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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↗
PubMed2006

Application of the new MMPI-2 Malingered Depression scale to individuals undergoing neuropsychological evaluation: relative lack of relationship to secondary gain and failure on validity indices.

The Malingered Depression (Md) scale for the MMPI-2 (Steffan, Clopton, & Morgan, 2003) was recently developed to detect attempts at malingering depressive symptomatology. The Steffan et al. cutoffs for the Md scale were derived through comparisons of undergraduate malingering simulators with depressed undergraduates. In order to explore the potential utility for neuropsychological practice, we examined the Md scale among 160 individuals with and without a context of secondary gain referred for neuropsychological evaluation. Md results were compared to other MMPI-2 validity indices and performance on effort testing. While Md was found to correlate highly with other validity indices from the MMPI-2, it was also correlated significantly with measures of depression, both in individuals with and without a secondary gain context. Md scores were not significantly different between secondary gain and no secondary gain groups, whereas FBS and L were significantly different. The effect of passing or failing validity indicators on rates of Md scores exceeding the Steffan et al. cutoffs was limited. Only among the few individuals exceeding a high threshold on the F scale or combinations of F, FBS, and effort indicators was it common to also surpass the Md cutoff. Overall, Md showed relatively little relationship to either secondary gain status or cognitive malingering in our sample. Given that such factors do not necessarily produce high scores on Md, the utility of the scale to clinical neuropsychologists appears low.

Adult↗
PubMed2006

Malingered psychosis leading to involuntary psychiatric hospitalization.

OBJECTIVE: To describe a patient with feigned psychosis who was admitted to an acute psychiatric unit under the Mental Health Act, and to discuss the clinical features of malingering in this treatment setting. METHOD: Case report. RESULTS: A 40-year-old man with no known past psychiatric history was brought by police to the Emergency Department. He gave a history of paranoia, hallucinations and bizarre behaviour and was admitted to a secure ward. Treatment with parenteral medication was required due to hostile and aggressive behaviour. Collateral history was inconsistent with his reported symptoms and, when confronted with this information, he acknowledged fabricating his symptoms in order to obtain a disability pension. CONCLUSIONS: It is important to consider malingering as a differential diagnosis in patients who present with atypical features and have clear external incentives for their behaviour. With improved health literacy and access to health information, individuals who are marginalized in society and have limited social and occupational opportunities may malinger symptoms for obvious personal gain. Inconsistency between reported symptoms and clinical observations, as well as contradictory collateral information from multiple sources, are helpful tools in diagnosing malingering. It is important for clinicians to identify malingerers early and limit unnecessary admissions.

Adult↗
PubMed2005

Factitious disorder and malingering in adolescent girls: case series and literature review.

Six cases of factitious disease and malingering in pediatric patients referred to an infectious diseases practice in a tertiary care children's hospital are described, and implications for general clinical practice are reviewed. All patients were girls aged 9-15 years. Two patients were malingering with the secondary gain of avoiding attendance at school. The other 4 patients presented with factitious illness without clear link to secondary gain, but rather for a psychological purpose. Three of the subjects admitted to self-induced or feigned illness. The 2 patients diagnosed with malingering did very well with early parental support, psychotherapy, and attention paid to school difficulties. The outcomes of the others with underlying psychological conflicts were less resolved. Factitious disorders and malingering occur in the pediatric population. A high index of suspicion is needed for prompt diagnosis and care.

Adolescent↗
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↗
PubMed2006

California verbal learning test indicators of Malingered Neurocognitive Dysfunction: sensitivity and specificity in traumatic brain injury.

The present study used well-defined traumatic brain injury (TBI) and mixed neurological (other than TBI) and psychiatric samples to examine the specificity and sensitivity to Malingered Neurocognitive Dysfunction (MND) of four individual California Verbal Learning Test (CVLT) variables and eight composite CVLT malingering indicators. Participants were 275 traumatic brain injury and 352 general clinical patients seen for neuropsychological evaluation. The TBI patients were assigned to one of five groups using the Slick, Sherman, and Iverson (1999) criteria: no incentive, incentive only, suspect, and malingering (both Probable MND and Definite MND). Within TBI, persons with the strongest evidence for malingering (Probable and Definite) had the most extreme scores. Good sensitivity (approximately 50%) in the context of excellent specificity (> 95%) was found in the TBI samples. Issues related to the appropriate clinical application of these data are discussed.

Brain Injuries↗
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↗
PubMed2000

Cross-validation of the MMPI-2 in detecting malingered posttraumatic stress disorder.

We attempted to cross-validate findings from a previous study (Elhai, Gold, Sellers, & Dorfman, in press) using a clinical sample of combat-related war veterans to distinguish genuine from malingered posttraumatic stress disorder (PTSD) on the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). The MMPI-2 scores of 124 male combat war veterans at the PTSD outpatient treatment program of a Veterans Affairs Medical Center were compared with those of 84 adult college students instructed and trained to malinger PTSD. MMPI-2 overreporting variables examined were F, F-Fb, F-K, F(p), Ds2, O-S, OT, and FBS. A stepwise discriminant analysis identified F. F-Fb, F-K, Ds2, O-S, and OT as the best malingering predictors. A predictive discriminant analysis yielded good hit rates for the model with impressive cross-validation results. We assessed cutting scores for the predictors of the model. We discuss clinical implications for using the MMPI-2 to distinguish malingered PTSD from combat-related PTSD.

Adolescent↗
PubMed2005

The detection of malingering in memory performance: the sensitivity and specificity of four measures in a UK population.

OBJECTIVES: To investigate the validity of a clinical neuropsychological battery for the detection of malingering on tests of memory. METHODS: A simulated scenario design was developed to investigate the effectiveness of a battery of four neuropsychological tests in the detection of malingering; the Coin in the Hand Test (CIH), Autobiographical Memory Index (AMI), Rey I 5-Item Test (RIT),and the Wechsler Mental Control Test (MCT). The performances of patients with an acquired brain injury (N = 40) were compared with two groups of controls instructed either to simulate a head injury performance (N = 40) or do their best (N = 40). RESULTS: The CIH and MCT demonstrated good validity and displayed high sensitivity and specificity. The RIT and the AMI was relatively poor in distinguishing between simulators and patients. CONCLUSIONS: The sensitivity and specificity of all four tests to the detection of malingering has been assessed. Two of the tests the CIH and MCT would be useful as a quick and accurate screening tool for detecting malingering.

Adult↗
PubMed2006

Assessment instruments measuring malingering used with individuals who have mental retardation: potential problems and issues.

Malingering, the exaggeration or fabrication of physical and/or psychological symptoms, can threaten the psychological assessment process (American Psychiatric Association, 2000). To enhance the validity of psychological evaluations, researchers have studied trends in malingering and developed instruments for its detection (Rogers, Bagby, & Dickens, 1992; Tombaugh, 1996). These instruments, however, may not be appropriate for individuals with significant subaverage intellectual functioning. Four instruments assessing malingering, frequently used in forensic evaluations, were administered to individuals with mental retardation. Results show that by utilizing established cut-off scores, we were able to classify a significant percentage of participants as "malingering," in spite of directions to perform optimally. Practical implications as well as directions for future research are discussed.

Adult↗