Malingering on the Personality Assessment Inventory: identification of specific feigned disorders

Profile validity is a primary consideration in the clinical assessment of psychopathology. Several indicators of negative impression management have been developed for the Personality Assessment Inventory (PAI; Morey, 1991) that can both indicate its presence and help differentiate effortful negative distortion from distortion arising from cognitive sets associated with psychopathology. In this study, we tested a method designed to delineate the specific Clinical scales relevant for interpretation of deliberately feigned disorders. We used associations between the Negative Impression Management (NIM) scale and Clinical scales in the normative standardization sample to derive NIM predicted scale scores in a regression framework. We contrasted these predicted scores with observed scores on Clinical scales to yield NIM predicted discrepancies hypothesized to identify those Clinical scales most salient for the interpretation of negative distortion. We found this method to be effective in identifying particular distortion on the relevant scales for individuals attempting to feign 3 specific diagnoses (major depressive disorder, generalized anxiety disorder, and schizophrenia).     

Does the Convergent Validity of the PAI Antisocial Features Scale Depend on Offender Response Style?

Researchers have recently questioned the utility of the response style indicators included on many self-report measures of personality and psychopathology. We examined whether the size of convergent validity coefficients for Personality Assessment Inventory (PAI) Antisocial Features (ANT) scores depends on PAI validity scale scores. Using PAI and Psychopathy Checklist–Revised (PCL–R) scores from 477 offenders evaluated for civil commitment as sexually violent predators, we found that PAI Positive Impression (PIM), Negative Impression (NIM), Malingering Index (MAL), Defensiveness Index (DEF), and Infrequency (INF) scores moderated the association between ANT and PCL–R scores. The association between ANT and PCL–R scores decreased as offenders overstated psychopathology (i.e., higher NIM or MAL scores) or exhibited increasing disengagement (i.e., higher INF scores). However, the association between ANT and PCL–R scores increased as offenders engaged in defensive reporting (i.e., higher PIM or DEF scores). The interaction effects were most common for ANT–E (Egocentricity), and to a lesser extent ANT–A (Antisocial Behaviors). PAI discriminant function validity indexes did not exhibit moderating effects on ANT and PCL–R scores. There was no evidence of validity scale suppression effects. These findings provide support for the potential role of some PAI response style measures for ANT scale interpretation in forensic settings.     

The predictive capacity of the MMPI-2 and PAI validity scales and indexes to detect coached and uncoached feigning

The objective of this study was to examine the relative effectiveness of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Personality Assessment Inventory (PAI) validity scales and indexes to detect malingering. Research participants were either informed (coached) or not informed (uncoached) about the presence and operating characteristics of the validity scales and instructed to fake bad on both the MMPI-2 and PAI. The validity scale and index scores produced by these research participants were then compared to those scores from a bona fide sample of psychiatric patients (n = 75). Coaching had no effect on the ability of the research participants to feign more successfully than those participants who received no coaching. For the MMPI-2, the Psychopathology F scale, or F(p), proved to be the best at distinguishing psychiatric patients from research participants instructed to malinger, although the other F scales (i.e., F and Fb) were also effective. For the PAI, the Rogers Discriminant Function index (RDF) was clearly superior to the other PAI fake-bad validity indicators; neither the Negative Impression Management scale nor Malingering Index were effective at detecting malingered profiles in this study. Overall, RDF proved to be marginally superior to F and F(p) in distinguishing MMPI-2 and PAI protocols produced by research participants asked to malinger and psychiatric patients. Both the RDF and the F and F(p) scales, however, were able to increase the predictive capability of one another.     

A multigroup confirmatory factor analysis of the Patient Health Questionnaire-9 among English- and Spanish-speaking Latinas

Depression is a significant problem for ethnic minorities that remains understudied partly due to a lack of strong measures with established psychometric properties. One screening tool, the Patient Health Questionnaire-9 (PHQ-9), which was developed for use in primary care has also gained popularity in research settings. The reliability and validity of the PHQ-9 has been well established among predominantly Caucasian samples, in addition to many minority groups. However, there is little evidence regarding its utility among Hispanic Americans, a large and growing cultural group in the United States. In this study, we investigated the reliability and structural validity of the PHQ-9 in Hispanic American women. A community sample of 479 Latina women from southern California completed the PHQ-9 in their preferred language of English or Spanish. Cronbach's alphas suggested that there was good internal consistency for both the English- and Spanish-language versions. Structural validity was investigated using multigroup confirmatory factor analysis. Results support a similar one-factor structure with equivalent response patterns and variances among English- and Spanish-speaking Latinas. These results suggest that the PHQ-9 can be used with confidence in both English and Spanish versions to screen Latinas for depression.     

Construct validity of the psychological inventory of criminal thinking styles in relationship to the PAI, disciplinary adjustment, and program completion

We evaluated the convergent and discriminant validity of the Psychological Inventory of Criminal Thinking Styles (PICTS; Walters, 1995) in a group of 199 maximum security prisoners. As anticipated, the PICTS Confusion scale correlated with the Personality Assessment Inventory (PAI; Morey, 1991) Negative Impression scale, whereas the PICTS Defensiveness scale paralleled the PAI Positive Impression scale. Also as predicted, a greater portion of the PICTS thinking style scales correlated with the PAI Antisocial Features scale than correlated with the PAI Somatic Complaints, Anxiety, Depression, Mania, Paranoia, and Schizophrenia scales. When the PICTS composite scales were converged onto behavioral indexes, modest statistically significant relationships surfaced between the PICTS Reactive scale and a record of disciplinary infractions and between the PICTS Proactive scale and program completion.     

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.     

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.     

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).     

Use of the Personality Assessment Inventory in Assessment of Posttraumatic Stress Disorder in Women

This study investigated the utility of the Personality Assessment Inventory (PAI) for the assessment of posttraumatic stress disorder (PTSD). Participants were 55 community-residing adult women who were administered a comprehensive battery that included the PAI and the Clinician-Administered PTSD Scale (CAPS). Participants were classified as either PTSD or non-PTSD based on the CAPS, and PAI profiles were compared between the two groups. Significant group differences were found for seven PAI clinical scales (Anxiety, Depression, Anxiety-Related Disorders, Somatic Complaints, Paranoia, Borderline Features, and Schizophrenia), one validity scale (Negative Impression), and two treatment scales (Nonsupport and Treatment Rejection). When all PAI scales and component subscales are considered, the largest group differences were found for the physiological subscale of the Depression scale (DEP-P) and the Traumatic Stress subscale of the Anxiety-Related Disorders scale (ARD-T). ARD-T and DEP-P also demonstrated excellent diagnostic utility. Finally, correlations between PAI scales and four CAPS symptom clusters provided additional validity evidence, in particular supporting a distinction between effortful avoidance and numbing. Taken together, these results support the use of the PAI in the assessment of PTSD.This study was the basis of a Masters thesis for Meghan McDevitt-Murphy. Portions of this study were presented at the annual meeting of the Association for Advancement of Behavior Therapy, November 2000.     

Detection of malingering of psychiatric disorder with the personality assessment inventory: an investigation of criminal defendants

To assess the diagnostic accuracy of the Personality Assessment Inventory (PAI; Morey, 1991) Validity scales for the detection of malingered psychiatric disorders, we divided a sample of criminal defendants referred for forensic evaluation by the federal courts into malingering and not malingering groups based on their performance on the Structured Interview of Reported Symptoms (Rogers, Gillis, & Bagby, 1990). Logistic regression analyses (LGAs) revealed that there were no differences between the malingering and not malingering groups with respect to age, race, years of education, history of drug abuse, or number of previous felony convictions. LGA with malingering versus not malingering as the criterion revealed that the PAI Negative Impression Management (NIM) scale but not the Rogers Discriminant Function (RDF; Rogers, Sewell, Morey & Ustad, 1996) nor the Malingering index (MAL; Morey, 1996) significantly differentiated the malingering from the not malingering group. Receiver operating characteristics analyses demonstrated acceptable sensitivity and specificity for the NIM scale but not the RDF scale or the MAL index. We discuss the results in terms of the suggested cutoff scores for the PAI Validity scales in detecting criminal defendants who are attempting to feign psychiatric disorder.     

Use of structured self-report assessment to diagnose borderline personality disorder during major depressive episodes

Diagnosis of borderline personality disorder (BPD) during episodes of major depression (MDE), although clinically important, is complicated in several respects when using self-report methods. Structured interview data were used to select a group of patients with comorbid BPD (n=21) from a sample of outpatients presenting with MDE. This group was compared with a group of MDE patients without BPD (n=24) and with a group of community controls (n=20) using self-report data from the Personality Assessment Inventory (PAI), the revised Personality Diagnostic Questionnaire (PDQ), and the Beck Depression Inventory (BDI). Analyses revealed that the BPD group obtained significantly higher scores on PAI and PDQ scales measuring features of BPD and on the PAI Negative Impression Management scale. The severity and type of MDE symptoms reported on the PAI and BDI did not differentiate the clinical groups. These data show that useful information for the diagnosis of BPD during depressive episodes can be gathered from self-report assessment instruments like the PAI.     

Deceptiveness on the PAI: a study of naïve faking with psychiatric inpatients

In this study, we sought to explore the diagnostic accuracy of the Personality Assessment Inventory (PAI; Morey, 1991) Validity scales (Negative Impression Management [NIM] and Positive Impression Management [PIM]) and indexes (Malingering index, Defensiveness index [DEF]; Morey, 1993, 1996; Cashel Discriminant Function; Cashel, Rogers, Sewell, & Martin-Cannici, 1995; and Rogers Discriminant Function [RDF]; Rogers, Sewell, Morey, & Ustad, 1996) to identify differences in profiles completed by psychiatric inpatients under standardized instructions (Time 1) and after random assignment (Time 2) to a fake good (n=21), fake bad (n=20), or retest (n=21) scenario. Repeated measures analysis of variance revealed a significant interaction effect. Whereas the retest group did not show any significant changes on the PAI variables from Time 1 to Time 2, both faking groups showed changes in expected directions. Discriminant function analyses revealed that NIM, RDF, and lower scores on DEF best differentiated between the faking bad and retest groups. PIM was the only nonredundant significant score discriminating the faking good and retest groups. Cutoffs for these scales and indexes established in prior research were supported using diagnostic efficiency statistics. Results suggest that NIM and RDF in faking bad scenarios and PIM in faking good scenarios are most sensitive to unsophisticated attempts to dissimulate by inpatient psychiatric patients.     

An Examination of PAI Clinical Descriptors and Correlates in an Outpatient Sample: Tailoring of Interpretive Statements

The Personality Assessment Inventory (PAI; Morey 1991, 2007) was designed to evaluate patterns of psychopathology utilizing validity, clinical, treatment, and interpersonal scales. Its psychometric strengths include easily read items, gradations of responses, and extensive validation. The primary focus of the current study is to examine item-level clinical correlates to inform interpretation. For external validity, the Psychiatric Diagnostic Screening Questionnaire (PDSQ; Zimmerman 2002) was utilized by examining individual items and subscales. The investigation used archival data from 192 outpatients. The most specific and detailed clinical correlates were found for PAI mood disorder scales. Several other clinical scales, such as Schizophrenia (SCZ), had comparatively few clinical correlates. The current findings underscore the need to further validate PAI external correlates in order to augment PAI statements.     

Index Contents of Volume 37 (1973)

The validity of various indicators of response distortion on the Personality Assessment Inventory–Adolescent (PAI–A; Morey, 2007a) and its potential usefulness to detect malingering were evaluated by having 17- and 18-year-old students complete the PAI–A attempting to simulate Attention-Deficit/Hyperactivity Disorder (ADHD) under coached or noncoached conditions. Scores for these respondents on the Negative Impression and Positive Impression scales, the Malingering Index, and the Rogers Discriminant Function (RDF) were compared to those of 17- and 18-year-old patients receiving clinical diagnoses of ADHD. Simulating respondents also completed the Conners Adult ADHD Rating Scale (CAARS) to determine if they could successfully simulate self-reported symptoms of ADHD. A total of 45% of simulating participants obtained CAARS scores reflecting clinically significant symptoms of ADHD. All indicators demonstrated the ability to distinguish between actual patients and feigned responses of successful simulators, with the RDF demonstrating the greatest accuracy in distinguishing these groups.     

Development and initial validation of validity scales for the NEO-Five Factor Inventory

Based upon the methodology established by Schinka, Kinder, and Kremer (Schinka, J. A., Kinder, B. N., & Kremer, T. (1997). Research validity scales for the NEO-PI-R: Development and initial validation. Journal of Personality Assessment, 68, 127–138), a set of validity scales were developed for the NEO-Five Factor Inventory (NEO-FFI, Costa, P. T., & McCrae, R. R. (1992). Revised NEO Personality Inventory and NEO Five Factor Inventory Professional Manual. Odessa, FL: Psychological Assessment Resources). In Study 1, 111 undergraduates completed the NEO-FFI and item means, standard deviations, and intercorrelations were used to construct measures of Positive Impression Management, Negative Impression Management, and Inconsistent Responding. In Study 2, 146 participants completed the NEO-FFI under one of five instructional sets (control, fake good, fake bad, graduate psychology and police academy admissions). A set of randomly produced NEO-FFI profiles were added to this data set. ANOVA results provided support for the utility of the validity scales, as they were differentially sensitive to random responding, positive and negative impression management in hypothesized ways.     

Detecting back irrelevant responding on the Personality Assessment Inventory in a psychiatric inpatient setting

The present studies focus on strategies for detecting back irrelevant responding (BIR) on the Personality Assessment Inventory (PAI; L. C. Morey, 1991). Moderate BIR levels can greatly affect the clinical scales of the PAI. Further, the PAI's Inconsistency and Infrequency validity scales are less than optimal for detecting BIR. L. C. Morey and C. J. Hopwood (2004) developed an alternative strategy for detecting BIR that involves comparison of 2 scales from the PAI short-form with the same 2 scales from the PAI full-instrument. The present study examines how different BIR levels affect the clinical, treatment, and interpersonal scales of the PAI in 2 psychiatric inpatient samples. The effectiveness of various strategies for detecting BIR in an inpatient setting is also discussed. Consistent with previous research, moderate rates of BIR impacted several PAI scales in a meaningful way. The Inconsistency and Infrequency validity scales of the PAI were relatively ineffective for detecting low-to-moderate BIR levels. Conversely, the short-form full-instrument comparison strategy was much more sensitive to BIR. Finally, a new BIR detection indicator is presented that improves sensitivity rates for detecting all BIR levels in an acute setting. The implications of these results for detecting BIR in inpatient settings are discussed.     

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.     

On the validity of validity scales: the importance of defensive responding in the prediction of institutional misconduct

This study examined the effects of defensive responding on the prediction of institutional misconduct among male inmates (N = 349) who completed the Personality Assessment Inventory (L. C. Morey, 1991). Hierarchical logistic regression analyses demonstrated significant main effects for the Antisocial Features (ANT) scale as well as main effects for the Positive Impression Management (PIM) scale in some instances. Significant ANT x PIM interactions also were evident, particularly when examining recommended cut scores on these scales. These results demonstrate the predictive validity of ANT with prisoners and reinforce the importance of context when considering whether validity scales are in fact valid.     

Feigning combat-related posttraumatic stress disorder on the personality assessment inventory

This study examined whether individuals who were instructed on the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) criteria for posttraumatic stress disorder (PTSD) could feign PTSD on the Personality Assessment Inventory (PAI; Morey, 1991). The study also investigated whether PAI indexes of symptom exaggeration, the Negative Impression Management (NIM) scale and the Malingering index, could identify individuals feigning PTSD. The diagnostic rule for PTSD (Morey, 1991, 1996) was applied to the profiles of a group of 23 veterans with combat-related PTSD and 23 male undergraduates instructed to malinger PTSD. Seventy percent of the student malingerers produced profiles that received diagnostic consideration for PTSD. The NIM cutting score (> or = 8) was highly effective in detecting simulation of PTSD but resulted in the misclassification of a large number of true PTSD cases. There were no significant differences in the overall efficiency of the test with various validity criteria. We discuss the implications of these findings for the use of the PAI in the diagnosis of combat-related PTSD.     

Acculturation and peritraumatic dissociation in young adult Latino survivors of community violence

This study examined the relationship between acculturation and peritraumatic dissociation in a sample of 304 physically injured Latino survivors of community violence. Item response theory analyses were conducted to document the measurement equivalence of English- and Spanish-language versions of a scale measuring peritraumatic dissociation. After establishing equivalence, structural equation modeling was used to determine the impact of acculturation on peritraumatic dissociation after controlling for other relevant covariates, including assault characteristics, intoxication before the assault, and trauma exposure history. Acculturation emerged as a significant and negative predictor of dissociation, so that high levels of acculturation were associated with low levels of peritraumatic dissociation. These findings offer a counterinstance to the emerging consensus that retention of Latin American cultural traditions serves to promote mental health.