The Effectiveness of the MMPI-2-RF in Detecting Feigned Mental Disorders and Cognitive Deficits: a Meta-Analysis

A cornerstone of forensic assessments involves the assessment of response styles, including feigning and malingering. As a forensic relevant instrument (FRI), the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) contains embedded overreporting scales that cover the three major domains: feigned mental disorders (i.e., F-r and Fp-r), feigned cognitive impairment (RBS and FBS-r), and feigned medical complaints (Fs). This meta-analytic review of 30 studies examined the effectiveness of various detection strategies and cut scores for the MMPI-2-RF. As an important clinical concern, several feigning scales (F-r, FBS-r, and RBS) exhibited marked elevations (Ms > 80 T) for genuine responders diagnosed with major depressive or somatoform disorders. However, the Fp-r—a true rare-symptoms detection strategy—proved highly effective for discriminating feigned from genuine psychopathology (ds > .90). For feigned cognitive impairment, the FBS-r produced very large effect sizes with feigned TBI (M d = 1.41); however, its cut scores were more indicative of general feigning than feigned cognitive impairment. Finally, Fs yielded a large effect size (d = 1.23) for feigned medical complaints, but its cut scores were more likely to identify examinees feigning mental disorders (M sensitivity = .74) than medical complaints (M sensitivity = .43). These findings are discussed within the context of clinical forensic evaluations.     

The SIMS Screen for Feigned Mental Disorders: the Development of Detection‐based Scales

Time‐efficient screens for feigned mental disorders (FMDs) constitute important tools in forensic assessments. The Structured Inventory of Malingered Symptomatology (SIMS) is a 75‐item true–false questionnaire that has been extensively studied as an FMD screen. However, the SIMS scales are not based on established detection strategies, and only its total score is utilized as a feigning screen. This investigation develops two new feigning scales based on well‐established detection‐strategies: rare symptoms (RS) and symptom combinations (SC). They are studied in a between‐subjects simulation design using inpatients with partial‐malingering (i.e., patients with genuine disorders asked to feign greater disabilities) conditions. Subject to future cross‐validation, the SC scale evidenced the highest effect size (d = 2.01) and appeared the most effective at ruling out examinees, who have a high likelihood of genuine responding. Copyright © 2014 John Wiley & Sons, Ltd.     

Detection of Feigned ADHD across Two Domains: The MMPI-2-RF and CAARS for Faked Symptoms and TOVA for Simulated Attention Deficits

Psychological assessments of Attention Deficit/Hyperactivity Disorder (ADHD) must consider possible feigning of ADHD symptoms and simulated deficits on attentional measures. Studies have consistently found that motivated examinees can easily feign ADHD with little research focused on its detection. Via a between-subjects simulation design, the current study investigated the MMPI-2-RF and the Conners Infrequency Index (CII) in a university sample by comparing four groups: feigned ADHD, feigned mental disorders, genuine ADHD, and non-ADHD controls. Encouragingly, the CII evidenced moderate discriminability between feigned ADHD and (a) genuine ADHD (d?=?0.97) as well as (b) feigned mental disorders (d?=?0.96). Because the MMPI-2-RF F-family scores did not differentiate ADHD feigners from other feigners or genuine ADHD, a Dissimulation (Ds) ADHD (Ds-ADHD) scale was developed by utilizing erroneous stereotypes as the detection strategy. While requiring cross-validation, the initial data demonstrated good discriminant validity in distinguishing feigned ADHD from both genuine ADHD and general feigning. As noted in the Discussion, ADHD assessments must systematically take into account examinees’ level of effort and actively evaluate the possibility of feigned ADHD.     

Validity of the Devereux Scales of Mental Disorders with adolescent psychiatric inpatients

Tested the validity of the Devereux Scales of Mental Disorders (DSMD; Naglieri, LeBuffe, & Pfeiffer, 1994) in a sample of 108 adolescent psychiatric inpatients. DSMD scales were compared to parent-report, interview-based, self-report and diagnostic measures. DSMD measures of conduct problems and delinquency were significantly associated with the predicted parent-report, interview-based, and diagnostic measures of conduct disorder and substance abuse and not with any measures of anxiety or depression. DSMD measures of anxiety and depression were related to other parent-report ratings of internalizing symptoms but had more limited convergent and discriminant validity. The DSMD was compared to the Child Behavior Checklist (CBCL; Achenbach, 1991) for diagnostic classification accuracy. The two measures were comparable in classifying oppositional or conduct disorder. The CBCL was superior for classification of major depression. The DSMD was superior for classification of substance abuse.     

Associations between Symptom Validity Test failure and scores on the MMPI-2-RF validity and substantive scales

This study examined the association between Symptom Validity Test (SVT) failure and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008), in the Forensic Disability Claimant samples described in the MMPI-2-RF Technical Manual (Tellegen & Ben-Porath, 2008 a, 2008b). SVTs used included the Word Memory Test (Green, 2003), the Computerized Assessment of Response Bias (Allen, Conder, Green, & Cox, 1997), the Medical Symptom Validity Test (Green, 2004), and the Test of Memory Malingering (Tombaugh, 1996). SVT failure was associated with significant elevations throughout the MMPI-2-RF overreporting validity scales and substantive scales. Pairwise contrasts between groups failing 0 and 3 SVTs revealed predominantly large effect sizes for the overreporting validity scales (d = 0.78-1.11), and many of the substantive scales, including the Cognitive Complaints (COG) scale. Results of this study demonstrate an association between SVT performance and elevated scores on the MMPI-2-RF. These results suggest that exaggeration of cognitive symptoms as demonstrated by SVT failure is also associated with overreported emotional, somatic, and neurocognitive complaints on the MMPI-2-RF.     

Detection of Feigned Mental Disorders on the Personality Assessment Inventory: A Discriminant Analysis

Psychological assessment with multiscale inventories is largely dependent on the honesty and forthrightness of those persons evaluated. We investigated the effectiveness of the Personality Assessment Inventory (PAI) in detecting participants feigning three specific disorders: schizophrenia, major depression, and generalized anxiety disorder. With a simulation design, we tested the PAI validity scales on 166 naive (undergraduates with minimal preparation) and 80 sophisticated (doctoral psychology students with 1 week preparation) participants. We compared their results to persons with the designated disorders: schizophrenia (n = 45), major depression (n = 136), and generalized anxiety disorder (n = 40). Although moderately effective with naive simulators, the validity scales evidenced only modest positive predictive power with their sophisticated counterparts. Therefore, we performed a two-stage discriminant analysis that yielded a moderately high hit rate (> 80%) that was maintained in the cross-validation sample, irrespective of the feigned disorder or the sophistication of the simulators.     

Detection of Feigned Posttraumatic Stress Disorder: A Comparison of the MMPI-2 and PAI

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Personality Assessment Inventory (PAI) were compared for detecting feigned posttraumatic stress disorder (PTSD) in a simulation research design. Participants were 85 undergraduates in one of three groups: PTSDs (n = 23), Fakers (n = 31), and Controls (n = 31). As expected, both the MMPI-2 and PAI discriminated PTSDs and Controls, with PTSDs scoring significantly higher on fake-bad validity scales and PTSD-relevant clinical scales. However, only the MMPI-2 discriminated Fakers and PTSDs, with Fakers scoring significantly higher on all MMPI-2 scales considered, but on only one PAI scale. Further, in logistic regression analyses the MMPI-2 demonstrated higher overall correct classification of PTSDs and Fakers than did the PAI. Although the MMPI-2 outperformed the PAI in detecting feigned PTSD, a substantial proportion of Fakers avoided detection by MMPI-2 fake-bad validity scales, suggesting that both tests are vulnerable to feigning of PTSD by motivated respondents with relatively limited coaching.     

Validity of the Substance Abuse Scales of the MMPI-2 in a College Student Sample

This study assessed the validity of three Minnesota Multiphasic Personality Inventory-2-based (MMPI-2: Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) substance abuse scales. The scales were the MacAndrew Alcoholism Scale-Revised (MAC-R; Butcher et al., i989) and the recently developed Addiction Acknowledgment Scale and Addiction Potential Scale (AAS & APS; Weed, Butcher, McKenna, & Ben-Porath, 1992), Study participants were 308 male and female college students who completed the MMPI-2 and the substance use disorder modules of the Diagnostic Interview Schedule. The MAC-R and the APS had a nonsignificant-to-weak relationship with substance dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders' (3rd ed., rex. [DSM-III-R]; American Psychiatric Association, 1980). The AAS had a moderate ability to identify the 33 study participants who met DSM-HI-R criteria for a substance use disorder, primarily alcoholism, Broadening the definition of substance abuse to a continuum of alcohol/drug problems did not alter the character of findings, These results highlight the relative superiority of direct (AAS) versus subtle (APS, MAC-R) scales to detect substance dependence and support studies that question the overall utility of traditional MMPI scales to identify substance abuse.     

Further validation of the MMPI-2 and MMPI-2-RF Response Bias Scale: findings from disability and criminal forensic settings

The present study extends the validation of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) Response Bias Scale (RBS; R. O. Gervais, Y. S. Ben-Porath, D. B. Wygant, & P. Green, 2007) in separate forensic samples composed of disability claimants and criminal defendants. Using cognitive symptom validity tests as response bias indicators, the RBS exhibited large effect sizes (Cohen's ds = 1.24 and 1.48) in detecting cognitive response bias in the disability and criminal forensic samples, respectively. The scale also added incremental prediction to the traditional MMPI-2 and the MMPI-2-RF overreporting validity scales in the disability sample and exhibited excellent specificity with acceptable sensitivity at cutoffs ranging from 90T to 120T. The results of this study indicate that the RBS can add uniquely to the existing MMPI-2 and MMPI-2-RF validity scales in detecting symptom exaggeration associated with cognitive response bias.     

A Cross-Validation of MMPI-2 Substance Abuse Scales

We evaluated the efficacy of the Addiction Potential Scale (APS) and the Addiction Acknowledgment Scale (AAS), two new scales designed to assess substance abuse problems with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), in samples from settings different from those used in their development. Results replicate earlier findings that both scales discriminate between psychiatric and substance abuse samples and do so more effectively than other substance abuse scales designed for use with the MMPI and carried over to the MMPI-2. Results also suggest that APS may be more resistant than AAS to response distortion.     

Incremental Validity of the MMPI-2 Content Scales in the Assessment of Personality and Psychopathology by Self-Report

The incremental contribution of the MMPI-2 Content Scales to the prediction of scores on self-report measures of personality and psychopathology was investigated. The MMPI-2, Beck Depression Inventory, State-Trait Personality Inventory, anti Symptom Checklist-90-Revised were administered to 596 subjects: 339 women anti 257 men. Zero-order correlational analyses indicated that both clinical and Content Scales correlated with each of the criterion measures. In all but one case, an MMPI-2 Content Scale was found to have the highest correlation with the extratest variables. Combined hierarchical, stepwise regression analyses demonstrated that the MMPI-2 Content Scales possess incremental validity vis-a-vis the clinical scales for both genders in relation to all of the criterion measures. Additional analyses indicated that the MMPI-2 clinical scales also possess incremental validity vis-a-vis the Content Scales. However, the incremental contribution of the clinical scales was of lesser magnitude. Implications of these findings for test interpretation and future research with the MMPI-2 are discussed.     

Positive response distortion by police officer applicants: association of Paulhus Deception Scales With MMPI-2 and Inwald Personality Inventory Validity Scales

Interpretation of positive response distortion (socially desirable responding) in employment evaluations is an important validity issue. This study of police officer applicants examined the construct validity of the Paulhus Deception Scales (PDS)-Moralistic Bias (MB; exaggerated adjustment/agreeableness) and Egoistic Bias (EB; exaggerated power/ status)-in relation to validity scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; L, K, and S) and Inwald Personality Inventory (IPI; Guardedness). In regression analyses, MB was significantly associated with each validity scale (particularly L and Guardedness), whereas EB was significantly, but weakly, associated with L only. MB is consistent with response distortion as reflected in L ("perfect" adjustment/personality) and Guardedness (denial of shortcomings/faults). EB is a unique form of response distortion that is not reflected in MMPI-2 or IPI validity scales. The relevance of EB to self-assessment among police officer applicants is an important practical concern in personnel selection and an important theoretical question for future response distortion research.     

The Moderating Influence of Disorder on Coached Overreporting Using the MMPI-2-RF

Overreporting has always been a concern within psychological evaluations. The Minnesota Multiphasic Personality Inventory-2-Restructured Form (Ben-Porath &; Tellegen, 2008/2011 Ben-Porath, Y. S., &; Tellegen, A. (2008/2011). MMPI-2-RF (Minnesota Multiphasic Personality Inventory—2 Restructured Form): Manual for administration, scoring, and interpretation. Minneapolis, MN: University of Minnesota Press. [Google Scholar]) contains validity scales designed for detecting noncredible responses. In this study, 270 undergraduates were instructed to feign either schizophrenia, posttraumatic stress disorder (PTSD) or generalized anxiety disorder (GAD); some participants were coached on symptoms and validity scales. Results at both the individual protocol and mean validity scale score levels suggest that each feigned disorder moderates the effectiveness of coaching on validity scale detection. One finding of this study suggests that schizophrenia is generally more difficult to successfully feign than PTSD or GAD. Another finding suggests that the majority of individuals able to avoid detection as symptom overreporters are able to successfully endorse at least some disorder-relevant symptoms. We suggest that future research focus on the systematic exploration of other factors influencing the effectiveness of validity scales as well as the development of validity scales designed to detect the overreporting of internalizing forms of psychopathology.     

Detection of overreported psychopathology with the MMPI-2-RF [corrected] validity scales

We examined the utility of the validity scales on the recently released Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2 RF; Ben-Porath & Tellegen, 2008) to detect overreported psychopathology. This set of validity scales includes a newly developed scale and revised versions of the original MMPI-2 validity scales. We used an analogue, experimental simulation in which MMPI-2 RF responses (derived from archived MMPI-2 protocols) of undergraduate students instructed to overreport psychopathology (in either a coached or noncoached condition) were compared with those of psychiatric inpatients who completed the MMPI-2 under standardized instructions. The MMPI-2 RF validity scale Infrequent Psychopathology Responses best differentiated the simulation groups from the sample of patients, regardless of experimental condition. No other validity scale added consistent incremental predictive utility to Infrequent Psychopathology Responses in distinguishing the simulation groups from the sample of patients. Classification accuracy statistics confirmed the recommended cut scores in the MMPI-2 RF manual (Ben-Porath & Tellegen, 2008).     

Integrating psychopathology and personality disorders conceptualized by the MMPI-2-RF and the MCMI-III: a structural validity study

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (Ben-Porath & Tellegen, 2008 ) Restructured Clinical scales and Higher Order scales were linked to the Millon Clinical Multiaxial Inventory-III (Millon, Millon, Davis, & Grossman, 2009 ) personality disorder scales and clinical syndrome scales in a Flemish/Dutch sample of psychiatric inpatients and outpatients, substance abuse patients, correctional inmates, and forensic psychiatric patients (N = 968). Structural validity of psychopathology and personality disorders as conceptualized by both instruments was investigated by means of principal component analysis. Results reveal a higher order structure with 4 dimensions (internalizing disorders, externalizing disorders, paranoid ideation/thought disturbance, and pathological introversion) that parallels earlier research on pathological personality dimensions as well as research linking pathological personality traits with mental disorders. Theoretical and clinical implications are considered.     

Assessment of Psychotic Disorders in Inpatient Children and Adolescents: Use of the Devereux Scales of Mental Disorders

The Devereux Scales of Mental Disorders (DSMD), with its 3-factor model of measurement (i.e., Internalizing, Externalizing, and Critical Pathology), may be useful in screening for psychotic disorders in children. This study assessed the ability of the DSMD to differentiate between inpatient children and adolescents with psychotic disorders (n = 18) and those with other clinical syndromes (n = 71). Results of ANCOVAs indicated that the psychotic group scored significantly higher on most DSMD scales and composites than the nonpsychotic clinical group. However estimates of effect size were particularly large for the Critical Pathology Composite and the Autism and Acute Problems Scales. Diagnostic efficiency statistics revealed that the DSMD's Critical Pathology Composite was highly accurate in differentiating between the 2 clinical groups. These findings support the utility of the DSMD in identifying children and adolescents with psychotic disorders.     

Effectiveness of NEO-PI-R Research Validity Scales for Discriminating Analog Malingering and Genuine Psychopathology

We investigated the research validity scales for the NEO Personality Inventory-Revised (NEO-PI-R) proposed by Schinka, Kinder, and Kremer (1997): Positive Presentation Management (PPM) and Negative Presentation Management (NPM). Additionally, an experimental analog to the Minnesota Multiphasic Personality Inventory-2's (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) F - K index was calculated by subtracting the raw score on PPM from the raw score on NPM (NPM - PPM). In 2 studies, all indexes showed significant between-group differences when samples of analog malingerers (n = 97) were contrasted with psychiatric outpatients (n = 272). The sensitivity and specificity of these validity indexes indicated that although none performed well in extremely low base rate environments, the NPM and NPM - PPM indexes showed promise when the base rate of faking bad rose to higher levels.     

Research Validity Scales for the NEO-PI-R: Additional Evidence for Reliability and Validity

We examined the reliability and validity of the research validity scales (Schinka, Kinder, & Kremer, 1997) for the NEO-Personality Inventory-Revised (NEO-PI-R) in a clinical sample. The Negative Presentation Management (NPM) and Positive Presentation Management (PPM) scales were found to have satisfactory internal consistency reliability. Support for the validity of these scales was provided by the pattern of convergent and discriminant correlations with respective Personality Assessment Inventory (PAI) validity scales. Finally, PAI profiles of individuals with invalid NPM scores were found to differ significantly from those with valid NPM scores. Comparisons of the invalid profiles with profiles from other clinical samples provided additional support for the use of the NPM scale as a measure of negative impression management.     

Examining the impact of unscorable item responses on the validity and interpretability of MMPI-2/MMPI-2-RF Restructured Clinical (RC) Scale scores

This article examined the impact of unscorable item responses on the psychometric validity and practical interpretability of scores on the Restructured Clinical (RC) Scales of the Minnesota Multiphasic Personality Inventory-2/Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2/MMPI-2-RF). In analyses conducted with five archival samples, we found that relatively large proportions of unscorable responses (defined as 10% or more of the items scored on a scale) were relatively uncommon, occurring most often in forensic samples. Simulated unscorable responses were inserted in varying proportions (10% to 90%) in place of the responses of participants in two of the archival samples for which criterion data were available. Analyses were conducted to gauge the impact of unscorable responses on the criterion validity of scores on these scales and their interpretability. Impact on validity was evaluated by examining correlations with extra-test variables as a function of increasing levels of unscorable responding. Interpretability was evaluated by examining the proportion of participants who produced clinically elevated RC Scale scores as a function of unscorable responding. Results indicate that whereas scale score validity was relatively robust up to a level of 50% unscorable responses, interpretability was substantially compromised at only 10% unscorable responding. This suggests that prorated scores may be used to correct for the impact of unscorable responses on the interpretability of RC Scale scores at levels as high as 50% unscorable responses. Classification analyses supported this possibility. Further steps needed to explore the feasibility of using prorated scores are discussed.     

Bridging the divide: comments on the Restructured Clinical Scales of the MMPI-2

In this comment, I discuss the target articles written by Nichols (2006/this issue) and Rogers, Sewell, Harrison, and Jordan (2006/this issue) regarding the Restructured Clinical (RC) Scales (Tellegen et al., 2003) of the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). Both articles provide thoughtful discussion of the extent to which the RC Scales achieved the primary goals set forth by Tellegen et al., but they set different tones and come to somewhat different conclusions. I argue that the initial studies conducted on the RC Scales suggest a promising future for them. However, further studies are needed to explore the construct validity of the scales, assess their incremental validity with respect to other more established MMPI-2 scale sets, and determine their interpretive meaning in clinical contexts.