The detection of feigned mental disorders on specific competency measures

Psychologists have standardized competency-to-stand-trial (CST) assessments through the development of specialized CST measures. However, their research has largely neglected the possibility that CST measures may be stymied by feigning mental disorders and concomitant impairment. The current study is the first systematic examination of (a) how feigned mental disorders may affect CST measures and (b) which scales are effective at identifying feigned cases. Bona fide patients (n = 65) were compared with suspected malingerers (n = 22) on 3 CST measures: the Georgia Court Competency Test (GCCT), the MacArthur Competence Assessment Tool--Criminal Adjudication, and the Evaluation of Competency to Stand Trial--Revised (ECST-R). Results indicated that these CST measures are vulnerable to feigning. The development of specialized GCCT and ECST-R scales yielded moderately effective screens for feigned mental disorders in the context of CST 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.     

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.     

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.     

The detection of feigned disabilities: the effectiveness of the Personality Assessment Inventory in a traumatized inpatient sample

Research on feigned mental disorders indicates that severe psychopathology coupled with significant trauma histories often complicate feigning determinations, resulting in inaccuracies on otherwise effective measures. As part of malingering assessments, the Personality Assessment Inventory (PAI) is often used because of its excellent validation and the availability of three feigning indicators (Negative Impression, Malingering Index, and Rogers Discriminant Function), which have evidenced large effect sizes and clinically useful cut scores. The current study examined the effectiveness of the PAI in a traumatized inpatient sample using a between-subjects simulation design. Although Negative Impression appeared affected by trauma--especially in conjunction with dissociative symptoms--very positive results were found for Malingering Index and Rogers Discriminant Function. They remained relatively unelevated under honest conditions, despite posttraumatic stress disorder and extensive comorbidity. Using single-point cut scores provided moderately good classification of feigned and genuine PAI profiles. For purposes of classification, the authors operationally defined small indeterminate groups that were considered too close to classify (i.e., ±5T of the cut scores). With indeterminate cases removed, the overall classification rates improved modestly. However, the more important finding involved the error rates for the indeterminate group, which exceeded 50%. Directions for further research are discussed.     

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.     

Assessing dimensions of competency to stand trial: construct validation of the ECST-R

Four decades of forensic research have left unanswered a fundamental issue regarding the best conceptualization of competency to stand trial vis-à-vis the Dusky standard. The current study investigated three competing models (discrete abilities, domains, and cognitive complexity) on combined data (N = 411) from six forensic and correctional samples. Using the Evaluation of Competency to Stand Trial-Revised (ECST-R), items representative of the Dusky prongs were used to test the three models via maximum-likelihood confirmatory factor analyses (CFA). Of the three, only the discrete abilities model evidenced a good fit, indicating that competency to stand trial should consider separately each defendant's factual understanding of the proceedings, rational understanding of the proceedings, and ability to consult with counsel. ECST-R competency scales, based on the current CFA, have excellent alphas (.83 to .89) and interrater reliabilities (.97 to .98).     

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.     

Assessing Axis I symptomatology on the SADS-C in two correctional samples: the validation of subscales and a screen for malingered presentations

The Schedule of Affective Disorders and Schizophrenia-Change Version (SADS-C; Spitzer & Endicott, 1978b) is a brief, highly reliable structured interview with clinical applications to diverse populations. This investigation involved reanalyses of data from 2 earlier studies (Rogers, Grandjean, Tillbrook, Vitacco, & Sewell, 2001; Ustad, Rogers, & Salekin, 1998). Focusing on 2 clinical samples from a metropolitan jail, we investigated its subscales via exploratory and confirmatory factor analysis. A good model fit was found (comparative fit index =.92; robust comparative fit index =.94) for 4 subscales (Dysphoria, Psychosis, Mania, and Insomnia) with good interrater reliability (M intraclass coefficient =.95) and clinical relevance. As a preliminary screen for feigned mental disorders, 2 detection scales (Symptom Combinations and Symptom Selectivity) were moderately successful. By maximizing negative predictive power, the SADS-C detection strategies proved effective at ruling out feigning for mentally disordered offenders with a high likelihood of genuine disorders.     

Feigned depression and feigned sleepiness: a voice acoustical analysis

We sought to profile the voice acoustical correlates of simulated, or feigned depression by neurologically and psychiatrically healthy control subjects. We also sought to identify the voice acoustical correlates of feigned sleepiness for these same subjects. Twenty-two participants were asked to speak freely about a cartoon, to count from 1 to 10, and to sustain an "a" sound for approximately 5s. These exercises were completed three times (within the same testing session) with three differing sets of instructions to the participants. These three conditions were presented in pseudo-random order to control for any order effects, and all subjects were na?ve to the intended purpose of this study. For all three conditions, mean speaking rates and pitch ranges were calculated. A series of paired t tests showed significant differences in the speaking rates (counting numbers and free-speech exercises) between the 'normal' and feigned sleepy conditions, and between the normal and feigned depression conditions, but not between the 'sleepy' and 'depressed' conditions. The results for pitch range, for all speech exercises, were not different between the normal and either the feigned depression or feigned sleepiness conditions. These results indicate that persons feigning depression and sleepiness demonstrate some level of conscious control of their speech rate, but they did not convincingly alter their pitch ranges while feigning depression or sleepiness.     

Recent interview-based measures of competency to stand trial: a critical review augmented with research data

Forensic experts are frequently asked to conduct competency-to-stand trial evaluations and address the substantive prongs propounded in Dusky v. United States (1960). In understanding its application to competency evaluations, alternative conceptualizations of Dusky are critically examined. With Dusky providing the conceptual framework, three interview-based competency measures are reviewed: the Georgia Court Competency Test (GCCT), the MacArthur Competence Assessment Tool-Criminal Adjudication (Mac-CAT-CA), and the Evaluation of Competency to Stand Trial-Revised (ECST-R). This review has a twin focus on reliability of each measure and its correspondence to Dusky prongs. The current review is augmented by new factor analytic data on the MacCAT-CA and ECST-R. The article concludes with specific recommendations for competency evaluations.     

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.     

The Development of the Inventory of Problems–29: A Brief Self-Administered Measure for Discriminating Bona Fide From Feigned Psychiatric and Cognitive Complaints

This article describes the development of the Inventory of Problems–29 (IOP–29), a new, short, paper-and-pencil, self-administered measure of feigned mental and cognitive disorders. Four clinical comparison simulation studies were conducted. Study 1 (n = 451) selected the items and produced an index of potential feigning. Study 2 (n = 331) scaled this index to produce a probability score, and examined its psychometric properties. Study 3 tested the generalizability of Study 2's findings with 2 additional samples (ns = 128 and 90). Results supported the utility of the IOP–29 for discriminating bona fide from feigned psychiatric and cognitive complaints. Validity was demonstrated in feigning mild traumatic brain injury, psychosis, posttraumatic stress disorder, and depression. Within the independent samples of Studies 2 and 3, the brief IOP–29 performed similarly to the MMPI–2 and Personality Assessment Inventory, and perhaps better than the Test of Memory Malingering. Classifications within these samples with base rates of .5 produced sensitivity, specificity, positive predictive power, and negative predictive power statistics of about .80. Further research is needed testing the IOP–29 in ecologically valid field studies.     

Damages and rewards: assessment of malingered disorders in compensation cases

The assessment of malingering poses unique challenges to forensic practitioners in compensation cases and disability determinations. Beyond malingering itself, false claims can be presented regarding both the source of genuine symptoms and their injurious effects on work and social functioning. The article examines how contextually based psychological factors can affect clients' presentation in compensation cases. Important distinctions between different types of response style (e.g. malingering, feigning, and secondary gain) are presented. In addition, empirically validated detection strategies provide a clinical framework for the assessment of feigned disorders. With an emphasis on compensation cases and clinically relevant disorders, the effectiveness of these detection strategies is considered for specific psychological measures.     

Feigned insanity in nineteenth-century America: Tactics,trials, and truth

Feigned insanity in nineteenth-century America is appraised through a review of the medical and legal literature. The authors focus on the explanations for feigning, procedures used in uncovering feigning, and the role of feigning in the courtroom. This discussion of feigned insanity demonstrates the remarkable consistency of approach to this form of malingering over the past 200 years.     

The incremental validity and clinical utility of the MMPI-2 infrequency posttraumatic stress disorder scale

The incremental validity and clinical utility of the recently developed Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Infrequency Posttraumatic Stress Disorder Scale (Fptsd) was examined in relation to the family of MMPI-2 F scales in distinguishing feigned post-traumatic stress disorder (PTSD) from disability claimants with PTSD. Research participants instructed to feign PTSD when completing the MMPI-2 scored significantly higher on the MMPI-2 family of F scales and the Fptsd scale compared with their responses when completing the MMPI-2 under standard instructions and the sample of claimants with PTSD. Although comparable in magnitude, effect sizes derived from mean group differences and hierarchical logistic regressions for the Fptsd scale never exceeded those for F(B), and F(P), F, F(B), and F(P) added incrementally to Fptsd in the prediction of feigned PTSD. These results suggest that the Fptsd scale does not afford any incremental predictive utility for detecting feigned PTSD relative to the complement of the existing family of F scales.     

Malingering as a categorical or dimensional construct: the latent structure of feigned psychopathology as measured by the SIRS and MMPI-2

The 6 nonoverlapping primary scales of the Structured Interview of Reported Symptoms (SIRS) were subjected to taxometric analysis in a group of 1,211 criminal and civil examinees in order to investigate the latent structure of feigned psychopathology. Both taxometric procedures used in this study, mean above minus below a cut (MAMBAC) and maximum covariance (MAXCOV), produced dimensional results. A subgroup of participants (n = 711) with valid Minnesota Multiphasic Personality Inventory-2 (MMPI-2) protocols were included in a second round of analyses in which the 6 nonoverlapping primary scales of the SIRS and the Infrequency (F), Infrequency-Psychopathology (Fp), and Dissimulation (Ds) scales of the MMPI-2 served as indicators. Again, the results were more consistent with dimensional latent structure than with taxonic latent structure. On the basis of these findings, it is concluded that feigned psychopathology forms a dimension (levels of fabrication or exaggeration) rather than a taxon (malingering-honest dichotomy) and that malingering is a quantitative distinction rather than a qualitative one. The theoretical and clinical practice implications of these findings are discussed.     

The validity and clinical utility of the MMPI-2 Malingering Depression scale

In this study, we examined the validity and clinical utility of the MMPI-2 (Butcher, Graham, Tellegen, Dahlstrom, & Kaemmer, 2001) Malingering Depression scale (Md) in relation to the MMPI-2 F scales (F, F(B), F(P)) to detect feigned depression. Overall, the F(B) scale and the F/F(P) scale combination were the best single predictors, although the Md scale did discriminate successfully cases of feigned depression from patients with bona fide depression. The Md scale added predictive capacity over the F scales, and the F(B) scale and the F/F(P) scale combination added predictive capacity over the Md scale; however, the actual increase in the number of cases predicted was minimal in each instance. In sum, although the Md scale is able to detect accurately feigned depression on the MMPI-2 (predictive validity), it does not confer a distinct advantage (incremental validity) over the existing standard validity scales-F, F(B), and F(P).     

Effectiveness of the MMPI-2-RF Validity Scales for Feigned Mental Disorders and Cognitive Impairment: A Known-Groups Study

The MMPI and MMPI-2 validity scales have long been accepted as standard tools in the assessment of feigned mental disorders (FMD) based on their extensive empirical validation. Studies are now examining MMPI-2-RF with modified validity scales plus the new Infrequent Somatic Responses Scale (F_S) and the recently-adapted Response Bias Scale (RBS). The current investigation used a known-groups design to examine the effectiveness of the MMPI-2-RF for differentiating FMD and feigned cognitive impairment (FCI) from patients with genuine disorders for a large civil forensic sample. Criterion measures included the Structured Interview of Reported Symptoms-2 (SIRS-2) for the FMD group, and below-chance performances on the Victoria Symptom Validity Test (VSVT) and the Test of Memory Malingering (TOMM) for the FCI group. For FMD, both F-r and F_P-r produced very large effect sizes (ds > 2.00). Moreover, the absence of severe elevations (≥80 T) on F-r proved effective at ruling-out most FMD. For the current study, a F_P-r cut score ≥90 T for FMD produced virtually no false-positives (0.01) and only a moderate level of false-alarms. As predicted by its detection strategies, most MMPI-2-RF validity scales have limited effectiveness with the FCI group. However, FBS-r and RBS may be useful in conjunction with other clinical data for ruling out FCI for genuine neuropsychological consults. An entirely separate concern is whether certain diagnostic groups, such as major depression, will have marked elevations on MMPI-2-RF scales thereby increasing the likelihood of false-positives. On this point, F_P-r performed exceptionally well with unelevated scores (Ms < 55 T) consistently across diagnostic categories.