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At least 19 recordsLinked to original sources
PubMedDate not supplied

On the diagnosis of malingered pain-related disability: lessons from cognitive malingering research.

BACKGROUND CONTEXT: Pain-related disability is a complex phenomenon. Malingering is a potential factor in the management of patients with pain. Methodological problems and inappropriate expectations regarding diagnostic accuracy have hampered the study of malingering detection in pain. In contrast, the study of cognitive malingering in neuropsychology has led to the development of many highly accurate and reliable detection techniques. This paper applies the methods and logic that have been successful for identifying cognitive malingering to the problem of malingering in patients with pain. PURPOSE: Outline the logic of a research methodology for studying malingering detection in pain and introduce a system for the diagnosis of malingering in pain. STUDY DESIGN: Literature review and conceptual synthesis. METHODS: Examination of the research methodology and diagnostic scheme used in the study of cognitive malingering; adaptation of these methods to the problem of malingering in pain. RESULTS: Lessons derived from the study of cognitive malingering were used to generate recommendations to enhance research into detection and diagnosis of malingered pain-related disability. A comprehensive, multidimensional system for diagnosing malingering in pain-related disability was proposed. CONCLUSIONS: Pain-related disability is a multifaceted phenomenon, therefore malingering can occur in different and sometimes multiple dimensions. It is presently possible to accurately detect and diagnose malingering in some patients with pain. More work is needed for some detection techniques to be appropriately calibrated in pain populations. This work must focus on controlling the false positive error rate.

Attitude to Health↗
PubMed2002

Cross-validation of indicators of malingering: a comparison of nine neuropsychological tests, four tests of malingering, and behavioral observations.

Few studies to date have cross-validated indicators of malingering that have been suggested on various neuropsychological tests. This study presents data cross-validating several indicators of malingering on neuropsychological tests, as well as on tests of malingering and via behavioral observations. It incorporates methodological recommendations by Rogers [Researching dissimulation. In: R. Rogers (Ed.), Clinical assessment of malingering and deception (pp. 309-327). New York: Guilford Press.] resulting in an ecologically valid design utilizing college students with a history of mild head injury as analog malingerers. Results indicated that the Letter Memory Test (LMT) and the Digit Memory Test (DMT) attained the highest hit rates for the detection of malingering, while the sensitivity of many other measures declined on cross-validation.

Journal Article↗
PubMed2004

Application of clinically-derived malingering cutoffs on the California Verbal Learning Test and the Wechsler Adult Intelligence Test-Revised to an analog malingering study.

This study examined the comparability of the California Verbal Learning Test (CVLT) and subtests of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) in clinically identified malingerers and undergraduates instructed to malinger in an analog design. Cutoffs on these measures were derived from various clinical samples of identified malingerers and were applied to these simulating malingerers to distinguish them from controls. Simulating malingerers performed significantly more poorly than controls on both tests and clinically derived cutoffs accurately discriminated between groups. As compared to the clinically-based findings from which these cutoffs were derived, sensitivity (detection of simulating malingering) tended to be lower, specificity (detection of not malingering) tended to be higher, but the overall classification rate was only slightly lower. These findings were consistent across the CVLT and subtests of the WAIS-R, several different sets of clinically derived cutoffs, and two base rates. Reasons for this pattern of findings are discussed, as are implications of the similarity between clinical and analog studies of malingering.

Adult↗
PubMed1984

Malingering and malingering-like behavior: some clinical and conceptual issues.

Malingering phenomena are reconceptualized along a continuum of other-deceptive, and "malingering-like" mixed-deceptive and self-deceptive categories, depending upon the degree of the subject's conscious self-awareness. This schema heuristically expands the malingering concept to include its multivaried range of clinical presentations which are ubiquitously encountered but underdiscussed in the literature.

Adaptation, Psychological↗
PubMed1997

Detection of malingering: validation of the Structured Inventory of Malingered Symptomatology (SIMS).

This article discusses the development and validation of a paper and pencil screening measure, the Structured inventory of Malingered Symptomatology (SIMS), designed to detect malingering. Test items were constructed from a combination of revised validity questions from existing instruments and characteristics of malingerers noted by existing research. Items were organized on one of five subscales by experienced clinical psychologists. College students (N = 476) were assigned to one of seven simulation conditions (i.e., psychosis, amnesia, neurologic impairment, mania, depression, low intelligence, and "fake bad") or an honestly responding group. All subjects were administered the SIMS, the F and K scales of the MMPI, 16PF Faking Bad scale, and portions of the malingering scale. The SIMS total score demonstrated the highest sensitivity rating (95.6%) for detection when compared with the other validity indices. Suggestions concerning further research using the SIMS as well as its potential utility in a complete evaluation process are discussed.

Adult↗
PubMed2006

Do tests of malingering concur? Concordance among malingering measures.

Malingering test accuracy is increasingly a major issue in psychology and law. Integrating results across measures might offset limitations of a single test, but the practical benefits of using several tests depend on the extent to which they misclassify the same individuals. Data from 66 evaluatees were used to assess the degree of overlap and consistency of classification among several commonly used malingering instruments. Although correlative data indicated that measures were highly redundant even across symptom domains, classification accuracy analyses revealed that findings based on conjunctions of these scales may not overlap to the degree that the correlations might suggest.

Data Collection↗
PubMed1999

Utility of the structured inventory of malingered symptomatology in identifying persons motivated to malinger psychopathology.

The Structured Inventory of Malingered Symptomatology (SIMS) is one of a number of recently developed instruments designed to identify persons exaggerating and/or fabricating psychiatric and cognitive symptomatology. Preliminary analog research indicated that the SIMS showed some promise as a screening device for identifying malingerers. This study examined the utility of the SIMS for identifying malingerers and, more importantly, its ability to distinguish truly symptomatic persons from persons fabricating symptomatology. In a sample of 197 participants who completed the SIMS and Symptom Checklist-90-Revised (SCL-90-R) under both honest and malingering instructional sets, sensitivity and specificity rates were generally high for the SIMS Total score and subscales. However, moderate correlations with the SCL-90-R were obtained in this sample, and specificity rates were lowest among a subset of participants reporting clinically significant levels of distress; both findings raise concerns regarding the potential for high false positive rates among clinical populations. Implications for clinical forensic practice are discussed and recommendations for future research are offered.

Adult↗
PubMed2003

Diagnostic accuracy of the Structured Inventory of Malingered Symptomatology (SIMS) in detecting instructed malingering.

This article addresses the psychometric properties of the Dutch translation of the Structured Inventory of Malingered Symptomatology (SIMS) when administered to undergraduate psychology students as well as psychiatric inpatients. Findings show that this SIMS version possesses good test-retest reliability and internal consistency. Also, simulation findings indicate that undergraduate students instructed to simulate pathology display higher SIMS scores than either normal controls or psychiatric inpatients. Data pooled over several samples (n=298) yielded sensitivity, specificity, and positive predictive power (PPP) rates that were all relatively high (>/=0.90). All in all, our findings provide a basis for cautious optimism regarding the usefulness of the SIMS as a screening tool for malingering.

Adult↗
PubMed2003

Attitudes towards malingering: a study among general practitioners and mental health officers in the military.

OBJECTIVE: The authors assessed the attitudes of military physicians and mental health officers regarding the phenomenon of malingering. METHOD: Questionnaires on attitudes regarding malingering and possible cues indicative of deception were sent to 115 general practitioners (GPs) and mental health officers (MHOs) in the Israel Defense Forces (IDF). RESULTS: 91 responses were received--a response rate of 80%. All the respondents claimed that they had seen cases of malingering. They estimated that every fourth soldier is malingering. GPs claimed that they had seen more cases of malingering as compared to MHOs. Those who estimated that malingering is very frequent in the military, also had higher estimates of malingering in their civil work. The most indicative clues of malingering among soldiers were inconsistency, flamboyant complaints, exaggeration of symptoms and accentuation of secondary gain. CONCLUSIONS: Among IDF GPs and MHOs, there currently appears to be moderate consensus regarding the frequency of malingering and its characteristic signs. The study provides further support to the notion that malingering is an important clinical phenomenon. We believe that the issue merits further research and scrutiny.

Attitude of Health Personnel↗
PubMed1993

Defrocking the fraud: the detection of malingering.

The purpose of this paper is to provide psychiatrists with practical advice on how to detect malingered mental illness. Various types of malingering are defined and the five major purposes of malingering are specified. The research literature on malingering is reviewed. Clinicians must be thoroughly grounded in the phenomenology of true mental disease to detect malingering. Detailed information about hallucinations is reviewed so that faked hallucinations that do not follow typical patterns can be more easily identified. Strategies for approaching persons suspected of malingering are suggested. Features of malingered mutism, mania, depression and mental retardation are described. The differential diagnosis of malingering, post-traumatic stress disorder, conversion disorder, and post-concussion syndromes after trauma is discussed. Clues to malingered psychoses and post-traumatic stress disorders are delineated. Finally, specific indicators of malingered insanity defenses are identified.

Depressive Disorder↗
PubMedDate not supplied

Pain, malingering and the WAIS-III Working Memory Index.

BACKGROUND CONTEXT: Pain patients often report cognitive symptoms, and many will include them in their claims of disability. There is empirical evidence that patients with pain do experience problems on attention-demanding cognitive tasks, but the results are mixed and the potential impact of exaggeration in the context of pain-related litigation has not been addressed. PURPOSE: 1) Examine the impact of pain and malingering on attention; 2) determine if the Working Memory Index (WMI) of the Wechsler Adult Intelligence Scale-3 (WAIS-III) can reliably detect malingering. STUDY DESIGN/SETTING: Study 1: simulator design; Study 2: clinical known-groups design. PATIENT SAMPLE: Study 1 used healthy college students; Study 2 used chronic pain patients and neurological patients. OUTCOME MEASURES: The WMI and its constituent subtests. METHODS: Study 1: College students were administered the WMI under three conditions: standard administration, with cold-pressor induced pain, or with instructions to simulate impairment due to pain. Study 2: Known-groups design in which the WMI was examined in non-malingering and definite malingering chronic pain patients, non-malingering moderate-severe traumatic brain injury, and memory disorder patients seen for routine psychological evaluation. Malingering was operationalized using published criteria. RESULTS: There were no group differences in WMI or its subtests among non-malingering groups, but some individual clinical patients with pain did score at a level suggestive of attentional impairment. The lowest scores were found in the simulated malingering college students and definite malingering clinical pain groups, in which about half scored worse than 95% of the non-malingering clinical patients. CONCLUSIONS: This study demonstrated that even when controlling for exaggeration some pain patients do exhibit problems with attentional function. However, significant impairment in WMI performance (eg, index score<or=70), particularly in the absence of brain dysfunction, cannot reasonably be attributed to the effects of either acute or chronic pain, even at moderate to severe levels, and likely reflects intentional exaggeration.

Adaptation, Psychological↗
PubMed2003

Daubert, cognitive malingering, and test accuracy.

Daubert v. Merrell Dow Pharmaceuticals (1993) held that trial judges should permit expert scientific testimony only when "the reasoning or methodology underlying the testimony is scientifically valid, and ... properly can be applied to the facts in issue." Vallabhajosula and van Gorp ("V & vG," 2001) have suggested that when the Daubert standard is applied to tests for malingered cognitive deficits, courts should deem admissible only results that meet this mathematical standard: assuming a pretest probability of .3, a "positive" score on the malingering test should yield a posttest probability of at least .8. This paper shows that V & vG's criterion may lead to misunderstandings about the kind of information maligering measures provide. After reviewing cases that have discussed both the Daubert decision and malingered cognitive deficits, this paper uses data from the Test of Memory Malingering (T.N. Tombaugh, 1996) to provide a general characterization of the mathematical properties of malingering measures. The paper then describes how pretest knowledge about malingering is combined with knowledge about a test's performance to generate a posttest probability of malingering. The results can help mental health experts respond to Daubert-inspired challenges to conclusions based on malingering measures.

Bayes Theorem↗
PubMed1997

The malingering of multiple sclerosis and mild traumatic brain injury.

In this investigation, neuropsychological testing was conducted with 69 college students that were instructed to malinger either multiple sclerosis (MS) or traumatic brain injury (TIB) or were non-malingering controls. The two malingering groups were divided into informed and non-informed groups. The informed groups received information concerning their respective condition, and the non-informed groups were asked simply to malinger. Generally, all malingering groups performed considerably below the levels of non-malingering controls on measures of attention, learning and memory, word fluency, abstract reasoning, visuoconstruction and manual dexterity. There appeared to be no difference in the manner in which subjects attempted to malinger MS as opposed to TBI. However, the severity of the portrayed deficit suggested by the test scores was disproportionate to the severity of the injury being requested. The pattern of deficit presented was quite global, with well below average performance demonstrated by all malingering groups across all domains.

Adolescent↗
PubMedDate not supplied

Malingering pain in the medicolegal context.

Malingering--the willful, deliberate, and fraudulent feigning or exaggeration of illness--was originally described as a means of avoiding military service. In present-day clinical practice, malingering may occur in circumstances where the person wishes to avoid legal responsibility or in situations where compensation or some other benefit might be obtained. In law, the term malingering is used in relation to persons to whom military regulations apply; in other situations, malingering is regarded as fraud and may lead to charges of perjury or criminal fraud. Assertions that an individual is malingering are particularly common in clinical settings where the complaint is of a subjective nature and is not accompanied by objectively demonstrable organic abnormalities. This may occur in relation to complaints of pain in situations where the person is entitled to receive pain-contingent compensation or is suing for damages. In this article, we will review the literature on pain and malingering and discuss attempts that have been made to develop methods and guidelines for the detection of malingered pain. There are, however, no valid clinical methods of assessment of possible malingering of pain. In our view, the ultimate issue of the veracity of the plaintiff is for the Court to decide, and epithets such as "malingerer" have no place in reports prepared for legal purposes by health care professionals.

Disability Evaluation↗
PubMed1998

Cognitive complaints in patients after whiplash injury: the impact of malingering.

OBJECTIVES: The validity of memory and concentration complaints that are often reported after a whiplash trauma is controversial. The prevalence of malingering or underperformance in post-whiplash patients, and its impact on their cognitive test results were studied. METHODS: The Amsterdam short term memory (ASTM) test, a recently developed malingering test, was used as well as a series of conventional memory and concentration tests. The study sample was a highly selected group of patients, who were examined either as part of a litigation procedure (n=36) or in the normal routine of an outpatient clinic (n=72). RESULTS: The prevalence of underperformance, as defined by a positive score on the malingering test, was 61% (95% CI: 45-77) in the context of litigation, and 29% (95% CI: 18-40) in the outpatient clinic (p=0.003). Furthermore, the scores on the memory and concentration test of malingering post-whiplash patients (n=43) and non-malingering post-whiplash patients (n=65) were compared with the scores of patients with closed head injury (n=20) and normal controls (n=46). The malingering post-whiplash patients scored as low as the patients with closed head injury on most tests. CONCLUSIONS: The prevalence of malingering or cognitive underperformance in late post-whiplash patients is substantial, particularly in litigation contexts. It is not warranted to explain the mild cognitive disorders of whiplash patients in terms of brain damage, as some authors have done. The cognitive complaints of non-malingering post-whiplash patients are more likely a result of chronic pain, chronic fatigue, or depression.

Adult↗
PubMed1998

Malingering assessment in behavioral toxicology: what, why, and how.

Neurobehavioral assessment is frequently made in a forensic context. The cognitive assessment may be biased due to an international manipulation of data by the patient motivated by attainment of compensation, that is, malingering. Although malingering is highly relevant in behavioral toxicology, the issue and its assessment are underrepresented in the literature. A routine assessment of malingering is important to reduce false-positive and false-negative errors in assessment, thereby establishing the credibility and validity of behavioral assessment. In the long run, the routine inclusion of malingering measurements might reduce claims and encourage employers to be more cooperative in behavioral toxicology studies. Guidelines for malingering assessment and research, inferred from the clinical and research literature, are discussed. Sensitivity to the problematic issues involved in assessing malingering behavior is an important step toward malingering detection in the clinical setting and to the establishment of assessment methods that are less confounded by these issues.

Behavior↗
PubMed2006

Psychopathy and malingering of psychiatric disorder in criminal defendants.

Because the use of deception is an important clinical characteristic of psychopathy, there is intuitive appeal to the idea that psychopathy and malingering are associated. There is, however, very little research showing that psychopaths are more likely to malinger. We classified a sample of criminal defendants as high, moderate, or low in psychopathy, based on PCL-R scores, and compared their scores on indices typically used to detect malingering on the MMPI-2, the PAI and the SIRS. The high psychopathy group scored significantly higher on the MMPI-2 F and F-K; the PAI NIM, and the SIRS, but not the MMPI-2 Fb, F(p), or the PAI RDF or Mal, lending some support for the DSM-IV recommendation that malingering should be considered whenever there is a diagnosis of antisocial personality disorder. Logistic regression analysis (LGA) revealed that Factor I but not Factor II of the PCL-R significantly discriminated malingerers from nonmalingerers with 75% correct classification. However, receiver operating characteristic (ROC) analysis revealed that psychopathy ratings had poor sensitivity and specificity in the detection of malingering. Calculation of the percentages of those exceeding accepted cut-offs on each of the malingering measures revealed that a high percentage of severe psychopaths did not attempt to feign psychiatric disorder. The results suggest that psychopathy is not a clinically useful indictor of malingering. The results are discussed in terms of confirmatory bias and the impact such a bias could have on the evaluation of criminal defendants.

Adult↗
PubMed1999

How well do standard clinical neuropsychological tests identify malingering? A preliminary analysis.

Neuropsychological research has primarily focused on identification of malingerers through specialized tests designed for this purpose. Little attention has been given to the degree to which traditional clinical measures differentiate between malingerers and non-malingerers. This study examined the neuropsychological performance of 81 subjects who had a history of mild to moderate head injury, some of whom are believed to have been motivated to malinger their test performance. Subjects were classified as malingerers or non-malingerers based on their history as well as their performance on specific neuropsychological malingering tests. Performance on traditional neuropsychological clinical measures was examined for both groups. Results indicated that subjects' pattern of neuropsychological performance was not a reliable indicator of malingering performance, supporting the notion that specialized malingering tests are a critically necessary component to clinical classification of malingering. However, level of performance may provide an indication of malingering, as probable malingerers consistently performed worse on traditional and clinical neuropsychological measures. These findings are discussed in the context of the malingering literature.

Adult↗