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PubMed2005

Detection and diagnosis of malingering in electrical injury.

This paper sought to demonstrate that diagnosable malingering does occur in Electrical Injury (EI) and examine the relationship of malingering to potential indicators of the presence and severity of neurological injury. Eleven consecutive EI patients seen for neuropsychological evaluation were presented. Over half the patients met the Slick et al. (1999) criteria for at least Probable MND. Most of the MND patients lacked evidence of a biologically meaningful exposure to electrical current. These findings highlight the importance of considering biological markers of neurological injury and of non-neurological factors, including effort/malingering, in the study of the neurocognitive consequences of EI.

Adult↗
PubMed2005

Performance of forensic and non-forensic adult psychiatric inpatients on the Test of Memory Malingering.

This study compared performance on the Test of Memory Malingering (TOMM [Tombaugh, T. N. (1996). Test of Memory Malingering (TOMM). New York: Multi Health Systems]) between a Forensic Psychiatric group and a Non-forensic Psychiatric group of 20 men each. It was hypothesized that the Forensic group would perform less well on the TOMM due to greater secondary gain for that population. The Forensic group (age, M=32.65 years; 16/20 were minorities) was composed of inpatients from a forensic psychiatric facility who had been referred for pre-trial evaluations. The Psychiatric group (age, M=41.00 years; 15/20 were Caucasian) were chosen from an inpatient psychiatric facility and had no pending legal involvement. As hypothesized, the Psychiatric group performed significantly better than the Forensic group on all TOMM trials. A TOMM score of below 45 on Trial 2 or the Retention Trial is consistent with probable response bias. Only one member of the Psychiatric group (the same individual) met this criterion, whereas seven members of the Forensic group met this criterion. The TOMM identified patients with pending legal charges as more likely to exert less effort than those with no obvious secondary gain.

Adult↗
PubMed2006

Wide-complex tachycardia as the presenting complaint in a case of malingering.

Fabrications of lethal dysrhythmias are an extremely rare manifestation of malingering, with only one case described more than two decades ago. Recognition of this clinical entity is important because the diagnosis may be difficult to make, therapeutic implications for the patient are significant, and financial consequences of misdiagnosis are considerable. In this case report, we present an unusual example of malingering, in which a patient intentionally mimicked repeated episodes of unstable wide-complex ventricular tachycardia, by tapping on the chest wall cardiac leads, while feigning concurrent episodes of chest pain.

Adult↗
PubMed2004

The Test of Memory Malingering (TOMM): normative data from cognitively intact, cognitively impaired, and elderly patients with dementia.

This research adds to the psychometric validation of the Test of Memory Malingering (TOMM) by providing data for samples of elderly patients who are cognitively intact, cognitively impaired (non-dementia), and with dementia. Subjects were 78 individuals referred for evaluation of memory complaints. Significant group differences emerged between the dementia group and the two other groups (normals and cognitively impaired), although the latter two did not differ from each other. One hundred percent of normals and 92.7% of the cognitively impaired group made fewer than five errors (the suggested cut-off) on Trial 2 or the Retention trial of the TOMM, yielding an overall correct classification rate of 94.7%. However, the rate of misclassification for persons with dementia was high whether using a cut-point score of five, eight, or ten errors. This investigation extends the validity and clinical utility of this instrument. Results suggest that the TOMM is an useful index for detecting the malingering of memory deficits, even in patients with cognitive impairment, but only when dementia can be ruled out.

Activities of Daily Living↗
PubMed2003

Is the emotional Stroop paradigm sensitive to malingering? A between-groups study with professional actors and actual trauma survivors.

Six professional actors, trained by psychologists and acting coaches to feign PTSD, were covertly enrolled into a treatment outcome study for PTSD with the aim of investigating malingering. During pretreatment assessment, individuals completed an emotional Stroop task. Vocal response latencies to different classes of stimuli were examined for sensitivity to malingering. Actor response latencies were compared to those of 6 nonlitigant PTSD patients and 6 nonanxiety controls. The actor/dissimulation group was able to feign an overall slowing of response latency across stimulus types, similar to the PTSD group. However, they were unable to modulate response latency as a function of stimulus content, a pattern that characterized the PTSD group. The use of information-processing paradigms to detect dissimulation is discussed.

Adolescent↗
PubMed1998

Screening for malingering in a correctional setting.

This study outlines the development of the Screening SIRS, an abbreviated version of the Structured Interview of Reported Symptoms (SIRS), for use as a screening measure of malingering in a correctional setting. Seventy-five inmates complaining of psychological impairment were tested for malingering. A subset of the participants was given both the original SIRS and the Screening SIRS as a separate test with the test order counterbalanced; the remainder were given the original SIRS and a derived classification was determined by extracting the Screening SIRS scale scores. Using Receiver Operating Characteristic analyses, classification based on the Screening SIRS was significantly better than chance. With a sensitivity of 87% and specificity of 73%, the Screening SIRS was highly predictive of classifications based on the original SIRS. These findings have instrumental implications in correctional settings where identification of possible malingerers through a screening procedure may facilitate optimal allocation of resources.

Adolescent↗
PubMed1990

Neuropsychology and malingering: comment on Faust, Hart, and Guilmette (1988)

Faust, Hart, and Guilmette (1988) recently reported on the inability of neuropsychologists to detect malingering in children who were asked to "fake bad" on a battery of neuropsychological measures. Because of methodological issues, implications of their research are not generalizable to the actual clinical setting. Limitations of the questionnaire format in detecting factitious results are discussed along with the inherent bias of such a research design to overinterpret pathology. The competency of the clinical neuropsychologist judges and their selection process are questioned. Last, some guidelines are offered for future research dealing with the issue of detection of malingering in neuropsychological practice.

Child↗
PubMed1990

To say it's not so doesn't prove that it isn't: research on the detection of malingering. Reply to Bigler.

Research that directly examines clinicians' capacity to detect malingering creates doubt about their success in this endeavor and about confident self-appraisals of detective abilities. We argue that Bigler's counterassertions lack supportive evidence or conflict with research on such topics as clinicians' level of training and experience and their judgmental accuracy. We further note that lack of both base rate information and definitive outcome information compound doubts about clinicians' capacity to detect malingering.

Child↗
PubMed2000

Detection of coached general malingering on the MMPI-2.

The current study examined the effects of validity-scale coaching on one's ability to feign general psychopathology. College students were coached on malingering strategies and completed the MMPI-2. Their responses were compared with students asked to malinger psychopathology without validity-scale coaching and with psychiatric inpatients completing the MMPI-2 under standard instructions. In accordance with previous research (e.g., J. R. Graham, D. Watts, & R. E. Timbrook, 1991), uncoached malingerers were adequately discriminated from patients by using the Infrequency (F) scale. However, as suggested by previous research (R. Rogers, R. M. Bagby, & D. Chakraborty, 1993), the F scale was not as effective at classifying coached malingerers. It was found that other validity indicators, such as the Infrequency Psychopathology Scale were more accurate at discriminating between coached malingerers and hospitalized patients.

Adolescent↗
PubMed2002

Screening for feigned psychiatric symptoms in a forensic sample by using the MMPI-2 and the structured inventory of malingered symptomatology.

Fifty-five men undergoing pretrial psychological evaluations for competency to stand trial or criminal responsibility in the federal justice system were administered the Structured Interview of Reported Symptoms (SIRS), the Minnesota Multiphasic Personality Inventory--2 (MMPI-2), and the Structured Inventory of Malingered Symptomatology (SIMS). On the basis of results from the SIRS, 31 were classified as honest responders and 24 as feigning. Significant differences between the 2 groups were found on all SIMS scales as well as on all tested MMPI-2 fake bad validity scales. The SIMS total score and the MMPI-2 Backpage Infrequency (Fb) scale had relatively high negative predictive power (100% and 92%, respectively). On the basis of this clinically relevant methodology, both tests have potential usefulness as screens for malingering.

Adult↗
PubMed2006

Screening for malingering in a criminal-forensic sample with the personality assessment inventory.

In this study, the authors examined how overreporting of psychopathology indices on the Personality Assessment Inventory (PAI; L. C. Morey, 1991) performed as screening measures for malingering in a sample of 166 defendants undergoing pretrial court-ordered evaluations in the federal criminal justice system. Using results from the Structured Interview of Reported Symptoms (SIRS; R. Rogers, R. M. Bagby, & S. E. Dickens, 1992) as the criterion measure of malingering, the authors found that the Negative Impression scale (NIM) was the most effective PAI screening measure (cut score > or = 81 T). NIM performed as well as an established comparison measure from the Minnesota Multiphasic Personality Inventory--2 (J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 1989; Infrequency [F] cut score > or = 95 T), supporting the use of either of these indices as reasonable screening measures to identify potential malingerers for subsequent evaluation.

Adult↗
PubMed1999

Diagnostic criteria for malingered neurocognitive dysfunction: proposed standards for clinical practice and research.

Over the past 10 years, widespread and concerted research efforts have led to increasingly sophisticated and efficient methods and instruments for detecting exaggeration or fabrication of cognitive dysfunction. Despite these psychometric advances, the process of diagnosing malingering remains difficult and largely idiosyncratic. This article presents a proposed set of diagnostic criteria that define psychometric, behavioral, and collateral data indicative of possible, probable, and definite malingering of cognitive dysfunction, for use in clinical practice and for defining populations for clinical research. Relevant literature is reviewed, and limitations and benefits of the proposed criteria are discussed.

Cognition Disorders↗
PubMed2001

Identification of malingered head injury on the wechsler adult intelligence scale - 3rd edition.

Head injured patients show an IQ subtest pattern that can be discriminated from the profile produced by individuals who attempt to malinger intellectual decline due to head trauma. The current paper demonstrates that previously replicated methods for making this discrimination on the WAIS - R generalize to the WAIS - 3. The discriminant function equation accurately classified 83% of nonlitigating head-trauma patients with documented injuries and 72% of persons simulating intellectual impairment due to head trauma. A total of 45% of litigating mild head-trauma patients with purported intellectual decline but no documented loss of consciousness, hospitalization, or CT abnormality were classified as malingering by the discriminant function. A Vocabulary-Digit Span difference score provided 71% overall diagnostic accuracy, and may be informative when screening profiles by visual inspection or when complete WAIS - 3 results are unavailable.

Adult↗
PubMed2002

Detecting malingered performance with the Wisconsin card sorting test: a preliminary investigation in traumatic brain injury.

The present study examined the classification accuracy of four potential Wisconsin Card Sorting Test malingering indicators (Bernard and Suhr formulas and two types of Unique responses). Participants were 89 traumatic brain-injury (TBI) patients assigned to malingering and nonmalingering groups on the basis of the Slick, Sherman, and Iversion (1999) criteria. Individual Sensitivities were greater than .33 with acceptable Specificity. Combined Sensitivity for two of the indicators was greater than.60. Overall, this study demonstrated three distinct approaches to the WCST used by probable malingerers. The clinical relevance of these findings and directions for future research are discussed.

Adult↗
PubMed2003

Detection of malingering using atypical performance patterns on standard neuropsychological tests.

Cut-off scores defining clinically atypical patterns of performance were identified for five standard neuropsychological and psychological tests: Benton Visual Form Discrimination (VFD), Fingertapping (FT), WAIS-R Reliable Digit Span (RDS), Wisconsin Card Sorting Failure-to-Maintain Set (FMS), and the Lees-Haley Fake Bad Scale (FBS) from the MMPI-2. All possible pair-wise combinations of scores beyond cut-off (e.g., for VFD and FT; for RDS and FBS), correctly identified 21 of 24 subjects (87.5%) meeting criteria for definite malingered neurocognitive dysfunction, and 24 of 27 (88.9%) subjects with moderate to severe closed head injury. On cross-validation, 15 of 17 subjects (88.2%) meeting criteria for probable malingered neurocognitive dysfunction were correctly identified, with 13 of 13 nonlitigating neurologic patients, and 14 of 14 nonlitigating psychiatric patients correctly classified as having motivationally-preserved performance. Combining the derivation and cross-validation samples yielded a sensitivity of 87.8%, specificity of 94.4%, and combined hit rate of 91.6%.

Adolescent↗
PubMed2003

Definite malingered neurocognitive dysfunction in moderate/severe traumatic brain injury.

There has been disagreement in the literature about whether persons with documented neuropathology can be diagnosed as malingering. To address this question, we present three moderate severe traumatic brain injury patients who were evaluated in the context of litigation who met the Slick, Sherman, and Iverson (1999) criteria for a diagnosis of "Definite Malingered Neurocognitive Dysfunction." Each performed significantly below-chance on at least one forced-choice symptom validity test, thereby demonstrating a deliberate attempt to appear impaired. These cases represent the first definitive evidence of an intentional effort to appear impaired in the context of documented moderate/severe traumatic brain injury.

Adult↗
PubMed2005

Derived trail making test cutoffs and malingering among substance abusers.

The Trail Making test (TMT) is often used to screen for cognitive impairment in substance abusers. A possible limitation of the TMT in clinical settings is that substance abusers may malinger and give poor effort. Data from the Drug Abuse Treatment Outcome Study (DATOS) were analyzed to develop derived TMT cutoffs. Data were analyzed to determine number of substance abusers that fell beyond the upper end of the distribution of selected derived TMT scores at the 10, 5, and 1 percentiles. These percentiles were set for alcoholics (n = 1000), cocaine abusers (n = 4306), and heroin abusers (n = 1548) for TMT selected derived scores. Inspection of the selected TMT derived scores yielded an impression that the percentile values for the 3 sub-samples of primary drugs of abuse, alcohol, cocaine, and heroin, are actually very similar at each of the 3 percentile levels. This would suggest that these estimates are actually quite stable and reinforces the notion that they may be creditable estimates. The proper use of the derived TMT cutoff scores is to alert clinicians to the increasingly higher probability of poor effort when a substance abuser in one of the three groups scores beyond the one percent cutoff for the primary drug of abuse sample. Clearly, the use of these cutoffs needs further empirical validation before they would be considered as a single source to suggest malingering. Great caution is suggested in using these cutoff scores for clinical purposes with substance abusing patients in their current state of validation. In short, further research is warranted.

Adolescent↗
PubMed1989

Refining the forced-choice method for the detection of malingering.

For seven years following head trauma, a 45-year-old restaurant owner had claimed that he was unable to work because of impaired memory. A specially designed forced-choice memory test yielded performance significantly below the chance level and thus indicated malingering. This case illustrates some means of increasing the utility of forced-choice malingering tests.

Accidents, Occupational↗