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PubMed2003

The construct validity of the Lees-Haley Fake Bad Scale. Does this scale measure somatic malingering and feigned emotional distress?

The Fake Bad Scale (FBS [Psychol. Rep. 68 (1991) 203]) was created from MMPI-2 items to assess faking of physical complaints among personal injury claimants. Little psychometric information is available on the measure. This study was conducted to investigate the psychometric characteristics of the FBS using MMPI-2 profiles from six settings: Psychiatric Inpatient (N=6731); Correctional Facility (N=2897); Chronic Pain Program (N=4408); General Medical (N=5080); Veteran's Administration Hospital Inpatient (N=901); and Personal Injury Litigation (N=157). Most correlations of the FBS and raw scores on the MMPI-2 were positive with correlations among the validity scales being lower than correlations among the clinical and content scales. The FBS was most strongly correlated with raw scores on Hs, D, Hy, HEA, and DEP. When the more conservative cutoff of 26 was used, the FBS classified 2.4-30.6% of individuals as malingerers. The highest malingering classification was for the women's personal injury sample (37.9%) while the lowest was among male prison inmates (2.3%). Compared to men, in most samples, almost twice as many women were classified as malingerers. The results indicate that the FBS is more likely to measure general maladjustment and somatic complaints rather than malingering. The rate of false positives produced by the scale is unacceptably high, especially in psychiatric settings. The scale is likely to classify an unacceptably large number of individuals who are experiencing genuine psychological distress as malingerers. It is recommended that the FBS not be used in clinical settings nor should it be used during disability evaluations to determine malingering.

Adult↗
PubMedDate not supplied

[Malingering among workers seeking disability insurance].

OBJECTIVE: Describe the frequency and characteristics of Mexican Social Security workers with malingering disorder that request disability pension. MATERIAL AND METHODS: Comparative survey made among 136 workers seen during 2001, which were divided into three groups: malingering workers (MW), workers without disability (WOD), and workers with disability (WWD). We administered the Z Test for scaled variables and Z2 Test for nominal variables to identify group differences RESULTS: The incidence ofmalingering was of 2.2/100,000 workers. Mean age was 41.9 +/- 10.1 years, 440 was the average number of days of labor disability; 51 (37%) workers were malingerers. 35 (26%) workers were work disabled and 50 (37%) without disability. Malingerers had higher level of schooling compared with WOD and WWD (p < 0.02); most worked at the Social Security (p < 0.05), with lower number of previous jobs (p < 0.05), presented longer work disability (p < 0.05). Depressive symptoms were not frequently noted (p < 0.025) and all had normal electroencephalogram and brain computed tomography studies. CONCLUSIONS: Malingering workers who request work disability pensions follow a particular pattern that differs from other workers that request disability assessment at the Social Security Institute of Mexico.

Adult↗
PubMed1987

Mutism, malingering, and competency to stand trial.

Mutism and mental illness have had a long-standing historical relationship with regard to the issue of competence to stand trial. This article reports a defendant who remained mute for 10 months and describes his use of the symptom of mutism in his malingering. Although mutism is frequently used by defendants for malingering, clinicians must have a high index of suspicion for the possibility. We recommend a comprehensive evaluation including neurologic workup, repeat interviews, observation of the defendant at unsuspected times for communicative speech with other inmates, study of handwriting sample, collateral nursing documentation, and, if necessary, Pentothal interviews to establish authenticity of mutism. The authors review the historical background and legal considerations of the relationship between mutism and malingering.

Forensic Psychiatry↗
PubMed1995

The electrodiagnostic examination with hysteria-conversion reaction and malingering.

Electrodiagnostic examination (EDX) can be helpful in assessing patients with hysteria-conversion reaction (H-CR) and malingering. The EDX with both H-CR and malingering are identical, but the electromyographer usually distinguishes one from another based on how the patient responds to the situation. EDX not only can demonstrate that symptoms are probably nonorganic in nature, but also can show that symptoms attributed clinically to H-CR and malingering actually have an organic basis.

Conversion Disorder↗
PubMed1993

Use of biographical and case history data in the assessment of malingering during examination for disability.

This study examine the relationship of biographical and case history data thought to be associated with malingering to known indices of malingering based on MMPI and sentence-completion test data. Subjects were 65 patients who had undergone formal psychiatric evaluations in connection with ongoing litigation over injury-related disability. Biographical/case history data were reduced to six factors, which were correlated with six MMPI and five sentence completion test variables. Of the 66 correlations, 24 were significant, supporting the relevance of biographical and case history data in assessing malingering under these circumstances.

Accidents, Occupational↗
PubMed1995

A clinical investigation of malingering and psychopathy in hospitalized insanity acquittees.

This study compares Psychopathy Checklist-Revised (PCL-R) scores, DSM-III-R diagnoses, and select behavioral indices between hospitalized insanity acquittees (N = 18) and hospitalized insanity acquittees who successfully malingered (N = 18). The malingerers were significantly more likely to have a history of murder or rape, carry a diagnosis of antisocial personality disorder or sexual sadism, and produce greater PCL-R factor 1, factor 2, and total scores than insanity acquittees who did not malinger. The malingerers were also significantly more likely to be verbally or physically assaultive, require specialized treatment plans to control their aggression, have sexual relations with female staff, deal drugs, and be considered an escape risk within the forensic hospital. These findings are discussed within the context of insanity statutes and the relevance of malingering, psychopathy, and treatability to future policy concerning the disposition of insanity acquittees.

Adult↗
PubMed2004

Diagnostic, expanatory, and detection models of Munchausen by proxy: extrapolations from malingering and deception.

OBJECTIVE: The overriding objective is a critical examination of Munchausen syndrome by proxy (MSBP) and its closely-related alternative, factitious disorder by proxy (FDBP). Beyond issues of diagnostic validity, assessment methods and potential detection strategies are explored. METHODS: A painstaking analysis was conducted of the MSBP and FDBP literature as it relates diagnostic and assessment issues. Given the limitations of this literature, extrapolations were provided from the extensive theory and research on malingering as a related response style. RESULTS: Diagnostic formulations for both MSBP and FDBP de-emphasize the clinical characteristics of the perpetrator. In the case of FDBP, inferential judgments about motivation (e.g., adoption of a sick role) are challenging on conceptual and clinical grounds. When explanatory models from malingering are applied, most research has focused pathogenic models, often allied with psychodynamic thought. Finally, clinical methods for the assessment of MSBP and FDBP are not well developed. CONCLUSIONS: Refinements in the conceptualization of MSBP and FDBP can be provided through prototypical analysis. Drawing from malingering research, explanatory models should be expanded to include adaptational and criminological models. Finally, detection strategies for MSBP and FDBP must be formally operationalized and rigorously validated.

Adult↗
PubMed1996

Using multiple objective memory procedures to detect simulated malingering.

The present study evaluated five objective assessment procedures used to detect malingered memory deficits. Twenty students and 20 psychiatric subjects completed the procedures under instructions to malinger and/or try their best. These groups were compared to 20 memory-impaired subjects who completed the procedures under instructions to try their best. While each test was able to correctly classify all of the subjects performing their best and the actual memory-impaired patients, the correct classification rates for experimental-malingerers varied from 5%-85% on the 10 scores derived from the five tests. Combining all of the cutting scores, and using deficient performance on one procedure as the criteria for classification, resulted in a 92.5% hit rate for subjects who were instructed to malinger and a 100% hit rate for the control and memory-impaired subjects who were instructed to try their best.

Adult↗
PubMed1999

Malingering, hysteria, and the factitious disorders.

The arguments contained within this paper take as their starting point the suggestion that malingering is related along three separate continua to the nosological entities of antisocial behaviour, hysteria and the factitious disorders. The paper is both an attempt to show how these continua can be underwritten and at the same time a discussion of the aetiology of the disorders in question. It will be argued that the aetiological accounts of hysteria and the factitious disorders found in the psychiatric literature fail to make room for an account of the nature of the relationships of these disorders with malingering and thereby fail to fulfil the most important constraint on the acceptability of explanations in this area. In discussing the factitious disorders in the light of this constraint it will be suggested that psychodynamic explanations are vacuous and folk-psychological explanations in principle unavailable. With regard to hysteria it will be suggested that an explanatory account which embraces all the required phenomena and accommodates the close relationship of the disorder to malingering must make use of cognitive-psychologically informed account of self-deception which treats hysterical beliefs as beliefs which are formed as a result of a failure to accurately appraise the subjectively available evidence.

Journal Article↗
PubMed1997

The detection of simulated malingering using a computerized priming test.

A word completion priming test was used to differentiate between normal student control subjects and students instructed to malinger. Controls (n = 60) were instructed to do their best, while malingering subjects (n = 60) were instructed to fake a memory deficit for credit and possible financial compensation. Subjects initially rated and completed stems for words that had at least 10 possible completions. Thirty minutes later, subjects rated and completed stems for words that were either uniquely defined by the stem or could only be completed with a variation of the word. Simulated malingerers and controls differed significantly on response latencies (time to produce rated words-time to produce baseline words, 10 second time limit) and priming scores. Discriminant function analyses showed that as high as 92% of the controls could be correctly identified, and 73% of the malingerers could be correctly identified. These results indicate that priming tests can be used in the detection of malingering.

Journal Article↗
PubMed2002

Malingering, coaching, and the serial position effect.

The normal pattern of performance on list-learning tasks is to recall more words from the beginning (primacy) and end (recency) of the list. This pattern is also seen in patients with closed head injury, but malingerers tend to recall less words from the beginning of word lists, leading to a suppressed primacy effect. The present study examined this pattern on both learning trials and delayed recall of the Auditory Verbal Learning Test (AVLT) in 34 persons performing with normal effort, 38 naive malingerers, 33 warned malingerers, and 29 head-injured patients. Both malingering groups had lower scores on the primacy portion of the list during learning trials, while normals and head-injured patients had normal serial position curves. During delayed recall, normals and head-injured patients did better than the two malingering groups on middle and recency portions of the list. Findings suggest that the serial position effect during learning trials may be a useful pattern of performance to watch for when suspicious of malingering.

Journal Article↗
PubMed1999

Comment: Warning malingerers produces more sophisticated malingering.

Warning persons that attempts to malinger on neuropsychological testing will be detected is not an effective way of reducing malingering behavior. Rather, the literature on coaching consistently shows that malingerers who are warned of the presence of symptom validity assessment techniques are able to feign deficits in a less exaggerated and more believable fashion and therefore elude detection. Warning persons about the presence of these techniques reduces the validity and scientific quality of forensic evaluations. Rather than warning persons that they will be caught if they try to malinger, we recommend that persons be told to do their best and that forensic examiners encourage maximum effort, consistent with accepted testing practices and test manual instructions.

Comment↗
PubMed1998

A comparison of four tests of malingering and the effects of coaching.

This study examined the ability of four measures of suboptimal performance to correctly classify four groups of subjects (normal controls, uncoached malingering, coached malingering, and head injured). Only the Portland Digit Recognition Test-Computerized (PDRT-C) identified simulating malingerers with greater than chance accuracy while minimizing false positives. Coached subjects were better able than their uncoached counterparts to avoid detection on all measures. In an additional analysis, a discriminant function using the response latency and total correct scores from the PDRT-C identified 70% of the coached malingerers on cross validation. The three other tests (Nonverbal Forced Choice Test, 21-Item Test, and Dot Counting Test) failed to obtain a satisfactory classification rate for the malingering groups as a whole and coached malingerers in particular.

Journal Article↗
PubMed1994

Neuropsychological assessment and malingering: a critical review of past and present strategies.

In recent years, neuropsychologists and clinical psychologists have shown a greatly increased interest in methods of discriminating malingerers from legitimate psychiatric and neurological patients. In part, this increased interest has resulted from increased demand from the legal system (i.e., pertaining to disposition of personal injury, worker's compensation, medical malpractice, and criminal cases) for expert psychological testimony which can distinguish malingering from genuine neuropsychological deficits. Additional interest, and some controversy, has been generated by recent research studies that have reported no success in diagnosing malingering, although others have reported more positive evidence. The present literature review describes the historical and current methods of detecting malingerers, along with the empirical evidence supporting, or condemning, their use. The majority of empirical studies suggest that although malingering of brain dysfunction is not easy to detect, it is possible to detect, if looked for deliberately. Review and critique of the available strategies indicates that a multidimensional, multimethod approach is needed. Continued research effort is needed on this important clinical issue.

Journal Article↗
PubMed1997

A pilot study of the Personality Assessment Inventory (PAI) in corrections: assessment of malingering, suicide risk, and aggression in male inmates.

Provision of mental health services to correctional populations places considerable demands on clinical staff to provide efficient and effective means to screen patients for severe mental disorders and other emergent conditions that necessitate immediate interventions. Among the highly problematic behaviors found in correctional settings are forms of acting out (e.g., suicide and aggression towards others) and response style (e.g., motivations to malinger). The current study examined the usefulness of the Personality Assessment Inventory (PAI) in assessing problematic behaviors in a corrections-based psychiatric hospital. As evidence of criterion related validity, selected PAI scales were compared to (a) evidence of malingering on the Structured Interview of Reported Symptoms (SIRS), (b) suicidal threats and gestures, and (c) ratings of aggression on the Overt Aggression Scale (OAS). In general, results supported the use of the PAI for the assessment of these problematic behaviors.

Adult↗
PubMed1990

The detection of malingering in neuropsychological assessment.

Although malingering, or the manipulation of data by the patient, is a problem commonly faced by neuropsychologists, there has been little systematic investigation of this problem. This paper reviews the literature on the detection of malingering in assessment instruments commonly used by clinical neuropsychologists. Criticism of previous research is discussed, and suggestions are made both for future research and for clinical practice.

Brain Damage, Chronic↗
PubMed1996

Practical guidelines in the use of symptom validity and other psychological tests to measure malingering and symptom exaggeration in traumatic brain injury cases.

The detection of malingering or symptom exaggeration has become an essential component in forensic neuropsychological evaluations, particularly in cases involving personal injury claims. Symptom Validity Tests refer to those measures that can be utilized to detect test performance that is so poor that it is below the level of probability, often times even among brain-damaged populations. This article outlines legal standards for expert testimony in regard to forensic neuropsychological personal injury evaluations. The article provides an outline of specific Symptom Validity Tests and Indicators, and reviews literature supporting test sensitivity and validity. In addition, the use of symptom checklists and questionnaires is discussed, as well as the appropriate use of Symptom Validity Tests and Indicators to establish the presence or absence of malingering or symptom exaggeration.

Brain Injuries↗
PubMedDate not supplied

Ocular malingering and hysteria: diagnosis and management.

Confronted with a claim of poor vision in the absence of any apparent pathology, the ophthalmologist must consider the possibility that the patient is malingering or hysterical. The authors define four categories of such patients, and recommend diagnostic approaches for each. Specific diagnostic tests are described, as are methods of managing patients once the diagnosis of malingering or hysteria has been made.

Evoked Potentials↗