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Topics in Assessment of Malingering



1: Psychiatr Clin North Am. 2007 Dec;30(4):645-62.Read full text article.

Malingering in the medical setting.

University of California, Davis School of Medicine, Department of Psychiatry and Behavioral Sciences, Division of Psychiatry and the Law, 2230 Stockton Blvd, 2nd Floor, Sacramento, CA 95817, USA.

Malingering of mental illness has been studied extensively; however, malingered medical illness has been examined much less avidly. While in theory any ailment can be fabricated or self-induced, pain--including lower back pain, cervical pain, and fibromyalgia--and cognitive deficits associated with mild head trauma or toxic exposure are feigned most frequently, especially in situations where there are financial incentives to malinger. Structured assessments have been developed to help detect both types of malingering; however, in daily practice, the physician should generally suspect malingering when there are tangible incentives and when reported symptoms do not match the physical examination or no organic basis for the physical complaints is found.

PMID: 17938038 [PubMed - in process]


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1: J Consult Clin Psychol. 1996 Dec;64(6):1425-30.Read full text article.

Assessing dissimulation among Social Security disability income claimants.

Department of Psychology, Occidental College, Los Angeles, California 90041, USA.

Social Security disability income programs have been tested by increasingly politicized concerns regarding widespread fraud among claimants. This study was an initial investigation of malingering among claimants in Los Angeles seeking disability income on psychological grounds. After a review of 100 disability income applications, a population-appropriate instrument was developed from established psychometric indices of malingering. The Composite Disability Malingering Index was completed by 167 disability claimants (possible malingerers), a sex, age and IQ cognate group of 63 psychologically disabled individuals without incentive to malinger (disabled nonmalingerers), and 45 disability examiners with instructions to malinger (instructed malingerers). The mean score of instructed malingerers and the score at the 95th percentile of the disabled nonmalingerers converged, indicating 8 as the critical score. This cutting score found 32 (19%) of disability claimants to be malingering. Self-reported substance abuse history was the only participant variable that significantly predicted higher malingering scores.

PMID: 8991329 [PubMed - indexed for MEDLINE]


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1: J Appl Psychol. 2007 Sep;92(5):1270-85.Read full text article.

Personality measurement, faking, and employment selection.

Hogan Assessment Systems, Tulsa, OK 74114, USA.

Real job applicants completed a 5-factor model personality measure as part of the job application process. They were rejected; 6 months later they (n = 5,266) reapplied for the same job and completed the same personality measure. Results indicated that 5.2% or fewer improved their scores on any scale on the 2nd occasion; moreover, scale scores were as likely to change in the negative direction as the positive. Only 3 applicants changed scores on all 5 scales beyond a 95% confidence threshold. Construct validity of the personality scales remained intact across the 2 administrations, and the same structural model provided an acceptable fit to the scale score matrix on both occasions. For the small number of applicants whose scores changed beyond the standard error of measurement, the authors found the changes were systematic and predictable using measures of social skill, social desirability, and integrity. Results suggest that faking on personality measures is not a significant problem in real-world selection settings. (c) 2007 APA.

PMID: 17845085 [PubMed - indexed for MEDLINE]


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1: Pain Med. 2007 Jul-Aug;8(5):433-7.Read full text article.
Comment in:
Pain Med. 2007 Jul-Aug;8(5):438-40; author reply 447-8.
Pain Med. 2007 Jul-Aug;8(5):441; author reply 447-8.
Pain Med. 2007 Jul-Aug;8(5):442-4; author reply 447-8.
Pain Med. 2007 Jul-Aug;8(5):445-6; author reply 447-8.

Physicians being deceived.

Department of Pharmacology, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY 10021, USA.

OBJECTIVE: In several high profile prosecutions of physicians for prescribing opioids, prosecutors claimed that the doctors should have known the individuals were feigning pain solely to obtain the prescriptions. This study was to determine how readily physicians can tell that patients lie. METHODS: A literature search was done for studies of standardized patients used to evaluate physicians' practices. Standardized patients are actors taught to mimic a patient with a specific illness. The papers were then reviewed for the frequency with which the physician correctly identified which office visits were by the standardized (lying) patients. RESULTS: Six studies of practicing physicians using standardized patients reported the frequency with which these actors were identified as the standardized patients. This occurred around 10% of the time. Some real patients were erroneously identified as the actors. CONCLUSION: Deception is difficult to detect. In the current legal climate surrounding prescribing opioids, accepting patients' reports of pain at face value can have significant legal consequences for the doctor. While doctors must make every reasonable effort to confirm the diagnosis and need for opioid therapy, allowance must be made for the fact that conscientious doctors can be deceived.

PMID: 17661857 [PubMed - indexed for MEDLINE]


1: Int J Neurosci. 2007 Aug;117(8):1185-92.Read full text article.

Detection of feigned cognitive dysfunction using special malinger tests: a simulation study in naïve and coached malingerers.

Maastricht University, Maastricht, The Netherlands.

The aim of the present study was to compare the accuracy of the Amsterdam Short Term Memory (ASTM) test with that of the Structured Inventory of the Malingered Symptomatology (SIMS) in detecting feigning of cognitive dysfunction in naïve and coached participants. Ninety undergraduate students were administered the ASTM and the SIMS and asked to respond honestly (controls; n = 30), or instructed to malinger cognitive dysfunction due to head injury. Before the both instruments were administered, naïve malingerers received no further information (n = 30), whereas coached malingerers were given some information about brain injury and a warning not to exaggerate symptoms (n = 30). Both tests correctly classified 90% of the naïve malingerers. The ASTM detected 70% of the coached malingerers, whereas the SIMS continued to detect 90% of them. The findings suggest that coaching undermines the diagnostic accuracy of the ASTM, but does not seem to influence the accuracy of the SIMS.

PMID: 17613120 [PubMed - indexed for MEDLINE]


1: Clin Neuropsychol. 2007 May;21(3):532-46.Read full text article.

Test of Memory Malingering (TOMM) scores are not affected by chronic pain or depression in patients with fibromyalgia.

Department of Psychiatry, University of British Columbia, Riverview Hospital, Vancouver, BC Canada.

Neuropsychologists routinely give effort tests, such as the Test of Memory Malingering (TOMM). When a person fails one of these tests, the clinician must try to determine whether the poor performance was due to suboptimal effort or to chronic pain, depression, or other problems. Participants were 54 community-dwelling patients who met American College of Rheumatology criteria for fibromyalgia (FM). In addition to the TOMM, they completed the Beck Depression Inventory-Second Edition, Multidimensional Pain Inventory-Version 1, Oswestry Disability Index-2.0, British Columbia Cognitive Complaints Inventory, and the Fibromyalgia Impact Questionnaire. The majority endorsed at least mild levels of depressive symptoms (72%), and 22% endorsed "severe" levels of depression. The average scores on the TOMM were 48.8 (SD = 1.9, range = 40-50) for Trial 1, 49.8 (SD = 0.5, range = 48-50) for Trial 2, and 49.6 (SD = 0.9, range = 45-50) for Retention. Despite relatively high levels of self-reported depression, chronic pain, and disability, not a single patient failed the TOMM. In this study, the TOMM was not affected by chronic pain, depression, or both.

PMID: 17455036 [PubMed - indexed for MEDLINE]


1: Brain Inj. 2007 Mar;21(3):319-26.Read full text article.

Correlates of invalid neuropsychological test performance after traumatic brain injury.

Psychology Service, Mary Free Bed Rehabilitation Hospital. Grand Rapids, MI, USA.

PRIMARY OBJECTIVE: To investigate external correlates of invalid test performance after traumatic brain injury, as assessed by the California Verbal Learning Test - Second Edition (CVLT-II) and Word Memory Test (WMT). RESEARCH DESIGN: Consecutive 2-year series of rehabilitation referrals with a diagnosis of traumatic brain injury (n = 87). METHODS AND PROCEDURES: Logistic regression analysis was used to determine which demographic and neurological variables best differentiated those with vs. without actuarial CVLT-II or WMT evidence for invalid responding. MAIN OUTCOMES AND RESULTS: Twenty-one participants (about 24%) performed in the invalid range. The combination of a premorbid psychiatric history with minimal or no coma was associated with an approximately four-fold increase in the likelihood of invalid performance. CONCLUSIONS: Premorbid psychosocial complicating factors constitute a significant threat to validity of neuropsychological test results after (especially mild) traumatic brain injury. At the same time, care should be taken to not routinely assume that all persons with mild traumatic brain injury and premorbid psychiatric histories are simply malingering. The WMT appears to be a promising instrument for the purpose of identifying those cases where neuropsychological test results are confounded by factors not directly related to acquired cerebral impairment.

PMID: 17453760 [PubMed - in process]


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1: Assessment. 2001 Jun;8(2):205-12.

Comparison of the Fake Bad Scale and other MMPI-2 validity scales with personal injury litigants.

Department of Psychiatry and Psychology, Straub Clinic and Hospital, Honolulu, Hawaii 96813, USA.

Five MMPI-2 validity scales were evaluated with 120 personal injury litigation patients (LP) and 208 clinical patients (CP) along with 43 normal participants (NP). The validity measures included the Fake Bad Scale (FBS), Infrequency scale (F), Back Infrequency scale (Fb), Infrequency-Psychopathology scale (F[p]), and the Dissimulation scale-2 (Ds2). Results showed that only the FBS significantly differentiated the LP and CP, whereas the LP and CP scored significantly higher than the NP on FBS, F, Fb, and Ds2. The content of the FBS, with several items from the Hypochondriasis (Hs) and Hysteria (Hy) Scales, appears to enhance the FBS' ability to detect the somatic overreporting often observed with personal injury claimants. The authors suggest that the FBS may be a useful index of symptom magnification when employed within a comprehensive assessment of malingering in personal injury plaintiffs.

PMID: 11428699 [PubMed - indexed for MEDLINE]


1: Arch Clin Neuropsychol. 2007 Feb;22(2):213-23. Epub 2007 Feb 5.Read full text article.

A survey of neuropsychologists' beliefs and practices with respect to the assessment of effort.

Department of Psychology, Saint Louis University, 221 North Grand, St. Louis, MO 63103, USA.

The current study investigated neuropsychologists' beliefs and practices with respect to assessing effort and malingering by surveying a sample of NAN professional members and fellows (n=712). The results from 188 (26.4%) returned surveys indicated that 57% of respondents frequently included measures of effort when conducting a neuropsychological evaluation. While a majority of respondents (52%) rarely or never provide a warning that effort indicators will be administered, 27% of respondents often or always provide such a warning. The five most frequently used measures of effort or response bias were the Test of Memory Malingering (TOMM), MMPI-2 F-K ratio, MMPI-2 FBS, Rey 15-item test, and the California Verbal Learning Test. However, the TOMM, Validity Indicator Profile, Word Memory Test, Victoria Symptom Validity Test, and the Computerized Assessment of Response Bias were rated as most accurate for detecting suboptimal effort. These results and other findings are presented and discussed.

PMID: 17284353 [PubMed - indexed for MEDLINE]


1: Clin Neuropsychol. 2007 Nov;21(6):929-42.Read full text article.

Identification of feigned mental retardation using the new generation of malingering detection instruments: preliminary findings.

University of Kentucky, Lexington, KY, USA.

A recent Supreme Court decision - Atkins v. Virginia, 536 U.S. 304 (2002) - prohibiting the execution of mentally retarded (MR) defendants may have raised the attractiveness of feigning this condition in the criminal justice system. Unfortunately, very few published studies have addressed the detection of feigned MR. The present report compared results from tests of intelligence, psychiatric feigning, and neurocognitive faking in a group of 26 mild MR participants (MR) and 25 demographically matched community volunteers asked to feign MR (CVM). Results showed that the CVM suppressed their IQ scores to approximate closely the level of MR participants. WAIS-III and psychiatric malingering measures were relatively ineffective at discriminating feigned from genuine MR. Although neurocognitive malingering tests were more accurate, their reduced specificity in MR participants was of potential concern. Revised cutting scores, set to maintain a Specificity rate of about .95 in MR clients, were identified, although they require cross-validation. Overall, these results suggest that new cutting scores will likely need to be validated to detect feigned MR using current malingering instruments.

PMID: 17886151 [PubMed - in process]


1: Arch Clin Neuropsychol. 2003 Mar;18(2):181-97.Read full text article.

Quantitative measures of memory malingering on the Wechsler Memory Scale--Third edition in mild head injury litigants.

Suite 1003, 37 Bligh Street, 2000, NSW, Sydney, Australia.

Wechsler Memory Scale-Third edition (WMS-III) performance in 25 mild traumatic brain injury (TBI) litigants who met the criteria for probable malingered neurocognitive dysfunction (MND) was compared with 50 nonmalingering subjects. The base rate for probable MND in the population studied was 27%. Overall, malingerers showed globally depressed memory function. They returned significantly poorer scores than nonmalingerers on all WMS-III indexes and subtests, and on selected WMS-III index difference scores and intelligence-memory difference scores. Using the minimum score returned in the nonmalingerers as the cut-off for malingering, the delayed auditory recognition memory tasks were highly effective in detecting malingering. Raw scores below 43 on the auditory recognition-delayed (AR-D) subtest or below 18 on word list II-recognition, identified around 80% of the malingerers. In a group of 50 severe TBI litigants, only a very small proportion (i.e., <10%) returned scores below the cut-offs for malingering for the mild TBI subjects.

PMID: 14591470 [PubMed - indexed for MEDLINE]


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Malingering Research Update
by Kenneth S. Pope, PhD, ABPP

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