMed1998

The medical detection of simulated occupational injuries: a historical and social analysis.

Occupational malingering is often thought to involve the deliberate feigning of disease by workers seeking undeserved financial gain. Concern about this form of malingering grew in the late 19th century as a result of the emergence of the new industrial economy and the institution of workers' compensation insurance. Medical judgments about the simulation of work injuries have placed physicians in a crossfire between the interests of employers and workers in numerous medicolegal debates. Because of uncertainty about the true cause of many occupational disorders and the highly charged social environment in which medical opinions are rendered, physicians' views about malingering are often swayed by cultural, political, and economic forces. The historical record shows that a medical diagnosis of occupational malingering can reflect deep-seated cultural and social biases toward women, Jews, immigrants, and other groups representing a potential threat to the privileged social class. Current efforts to eliminate fraudulent workers' compensation claims must be sensitive to the inherent ambiguities in the medical determination of work-relatedness and the potential for judgments about simulated work injuries to conceal deep-seated social biases and class prejudices.

Accidents, Occupational↗
PubMedDate not supplied

The employee who seeks to benefit from being ill.

The presence of physical symptoms that do not correlate with a disease process are often frustrating to healthcare professionals, are difficult to diagnose and may consume an inordinate proportion of healthcare resources. However, proper and complete physical and psychological assessment and treatment is becoming increasingly possible and essential. Physical illness may occur concomitantly and sometimes as a result of psychological distress, which has displayed itself in a diagnosed mental illness. In other cases physical symptoms may be caused by unconscious dynamics, and the process becomes the primary presenting mental concern. In other cases the physical illness is part of a conscious process and motivated by the hope of gain. Differentiation between physical symptoms of unconscious and conscious origin is important in selecting the correct response. A manager must first of all be alert for physical symptoms that appear to be consciously motivated, as in a disorder called "malingering." The essential feature of malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding work or obtaining financial compensation. Managers may inadvertently encourage malingering in the workplace by inappropriate responses to employees who present a physical complaint that is consciously motivated for gain. When the manager can recognize this phenomenon as malingering, appropriate managerial intervention can cause this behavior to be controlled and even eliminated and thus enhance productivity.

Employment↗
PubMed1986

[Simulation of mental disorders. 1. Psychopathologic and psychosociodynamic aspects in a military environment].

In this paper, the author studies the malingering as a problem in the relationship between the doctor, patients and environment. Our field is the military community. After descriptive approach in the psychopathological disorders, the psychopathological and psychodynamic points of view give us the possibility to reach the most important level. This author's ideas are as follow--malingering is not a diagnostic but will be amount the general conditions of the relationship between doctor and his patient. The malingering is in some community, more one behavior of suspicion about some people than an attribution supported by facts. Finally, the suspicion of malingering as to be considered as an expression of the psychic phenomena in real groups funermore in the psychanalytical approach of the groups.

Diagnosis, Differential↗
PubMed1995

The detection of deception.

In clinical situations patient honesty and self-interest usually coincide; however, in legal circumstances patients may be motivated to deceive and may be skilled in doing so. Research raises doubts about the capacity of health professionals to detect malingering, particularly when there is less known about conditions or expected symptom patterns, more definitive tests are lacking or require patient cooperation, and diagnosis depends substantially on patient self-report. Given the lack of systematic feedback about our judgmental accuracy when deciding the presence or absence of malingering, clinical experience per se provides an inadequate means for identifying and correcting erroneous practices and for determining just how confident we ought to be in our subjective impressions. Thus, in the appraisal of malingering, it is dangerous to place too much dependence on subjective confidence. Methods are discussed that can supplement medical examination and increase the accuracy of malingering detection.

Diagnosis, Differential↗
PubMed1995

Influence of prior knowledge and experience on the ability to feign mild head injury symptoms in head injured and non-head-injured college students.

The present study investigated the effects of personal knowledge, experience and beliefs about traumatic brain injury (TBI) on persons' ability to successfully feign neuropsychological impairment. Head-injured and non-injured subjects completed the Head Injury Misconception Survey, and were evenly divided into malingering or control (do best) conditions. Subjects were given a scenario which asked them to imagine that they had been in a prior accident and were involved in litigation. They were then asked to either malinger or respond in the best way possible to a battery of neuropsychological tests. While instructions to malinger had a pronounced effect, knowledge of brain injury did not significantly influence an individual's ability to feign neuropsychological impairment. Future directions in the study of malingering are also discussed.

Journal Article↗
PubMed1991

The detection of faked deficits on the Rey Auditory Verbal Learning Test: the effect of serial position.

The ability of subjects to fake deficits on the Rey Auditory Verbal Learning Test (AVLT) was evaluated. Subjects were randomly assigned to one of two malingering groups - one with a financial incentive (N = 30) and one without (N = 28) - or a control group (C) (N = 28), and a group of closed head injury patients (CHI) (N = 18) was matched on age, sex, and education level. The two malingering groups did not differ significantly and were combined into a single malingering group (M) (N = 57). There was a significant serial position (the pattern of "recency" and "primacy" effects in recall) by group interaction effect, which may be the most promising indicator of deliberate distortion. When only level of performance was examined, the M group could fake believable deficits, but when the serial position effect was examined, it revealed that this was accomplished by suppression of recall from the first third of the word list (reducing the "primacy effect"), a recall pattern which did not occur in either the C or CHI group and may be an indication of malingering.

Clinical Trial↗