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PubMed1996

Differential vulnerability between postconcussion self-report and objective malingering tests in identifying simulated mild head injury.

The present study examined the ability of analog malingerers to feign postconcussion symptoms and neuropsychological performance patterns seen in mild head-injured patients. Experimental subjects were randomly assigned to either a control condition, asked to feign deficits consistent with mild head injury without task specific instruction, or feign deficits while given task-specific instruction. A separate group of mild head-injured patients served as a clinical comparison group. Analog malingering groups accurately simulated levels of postconcussive symptoms seen in the mild head-injured patients. However, poorer performance was displayed by the analog malingerers on the objective malingering tests. Coaching did not facilitate realistic patterns of performance for analog malingerers. The results of this study indicate that analog malingerers accurately replicated self-reported postconcussive symptoms, but were less able to simulate objective clinical malingering test performance. These results suggest that self-report measures of postconcussive symptoms and clinical tests are differentially vulnerable to simulation attempts.

Adolescent↗
PubMed1998

Detecting malingered memory deficits with the Recognition Memory Test.

The purpose of the present study was to examine the efficacy of using the Recognition Memory Test (RMT) as a marker for malingered memory deficits. Data from 60 subjects, including 40 patients seen for neuropsychological evaluation and 20 university undergraduates, are reported. The university students were given experimental instructions to malinger. Students were compared to 20 memory-impaired and 20 memory-nonimpaired patients. The students who were instructed to malinger memory impairment performed more poorly than both groups of patients. Discriminant function analyses using the two scores derived from the RMT as predictors of group membership resulted in a 100% initial correct classification rate and a 96.7% correct classification rate on cross-validation.

Adolescent↗
PubMed2006

Classification accuracy of the test of memory malingering in traumatic brain injury: results of a known-groups analysis.

This study used a known-groups design to determine the classification accuracy of the Test of Memory Malingering (Tombaugh, 1996, 1997) in detecting cognitive malingering in traumatic brain injury (TBI). Forty-one of 161 TBI patients met Slick, Sherman, and Iverson (1999) criteria for Malingered Neurocognitive Dysfunction. Twenty-two no-incentive memory disorder patients were also included. The original cutoffs (<45) for Trial 2 and Retention demonstrated excellent specificity (less than a 5% false positive error rate) and impressive sensitivity (greater than 45%). However, these cutoffs are actually conservative in the context of mild TBI. Over 90% of the non-MND mild TBI sample scored 48 or higher on the Retention Trial and none scored less than 46 while 60% of the MND patients claiming mild TBI were detected at those levels. Trial 1 also demonstrated excellent classification accuracy. Application of these data to clinical practice is discussed.

Adult↗
PubMed2005

Probable malingering and performance on the test of variables of attention.

Fifty subjects with mild head injury involved in personal injury litigation and 2 subjects referred for evaluation of their disability status underwent comprehensive neuropsychological examination including the Test of Variables of Attention (TOVA). Group status was determined by performance on symptom validity testing. Twenty-six subjects who failed symptom validity testing formed the probable malingering (PM) group, while 26 subjects who passed symptom validity testing comprised the not malingering (NM) group. Subjects in the PM group performed significantly worse on all TOVA variables relative to subjects in the NM group. Discriminant function analyses revealed that TOVA omission errors >/=3 errors was the best predictor of group status. Malingering research employing a group of probable clinical malingerers has direct generalizability to real-world settings.

Adult↗
PubMed2001

Pattern visual evoked potentials in malingering.

OBJECTIVES: We previously developed a new method for estimating objective visual acuity by means of pattern visual evoked potentials (PVEP). In this study, this method was applied to the diagnosis of malingering. MATERIALS AND METHODS: Six patients ranging in age from 40 to 54 years (mean 47 years) with suspected malingering were evaluated by means of the visual evoked potential test, optokinetic nystagmus (OKN) inhibition test, and the visual field test. In the PVEP study, the stimulus consisted of black and white checkerboards (39', 26', 15', and 9') with a visual angle of 8 degrees, contrast level of 15%, and a frequency of 0.7 Hz. One hundred PVEP responses were averaged per session. RESULTS: Routine ophthalmic examinations were normal in all patients. Five patients had a tubularly constricted visual field, and the remaining patient had a normal visual field. The objective visual acuities of the six patients estimated from PVEP were better than their subjective visual acuities estimated with Landolt rings. CONCLUSIONS: Among a variety of psychophysical and electrophysiologic ancillary tests, we consider our PVEP method a useful method for objectively determining visual acuity in a patient with signs of ocular malingering.

Adult↗
PubMed2003

Malingered neurocognitive dysfunction in neurotoxic exposure: an application of the Slick criteria.

Toxic torts are increasing across the country and often the results of the neuropsychological evaluation are crucial for defining damages. Therefore, the accurate differentiation of those damaged by toxic exposure from those exaggerating or fabricating deficits is important. However, there is little research on malingering in this context. Presented are four patients claiming cognitive deficits after apparent occupational neurotoxic exposure who were diagnosed as malingering using the Slick, Sherman, and Iverson criteria. The goals of this article were to (1) illustrate the application of the Slick Criteria; (2) discuss current knowledge about the neurological and neurocognitive effects of toxic substances and its impact on clinical decision-making; (3) discuss the application of the Slick Criteria, specifically, and malingering research, generally, to toxic exposure cases; and (4) propose a paradigm in which medical, toxicological and neuropsychology professionals coordinately evaluate cases of alleged neurotoxic chemical exposure.

Adult↗
PubMed1985

A brief test for measuring malingering in schizophrenic individuals.

The M Test, a brief test for measuring malingering of schizophrenic illness, contains true-false items describing actual symptoms of schizophrenia, bizarre attitudes and beliefs, and fake symptoms. Normal subjects rarely endorsed any of the items. The responses of genuinely ill schizophrenic inpatients were compared with those of normal subjects who had been asked to fake malingering after being educated about the symptoms of schizophrenia and forewarned about the purpose of the test. The test significantly discriminated between genuinely ill patients and malingerers. The test correctly identified 87.3% of the schizophrenic subjects and 78.2% of the malingering normal subjects.

Factitious Disorders↗
PubMed2003

An MMPI-2 scale to detect malingered depression (Md scale).

A specialized Minnesota Multiphasic Personality Inventory-2 (MMPI-2) validity scale was constructed to detect individuals who are knowledgeable about either depression or MMPI-2 detection strategies and who subsequently attempt to malinger depressive symptoms on the MMPI-2. The Malingered Depression (Md) scale consists of 32 items that discriminated college students who feigned depression from those who were genuinely depressed. Further information about the incremental validity and the utility of the Md scale was obtained in a cross-validation study with additional college students who feigned depression and a sample of students with clinically significant depressive symptoms. The results indicate that the Md scale possesses promising value in detecting malingered symptoms of depression.

Adult↗
PubMed2005

WAIS digit span-based indicators of malingered neurocognitive dysfunction: classification accuracy in traumatic brain injury.

The present study determined specificity and sensitivity to malingered neurocognitive dysfunction (MND) in traumatic brain injury (TBI) for several Wechsler Adult Intelligence Scale (WAIS) Digit Span scores. TBI patients (n = 344) were categorized into one of five groups: no incentive, incentive only, suspect, probable MND, and definite MND. Performance of 1,063 nonincentive patients (e.g., cerebrovascular accident, memory disorder) was also examined. Digit Span scores included reliable digit span, maximum span forward both trials correct, maximum span forward, combined maximum forward and backward span, Digit Span scaled score, maximum span backward both trials correct, and maximum span backward. In TBI, sensitivity to MND ranged from 15% to greater than 30% at specificities of 92% to 98%. Patient groups with documented brain pathology had higher false-positive error rates. These results replicate previous known-groups malingering studies and provide valuable data supporting the WAIS Digit Span scores in detection and diagnosis of malingering.

Adolescent↗
PubMed1988

The detection of malingering in criminal forensic groups: MMPI validity scales.

Despite the value of the MMPI to the forensic assessment of malingering (exaggeration) of psychopathology, few studies have assessed the accuracy of the MMPI validity scales in criminal forensic populations. We administered the MMPI to 35 insanity defendants undergoing evaluation for fitness to stand trial and/or sanity at the time of the crime, who stood to benefit from being assessed as psychologically disturbed, and 39 subjects previously found not guilty by reason of insanity (NGRI), who did not stand to gain from such an assessment, Insanity defendants showed significantly more malingering than NGRI subjects, p less than .05. Racial differences did not affect the data. These findings support the efficacy of MMPI validity scales in assessing malingering within criminal forensic groups, and support the generalizability of the scales across race.

Adolescent↗
PubMed1994

An empirical study of malingering schizophrenia on the Rorschach.

We investigated whether it is possible to fake schizophrenia on the Rorschach test. We also developed and attempted to validate variables (modified responses) that might distinguish malingerers from true schizophrenics. Forty nonschizophrenic, nonpatient subjects, randomly assigned to either a control or malingering condition, and 20 schizophrenic subjects were administered the Rorschach. Dependent variables included indices associated with schizophrenia and modified responses. As expected, some malingering subjects did successfully fake schizophrenia. Modified responses did help to distinguish groups but were not completely successful. Post hoc analyses of differences were also presented. We concluded (a) that some malingerers, given some information about schizophrenia, may successfully fake schizophrenia and (b) that the modified responses show promise in assisting detection of malingering.

Adult↗
PubMed1998

Susceptibility of the trauma symptom inventory to malingering.

This study examined the sensitivity and specificity of the Trauma Symptom Inventory (TSI; Briere, 1995), a self-report measure of psychological sequelae of potentially traumatic events, to malingering. An optimal cutting score for a validity scale--Atypical Responding (ATR)--designed to identify exaggeration or other unusual response sets was developed in an analogue sample of 155 college students and subsequently applied to TSI profiles from several samples of patients with various psychiatric disorders. Use of a cross-validated T-score cutoff of 61 and below on the ATR scale produced good sensitivity (81%) and specificity (92%) rates in the analogue sample. Participants in the analogue sample who reported a history of traumatic experiences were no more able to successfully malinger trauma symptoms than were participants without such histories. Furthermore, false-positive rates in the clinical samples were generally low, suggesting that relatively few genuinely symptomatic individuals would be misclassified as malingering.

Adult↗
PubMed2000

Effect of symptom information and validity scale information on the malingering of depression on the MMPI-2.

MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) data from college students who were attempting to malinger depression (199 women and 171 men) were compared to MMPI-2 data from students who responded honestly (50 women and 45 men). Mean MMPI-2 scores were compared with analyses of variance, and students' success in malingering depression was evaluated with criteria based on cutting scores for validity indexes and on the clinical scales commonly associated with depression. Students who were given information about the validity scales or about the symptoms of depression were more successful at malingering than students who received no information, indicating that malingerers of depression may be able to elude detection by the MMPI-2 if they are informed about the validity scales or the symptoms of depression.

Adult↗
PubMed2006

MMPI-2 assessment of malingered emotional distress related to a workplace injury: a mixed group validation.

In this study, we examined the capacity of MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 2001) validity indexes to identify malingered depression associated with a workplace injury. We compared 27 graduate students simulating depression with archival records of 33 inpatients diagnosed with major depressive disorder. We employed a mixed-group validation design to generate true positive rates (TPR) and false positive rates (FPR) for the various MMPI-2 validity scales [F, FB, F(p), FBS, F - K, Ds2] while we accounted for base rates of malingering in each sample. The Fake Bad scale (FBS) was the only validity measure that produced acceptable TPR and FPR or a significant correlation with malingering status.

Accidents, Occupational↗
PubMed2006

Risk of false positives when identifying malingered profiles using the trauma symptom inventory.

The Trauma Symptom Inventory (TSI; Briere, 1995) is a 100-item self-report measure of posttraumatic symptomatology that includes an Atypical Response (ATR) validity scale designed to differentiate honest from malingered profiles. In this study, using an analogue design to experimentally manipulate honest and malingered responses on the TSI, we found that proposed ATR cut scores produce a significant risk of false positives. Furthermore, the functioning of proposed cut scores worsened when we used posttraumatic stress disorder relevant samples and low estimates of malingering base rates. In light of these findings, the TSI should be used with caution when assessing claims of posttraumatic stress in forensic or disability settings.

Adult↗
PubMed2002

Malingering dissociative identity disorder: objective and projective assessment.

Verification of dissociative identity disorder presents challenges given the complex nature of the illness. This study addressed the concern that this disorder can be successfully malingered on objective and projective psychological tests. 50 undergraduate women were assigned to a Malingering or a Control condition, then completed the Rorschach Inkblot Test and the Dissociative Experiences Scale II. The Malingering group were asked to simulate dissociative identity disorder; controls received instructions to answer all materials honestly. Analysis indicated that malingerers were significantly more likely to endorse dissociative experiences on the Dissociative Experiences Scale II in the range common to patients with diagnosed dissociative identity disorder. However, on the Rorschach there were no significant differences between the two groups. Results suggest that the assessment of dissociative identity disorder requires a multifaceted approach with both objective and projective assessment tools. Research is needed to assess these issues in clinical populations.

Adolescent↗
PubMed2002

Advances and issues in the diagnostic differential of malingering versus brain injury.

The past decade has seen numerous advancements in the assessment of malingered brain injury, though the current diagnostic system offers only guidelines in which malingering should be suspected. This article presents an overview of advances in the clinical and neuropsychological assessment of malingering, issues in diagnostic differential, neuropsychological test methods, and special issues presented by the medical-legal context, and other factors which may affect presentations. Cautions and recommendations for practice are presented.

Brain Injuries↗
PubMed2003

Exaggerated MMPI-2 symptom report in personal injury litigants with malingered neurocognitive deficit.

Traditional MMPI-2 validity scales, the Lees-Haley Fake Bad Scale (FBS), and the Arbisi and Ben Porath Infrequency Psychopathology Scale (F(p)) were evaluated in 33 personal injury litigants who had failed forced-choice symptom validity testing and other measures of effort in patterns consistent with the Slick, Sherman, and Iverson (1999) criteria for definite and probable malingered neurocognitive deficit (MND). The FBS was more sensitive to symptom exaggeration than F, Fb, and F(p). The definite and probable MND litigants also produced mean elevations on MMPI-2 scales 1, 3 and 7 that were significantly higher than those produced by various clinical groups including non-litigating severe closed head injury, multiple sclerosis, spinal cord injury, chronic pain, and depression. These data suggest that MMPI-2 profiles characteristic of malingered injury differ from those associated with malingered psychopathology.

Adult↗