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PubMed2000

Further investigation of traumatic brain injury versus insufficient effort with the California Verbal Learning Test.

The present study replicates and attempts to extend previous research using the California Verbal Learning Test (CVLT) to identify malingerers. Documented moderate and severe traumatic brain injury patients (n = 42) were compared with clinical malingerers identified by criteria other than the CVLT (n = 21), malingering simulators instructed in realistic potential injury sequelae (n = 25), and normal controls (n = 21). Results of discriminant function analyses for high and low base rates are reported, showing similar results. Also, the four individual cutoff scores (Recognition Hits, Discriminability, Total Words Recalled, Long Delay Cued Recall) from Millis, Putnam, Adams, and Ricker (1995) were evaluated with these groups. Similar specificity rates were found with all four variables, while sensitivity rates were slightly lower than that of Millis. Adjusted cutoffs derived from the new samples resulted in slightly improved overall classification rates. Overall, present findings support those of Millis et al. (1995) with regard to the use of the CVLT in detection of malingering. Exploratory use of Total Intrusions and Recognition Hits Compared to Long Delay Free Recall was not promising. Simulators were found to be fairly comparable in performance to actual malingerers, affirming their use in malingering research.

Journal Article↗
PubMed1997

Ability of the Cognitive Behavioral Driver's Inventory to distinguish malingerers from brain-damaged subjects.

The Cognitive Behavioral Driver's Inventory (CBDI) was analyzed for its ability to discriminate brain-damaged patients from intact subjects who feigned brain-damage. In a sample of 251 neurologically impaired patients and 48 malingering volunteers, the computer-administered distinguished most malingerers from genuine patients. A jackknifed count revealed that the CBDI had 90% sensitivity for detecting malingerers, and 98% specificity for detecting non-malingering brain damaged patients. Success was due to the inability of malingerers to avoid quantitative errors: excessive response latencies, unusual error rates, inflated variability in response latencies, and excessive within-subject, between-item variability. The computer-administered battery may be an effective clinical tool for identifying patients who malinger brain-damage in neuropsychological testing.

Journal Article↗
PubMed1989

[A clinical study of generalized amnesia].

Six cases of generalized amnesia were reported. Generalized amnesia caused by phenomena of genuinely psychogenic origin is a rare psychological disorder and spontaneous recovery from amnesia in a comparatively short period of time is one of the characteristics of this disorder. Three of the cases in this report developed amnesia which was prolonged in comparison with previously reported cases. A comparison between these six cases and previously reported cases of amnesia elucidated the general characteristics of this disorder, differential diagnosis from other disorders, the development of a new identity during the amnestic period, amnesia as an alternative to suicide, factors related to prolonged amnesia, and its treatment. Although differential diagnosis from other disorders, especially from malingering, is sometimes difficult, the patient's attitude toward amnesia, the development of the clinical course of amnesia, the premorbid personal history, and interpersonal relationships should be carefully observed and evaluated in order to differentiate generalized amnesia from malingering. During the amnestic period it was observed that three of the cases believed that they had names of other persons, and two of them recalled personal histories completely different from their own. Previously, such phenomena have been mainly discussed from the view-point of pseudologia fantastica or malingering in Japan. The author discusses how a new identity could be developed in cases of generalized amnesia. According to Abeles, et al., generalized amnesia can sometimes serve as psychological suicide. The author emphasizes that the patient's suicidal risk should be evaluated carefully, even if he or she does not seem highly suicidal superficially. Excessive haste to recover from amnesia may heighten the suicidal risk or help develop a distorted personal identity. The principle for the treatment is to exclude an unnecessary therapeutic manipulation and maintain a consistent and comprehensive psychotherapy. The author also discusses factors with which the duration of amnesia can be evaluated in the initial treatment planning. The premorbid personality, the premorbid social adjustment, previous conflicts leading to amnesia, the whole clinical picture of amnesia, the whereabouts of the patient's family, and the suicidal ideation should all be taken into account.

Adult↗
PubMed2000

Abnormal movements in complex regional pain syndrome: assessment of their nature.

Abnormal movements may be a clinical feature in complex regional pain syndrome (CRPS), but their basic nature is unclear. Between August 1989 and September 1998, patients fulfilling diagnostic criteria for CRPS (I or II) and displaying abnormal movements were entered into a prospective study. Fifty-eight patients, 39 women and 19 men, met entry criteria; 47 had sustained a minor physical injury at work. The patients exhibited various combinations of dystonic spasms, coarse postural or action tremor, irregular jerks, and, in one case, choreiform movements. Patients underwent rigorous clinical and laboratory evaluation aimed at characterizing their neurological disturbance. Surprisingly, no case of CRPS II but only cases of CRPS type I displayed abnormal movements. In addition to an absence of evidence of structural nerve, spinal cord, or intracranial damage, all CRPS I patients with abnormal movements typically exhibited pseudoneurological (nonorganic) signs. In some cases, malingering was documented by secret surveillance. This study highlights abnormal movements in CRPS as constituting a key clinical feature that differentiates CRPS I from CRPS II. They are consistently of somatoform or malingered origin, signaling an underlying psychoneurological disorder responsible for the entire CRPS profile.

Adolescent↗
PubMed2006

From flawed self-assessment to blatant whoppers: the utility of voluntary and involuntary behavior in detecting deception.

Malingering occupies a range on a continuum from biased self-perception to conscious, deliberate, serious lies. One aspect of this continuum is the element of self-conscious or deliberate control. Suggestions from Darwin's writings concerning the role of voluntary and involuntary activation of the facial muscles are examined and illustrated with data from a 40 year program of research on deception. The impact of the voluntary-involuntary distinction on the appearance, timing, symmetry and cohesion of facial expressions of emotion is explained. Data relevant to changes in vocal and gestural aspects of demeanor in honest and deceptive behavior are also reviewed. The relevance of these laboratory-based findings on the voluntary control of nonverbal behavior in assessing some types of malingering is discussed.

Behavior↗
PubMed1979

Symptoms at one year following concussion from minor head injuries.

Of 131 patients with mild concussion, 19 (14.5%) still had symptoms after 1 year. Of these 19 patients, 10 had some symptoms of which they had not complained at 6 weeks. Symptoms at 1 year were more common among women and among patients who had had positive neurological findings at 24 h. Of the 19 patients who had symptoms at 1 year, 8 were involved in law suits and 6 had been suspected of malingering 6 weeks after their accident. Five of these patients were both involved in law suits and suspected of malingering.

Adolescent↗
PubMed1996

Faking a profile: can naive subjects simulate whiplash responses?

The psychological symptom checklist, the SCL-90-R (Derogatis 1983), has been used to assess patients with a number of chronic pain syndromes. For whiplash injury, a characteristic profile has been found (Wallis et al. 1995). However, there is still a belief that patients with neck pain following whiplash injury may be malingering, and therefore the utility of the SCL-90-R as a screen for possible malingering is assessed here. Forty pain-free university students were asked to simulate chronic pain 6 months after a motor vehicle accident in order to ensure compensation. The SCL-90-R, McGill Pain Questionnaire and a visual analogue pain scale were used. Students' scores were compared with those of a group of 132 whiplash patients (Wallis et al. 1995). Differences between the two groups were striking; the students scored significantly higher than patients on all subscales of the SCL-90-R and on the visual analogue pain scale (Mann-Whitney P-values all less than 0.001). However, pain scores for both groups on the McGill Pain Questionnaire were similar. The conclusion was that it is very difficult for an ingenuine individual to fake a psychological profile typical of a whiplash patient.

Adult↗
PubMed2005

Detecting simulation of attention deficits using reaction time tests.

The current study examined if a newly developed series of reaction time tests, the Computerized Tests of Information Processing (CTIP), were sensitive to simulation of attention deficits commonly caused by traumatic brain injury (TBI). The CTIP consists of three reaction time tests: Simple RT, Choice RT, and Semantic Search RT. These tests were administered to four groups: Control, Simulator, Mild TBI, and Severe TBI. Individuals attempting to simulate attention deficits produced longer reaction time scores, made more incorrect responses, and exhibited greater variability than cognitively-intact individuals and those with TBI. Sensitivity and specificity values were comparable or exceeded those obtained on the Test of Memory Malingering. As such, the CTIP offers considerable promise of serving as a viable malingering test that uses a distinctively different paradigm than the two-item, forced-choice procedure employed by traditional symptom validity tests.

Adolescent↗
PubMed1996

Field of dreamers and dreamed-up fields: functional and fake perimetry.

PURPOSE: Hysterical and malingering patients can manifest visual field defects on perimetry (visual field testing), including defects suggestive of true visual pathway pathology. It has been shown that control subjects can easily imitate some pathologic defects with automated, computed perimetry. The authors sought to determine whether subjects could imitate the same pathologic defect with manual and automated perimetry. METHOD: Six subjects posed as patients with neurologic problems. They had manual perimetry with both an experienced and inexperienced technician followed by automated perimetry. They were later interviewed about the methods of the technicians and the difficulty of the exercise. RESULTS: Four of six subjects easily imitated the assigned defects with both technicians on manual perimetry and with automated perimetry. These included quadrantic, altitudinal, hemianopic, and enlarged blind-spot defects. Two subjects who were assigned cecocentral and paracentral scotomas instead produced enlarged blind spots by manual perimetry and defects suggestive of chiasmal pathology by automated perimetry. Paradoxically, some subjects found that experienced technicians were easier to fool than inexperienced technicians because of the systematic way in which experienced technicians defined defects. CONCLUSIONS: With minimal coaching, some subjects can imitate visual fields with enlarged blind spots, quadrantic, hemianopic, and altitudinal defects with ease and reproducibility by both automated and manual perimetry. Cecocentral and paracentral scotomas are harder to imitate but may be mistaken as representing chiasmal pathology. Paradoxically, experienced technicians may not be better at detecting hysterical or malingering individuals.

Adult↗
PubMed2003

A brief and unobtrusive instrument to detect simulation and exaggeration in patients with whiplash syndrome.

The objective of this study was to develop and test a brief and unobtrusive instrument to detect exaggeration and simulation in whiplash syndrome. The instrument consists of eight scenarios with ten response options that have to be ordered according to how easy a behavior is to perform. Twenty-five simulating and 25 non-simulating patients with whiplash syndrome of grades 2 and 3 according to the Quebec Task Force classification as well as 25 simulating and 25 non-simulating controls completed the instrument. In a cross-validation study 20 controls and 20 patients participated. Malingering and exaggeration scores were determined for each subject and patient. The scores were summed up and compared across malingering and exaggerating subjects and controls and cut-off values were determined to classify the patients. T-tests and a discriminant analysis were used to determine classification accuracy. The instrument correctly identified 94% of the simulators and 84% of the exaggerators in both samples. This brief and unobtrusive instrument can detect exaggeration and simulation in whiplash syndrome.

Adult↗
PubMed2002

Conversion motor paralysis disorder: analysis of 34 consecutive referrals.

STUDY DESIGN: We present our cumulative experience with patients sustaining the most dramatic type of Conversion Disorder (CD) - Conversion Motor Paralysis. SETTING: Rehabilitation departments, Reuth Medical Center, Tel-Aviv and Sheba Medical Center, Tel-Hashomer, Israel. METHODS: During the period 1973-2000, 34 patients with neurological symptoms without any anatomical or physiological basis were admitted to both rehabilitation departments. This number consists of less than 1% of the total acute traumatic and non-traumatic spinal cord disorders admitted annually to these centers. RESULTS: Twenty-five of the subjects were men (mean age of 30 years) and nine were women (mean age of 31.4 years). Neurological symptoms included: paraplegia (complete or incomplete) (18), hemiplegia or hemi paresis (11), tetraplegia (complete or incomplete) (three), monoplegia (one), triplegia (one). The final diagnosis on discharge was CD in 30 of the 34 cases, the remaining four being diagnosed as malingering. Functionally, nine patients had a complete recovery, 10 a partial recovery and 15 remained unchanged. CONCLUSION: Disabled people who experienced traumatic events resulting in various disabilities are admitted usually to a rehabilitation center. However, some of them are later diagnosed as having Conversion Disorder or malingering. We believe that their participation in active regular and integrative rehabilitation process is beneficial to most of them. Most of these patients gain functional independence and return to the main stream of life.

Adult↗
PubMed2004

[Strategies of visual acuity assessment].

Visual acuity can be assessed by different strategies. The constant-stimulus-, the stair-case-, the Best-PEST-strategies, and the EN ISO 8596 are discussed. In cases of presumed psychogenic visual impairment and malingering it can be useful to modify these strategies striving for a determination of the (minimum) visual acuity based on statistical analysis rather than "clinical experience". The EN ISO 8596 defines visual acuity by a 60 % criterion, thus implying guesswork, if recognition of the optotypes is uncertain. Therefore, the forced-choice-procedure is mandatory. Objective psychophysical (preferential looking, induction or suppression of rhythmic eye movements) and electrophysiological methods (VEP) of visual acuity assessment can be useful in infants, in the mentally handicapped, and in patients with presumed psychogenical influence or malingering.

Data Interpretation, Statistical↗
PubMed1999

[Clinical significance of objective vision assessment using visually evoked cortical potentials induced by rapid pattern sequences of different spatial frequency].

BACKGROUND: In patients where reliable subjective assessment of visual acuity is impossible, further diagnostics should be enhanced by an objective method. PATIENTS AND METHODS: A group of 34 patients was examined by objective assessment of visual acuity using visual evoked potentials (VEP) as described by Hajek and Zrenner in 1988. The presentation of five checkerboards with different spatial frequency in repetitive sequences on a TV-monitor elicits a series of transient visual evoked potentials. Shape and amplitude of each wavelet depends on check size and directly reflect a spatial tuning function with a low- and high-frequency cut-off. This amplitude is described by a polynomial fit (2nd order). The function's intersection with the x-axis at higher spatial frequencies leads to an estimation of the visual acuity. RESULT: This result is compared to the subjectively determined visual acuity. In the majority of the presented cases the suspected malingering was confirmed. CONCLUSION: Patients with suspected malingering represent the primary indication of the described method.

Adult↗
PubMed2002

Coaching and the ability to simulate mild traumatic brain injury symptoms.

This study assessed the ability of normal controls to simulate mild traumatic brain injury with or without the aid of general simulation strategies. An additional purpose was to evaluate the relative ability of four tests of performance motivation or malingering to discriminate among the five groups in this study. Twenty-one patients with documented mild traumatic brain injury (TBI) and 112 undergraduate students were administered the measures of symptom validity in randomized order with instructions either to perform to the best of their ability or to fake believable deficits. Students asked to malinger were either given instructions to do so with no guidance (No Strategies group or NS), a minimal level of guidance (Only Strategies group or OS) or a moderate level of guidance (Strategies and Example or SE). Students given simulation strategies (OS and SE groups) were able to match performance of the TBI group in only those instances when TBI performance was similar to the normal comparison group. When TBI performance fell considerably below the normal comparison group, naïve simulators (NS group) best approximated TBI performance. The degree of variability in the classification success of the four tests underscored the necessity of combining detection methods, as well as the need to develop new tests more resistant to attempts to feign brain injury.

Adult↗
PubMed2002

A comparison of three tests to detect feigned amnesia: the effects of feedback and the measurement of response latency.

Three experiments provided validation data for an English language version of the Amsterdam Short Term Memory Test (ASTM test) developed to detect feigned memory impairment. Using a simulation design, the ASTM test compared favourably with the Test of Memory Malingering (TOMM) and appeared better than a newly-devised Digit Recognition Test (DRT). Feedback on the correctness of responses had no significant effect on performance but notable trends were apparent. Simulators were significantly slower than controls on computerised versions of the ASTM test and the TOMM. Convergent findings indicate that the English language version of the ASTM test may be useful in detecting malingering.

Adolescent↗
PubMed2001

Biased responding: a case series demonstrating a relationship between somatic symptoms and impaired recognition memory performance for traumatic brain injured individuals.

Biased responding on the Sternberg Recognition Memory Test was observed in four patients with traumatic brain injury. None of these individuals met the Diagnostic and Statistical Manual's (DSM-IV) criteria for malingering. Individual recognition memory scores were high shortly after injury, declined to chance or below at the 6- and 12-month evaluations, and then showed substantial recovery by the 24-month evaluation. Recall memory performance actually declined slightly across this same 2-year period. Recognition memory scores were related to the extent to which the patients endorsed somatic items on the Hamilton Rating Scale for Depression (HAM-D). Poor performance was associated with high somatic scores. The relationship between memory and somatic scores on the HAM-D in this case series suggests that unconscious processes can influence memory performance and, because of this, that clinicians should not use such performance as a primary indicator of malingering. More importantly, biased responding and actual memory deficits may coexist. This is indicated in the current cases by the failure of recall memory to improve during the 2 years these patients were followed.

Adult↗
PubMed2004

Non-organic hearing loss redefined: understanding, categorizing and managing non-organic behaviour.

Addressing the complex factors that underpin any presentation of non-organic hearing loss (NOHL) is essential to that individual's proper management. The complex and often conflicting approaches taken to date are reviewed. Previous dichotomous models distinguish those assessed as consciously malingering for external benefits from those who generate symptoms unconsciously to meet psychological needs. Incorporating the DSM-IV-TR diagnosis of 'factitious disorder' into a new model bridges the conceptual gap. Three categories (malingering, factitious and conversion) are used distinctly, for the purpose of diagnosis, and on a continuum for the purpose of management. Motivating factors, type of gain, degree of intention and consistency of response during audiological assessment can all be related within the model. Advances in objective measurements have made the detection of NOHL easier. A reinvigoration of interest in effective diagnosis and management of the condition is therefore timely.

Adolescent↗
PubMed1990

Concurrent visual conversion reaction and simulated colour vision defects in a 12-year-old child.

Visual conversion reaction (VCR) is a psychosomatic anomaly which occasionally manifests in children, most commonly in the form of reduced vision and visual field defects. Malingering or conscious simulation for secondary gain would appear to be rare in children but occasionally VCR and simulation coexist. A case history is presented of a 12-year-old child with behavioural and reading difficulties who manifested reduced vision most probably attributable to VCR and severe colour deficiency, which was best explained in terms of simulation or malingering.

Child↗