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PubMed2001

The relationship between psychopathic personality features and malingering symptoms of major mental illness.

This study examined the relationship between psychopathy and malingering in a subsample of male prison inmates (n = 55) participating in a larger study of the clinical utility of various assessment measures in correctional settings. Participants' capacity to feign major mental illness successfully was evaluated using standard cutoff scores for the detection of malingering on a variety of instruments, including the Structured Inventory of Malingered Symptomatology (SIMS; G. P Smith & G. O. Burger, 1997), the Structured Interview of Reported Symptoms (SIRS; R. Rogers, R. M. Bagby, & S. E. Dickens, 1992), and the Personality Assessment Inventory (PAI; L. Morey, 1991). Psychopathic traits were assessed via the Psychopathic Personality Inventory (PPI; S.O. Lilienfeld & B. P Andrews, 1996). Correlations between the malingering indices and the PPI were low (-.14 to .14) and not statistically significant. These findings fail to support the clinical intuition that individuals with higher levels of psychopathy are likely to be more adept at malingering.

Adult↗
PubMed2004

Malingering indexes for the Halstead Category Test.

Two studies were conducted to evaluate potential malingering indexes on the Halstead Category Test. The aim of the first study was that of documenting that groups of individuals with established cognitive impairment did not score positively on the proposed indexes. Of the indexes considered, it was found that these groups made very few errors on subtests I and II of the test and improved their performance on subtest VI relative to V. Subtests I and II are very simple and both subtest V and VI involve the same principle. It was proposed that malingerers would make excessive numbers of errors on subtests I and II, and would not show improvement on subtest VI over subtest V. The second study compared the performance of patients with brain damage to students who were either trained to malinger or encouraged to perform as well as they could on the Category Test. Comparisons were made on the malingering indexes among these groups showing that mean scores of the patients with brain damage on several of the indexes did not differ from those of the students encouraged to do well, but both of these groups did significantly better than the student malingerers. A discriminant analysis of the set of malingering indexes classified 20% of the student malingerers as brain damaged, and 3.4% of the patients with brain damage as malingerers. A stepwise analysis indicated that number of errors on subtests I and II and Total Errors were particularly sensitive to malingering.

Adult↗
PubMed2006

Compensation and malingering in traumatic brain injury: a dose-response relationship?

The purpose of this study was to determine if there is a dose-response relationship between potential monetary compensation and failure on psychological indicators of malingering in traumatic brain injury. 332 traumatic brain injury patients were divided into three groups based on incentive to perform poorly on neuropsychological testing: no incentive; limited incentive as provided by State law; high incentive as provided by Federal law. The rate of failure on five well-validated malingering indicators across these groups was examined. Cases handled under Federal workers compensation laws showed considerably higher rates of failure and diagnosable malingering than cases handled under State law. The findings indicate that monetary compensation associated with workers compensation claims is a major motive for exaggeration and malingering of problems attributed to work-related brain injuries. The clinician's index of suspicion regarding exaggeration and malingering of symptoms and deficits should be much higher in the context of Federal workers compensation claims, particularly in patients who have suffered only mild traumatic brain injury.

Adult↗
PubMed2001

Base rate of a WMS-R malingering index in a sample of non-compensation-seeking men infected with HIV-1.

HIV-1 infected persons who are pursuing disability benefits are increasingly seeking neuropsychological assessment for purposes of corroborating functional impairment. Thus, research on the utility of measures of symptom validity among these patients is needed. Recently, Mittenberg, Azrin, Millsaps, and Heilbronner (1993) proposed a malingering index score for the WechslerMemoryScale-Revised that is derived by subtracting the Attention/Concentration Index (ACI) score from the General Memory Index Score (GMI). This study is a cross-validation of the specificity of the GMI-ACI Malingering Index in a sample of 55 non-compensation-seeking HIV-positive (HIV+) patients. An overall false-positive rate of 7% was observed for the GMI-ACI Malingering Index. However, further analyses showed that GMI-ACI Malingering Index scores were correlated with GMI scores such that false-positive errors were substantially higher (18%) among patients who obtained above-average GMI scores. These findings suggest a cautious approach to application of the GMI-ACI Malingering Index, particularly among patients who obtain above-average GMI scores.

Adult↗
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↗
PubMed1995

Maximizing internal and external validity in MMPI malingering research: a study of a military population.

The authors investigated the effectiveness of various commonly used Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1943) indices of exaggeration and malingering in detecting suspected malingering in a military sample of 121 enlisted men. To maximize external validity, only men undergoing psychological evaluation were used as participants. Forty-one participants were identified as suspected malingerers through multiple criteria and were contrasted with schizophrenic-spectrum and clinic outpatient groups. To improve internal validity, the 41 suspected malingering participants were asked to retake the test without exaggerating. Results revealed that there were many false positives and fewer, but nonetheless many, false negatives with standard malingering indices. It appeared that the Gough Dissimulation scale (Gough, 1947) might hold the most promise as a measure of malingering, but other scales are also useful. Individual comparisons between different samples and implications for MMPI-2 (Butcher et al., 1989) are presented.

Journal Article↗
PubMed2001

Malingering on the RAVLT. Part I. Deterrence strategies.

The effect of warning regarding detection of malingering on the Rey Auditory Verbal Learning Test (RAVLT) was examined in this study. Sixty undergraduate students were randomly assigned to one of four conditions: malingerers, malingerers-with-warnings, warning-only, and control. An incentive that appeared differential, but was an actual constant reward, was offered to participants who could fake in a believable manner (for those in malingering conditions), or to those who performed to the best of their ability (non-malingering conditions). It was predicted that warning participants about the possibility that faking could be detected would modify the behaviour of malingerers, but not those instructed to perform to the best of their ability. Warning had no effect on behaviour in either condition, which was consistent with expectations for the warning-only group, but not for the malingering group. Results are discussed in terms of the ethical and legal issues associated with malingering in neuropsychological practice.

Clinical Trial↗
PubMed2000

The effects of coaching on the sensitivity and specificity of malingering measures.

This study sought to identify patterns of performance indicative of malingering on the Auditory Verbal Learning Test (AVLT). Participants were randomly assigned to perform normally, simulate head injury, or simulate head injury with warning that there might be attempts to detect malingering. Participants completed an expanded AVLT and a forced-choice task, in addition to several other memory tests. The warned simulators performed worse than normals on the forced-choice task, but better than those simulating head injury without a warning, suggesting that the warned subjects recognized forced choice as a malingering test. A combination of AVLT indices was able to predict group status for both nai;ve and warned malingerers (73.6% for nai;ve malingerers, 84.8% for warned, no false positives). The forced-choice measure detected only 31.6% of the nai;ve malingerers when specificity was maximized, and detected only 6.5% of the warned malingerers, a significant drop in detection rate. Findings suggest that pattern of performance indices are useful in detecting malingering, even when subjects are aware of attempts to detect malingering.

Clinical Trial↗
PubMed2002

Malingering on subjective complaint tasks: an exploration of the deterrent effects of warning.

Assessing patient's subjective experience of illness is an important component of neuropsychological assessment. This information can be assessed using standardized self-reported complaint (SRC) checklists and may have specific applications in the assessment of malingering. Previous research suggests that subjective complaints can be faked under some circumstances, however, the extent to which this occurs when assessments are made using standardized SRC measures is less well understood. In addition, if complaints can be faked, this raises the question: What might reduce the likelihood of faked symptom reports? In this study, we randomly allocated 60 first-year undergraduate subjects to one of the three conditions: malingering, malinger-with-warning, and control. Using a repeated-measures analogue design, we assessed differences between groups on selected SRC measures. The measures used were the Neuropsychological Symptoms Checklist (NSC), the General Health Questionnaire-30 (GHQ-30), and the Depression, Anxiety, and Stress Scales (DASS). We expected to find that SRC measures would be vulnerable to faking, but also that warning malingerers about the possibility of detection would reduce faking behavior. Further, control group scores on SRC measures were calculated to produce preliminary complaint base rate data for these tests. Our results showed that SRC measures were vulnerable to faking. In addition, contrary to expectations, we found that warnings did not significantly deter malingering, although we observed that a trend in the expected direction and future studies with a larger sample size or a modified warning may be needed to further investigate warning efficacy. Broader implications of these findings are discussed in light of deterrence theory and recent debate over the use of SRC measures in the assessment of malingering.

Clinical Trial↗
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↗
PubMed2004

Effects of incentive and preparation time on performance and classification accuracy of standard and malingering-specific memory tests.

The effects of incentive and preparation on performance and classification accuracy of standard and malingering-specific tests were investigated in a simulation study using a 2 (no incentive vs. a $20 incentive) x 2 (immediate vs. delayed preparation) factorial design. Eighty undergraduate students and 15 individuals with traumatic brain injury were administered standard (viz., Digit Span and Visual Memory Span from the WMS-R) and malingering-specific (viz., the Rey 15-Item Memory Test and the Multi-Digit Memory Test) memory tests. Preparation time was found to have a significant effect on performance and classification accuracy on a number of these tests, but incentive was found to have a significant effect on the performance but not the classification accuracy of one test (viz., the Multi-Digit Memory Test). These findings suggest that extra-test variables such as incentive and preparation time should be taken into consideration in evaluating the utility of standard and malingering-specific memory tests in detecting malingering.

Adolescent↗
PubMed2006

Classification accuracy of the Test of Memory Malingering in persons reporting exposure to environmental and industrial toxins: Results of a known-groups analysis.

This study used a known-groups design to examine the classification accuracy of the Test of Memory Malingering in detecting cognitive malingering in patients claiming cognitive deficits due to exposure to environmental and industrial toxins. Thirty-three patients who met Slick et al. criteria for Malingered Neurocognitive Dysfunction were compared to 17 toxic exposure patients negative for evidence of malingering, 14 TBI patients and 22 memory disorder patients, both groups without incentive. The original cutoffs (<45) for Trial 2 and Retention demonstrated perfect specificity (0% false positive error rate) and impressive sensitivity (>50%). These findings indicate the TOMM can be used with confidence as an indicator of negative response bias in cases of cognitive deficits attributed to exposure to alleged neurotoxic substances.

Adult↗
PubMed2006

The prevalence of cognitive malingering in persons reporting exposure to occupational and environmental substances.

OBJECTIVE: Directly estimate the prevalence of cognitive malingering in persons claiming exposure to occupational and environmental substances. METHODS: Retrospective review of 128 neuropsychological cases with financial incentive. Estimates were based on two methods: (1) clinical identification using the Slick, Sherman and Iverson criteria for malingered neurocognitive dysfunction (MND), and (2) statistical modeling based on patient performance on several individual psychometric indicators of malingering. RESULTS: The prevalence based on the clinical method was 40%. The statistically based estimates ranged from 30% to more than 45% depending on model parameters. Different incentive parameters may influence prevalence. CONCLUSIONS: Cognitive malingering in toxic exposure is common and must be adequately addressed in the clinical neuropsychological assessment of toxic exposure and in research on its neurocognitive effects or findings will likely over-estimate the degree of cognitive impairment and related disability.

Adolescent↗
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↗