Feigning in adjudicative competence evaluations

Competence to stand trial (adjudicative competence) is the most requested forensic psychiatric evaluation, with an estimated 60,000 referrals annually. The challenge of detecting feigned incompetence has not been systematically studied until the past decade. Estimates of feigned adjudicative incompetence vary from 8 to 21%. This article reviews techniques for detecting malingered psychosis and malingered cognitive impairment during competence evaluations. Specific techniques for assessing feigned adjudicative incompetence and estimating the malingerer's genuine abilities are discussed. A stepwise approach to suspected feigned adjudicative incompetence is proffered. Copyright © 2010 John Wiley & Sons, Ltd.     

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.     

Risk of false positives when identifying malingered profiles using the trauma symptom inventory

The Trauma Symptom Inventory (TSI; Briere, 1995) is a 100-item self-report measure of posttraumatic symptomatology that includes an Atypical Response (ATR) validity scale designed to differentiate honest from malingered profiles. In this study, using an analogue design to experimentally manipulate honest and malingered responses on the TSI, we found that proposed ATR cut scores produce a significant risk of false positives. Furthermore, the functioning of proposed cut scores worsened when we used posttraumatic stress disorder relevant samples and low estimates of malingering base rates. In light of these findings, the TSI should be used with caution when assessing claims of posttraumatic stress in forensic or disability settings.     

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.     

An MMPI-2 scale to detect malingered depression (Md scale)

A specialized Minnesota Multiphasic Personality Inventory-2 (MMPI-2) validity scale was constructed to detect individuals who are knowledgeable about either depression or MMPI-2 detection strategies and who subsequently attempt to malinger depressive symptoms on the MMPI-2. The Malingered Depression (Md) scale consists of 32 items that discriminated college students who feigned depression from those who were genuinely depressed. Further information about the incremental validity and the utility of the Md scale was obtained in a cross-validation study with additional college students who feigned depression and a sample of students with clinically significant depressive symptoms. The results indicate that the Md scale possesses promising value in detecting malingered symptoms of depression.     

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.     

MMPI-2 assessment of malingered emotional distress related to a workplace injury: a mixed group validation

In this study, we examined the capacity of MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 2001) validity indexes to identify malingered depression associated with a workplace injury. We compared 27 graduate students simulating depression with archival records of 33 inpatients diagnosed with major depressive disorder. We employed a mixed-group validation design to generate true positive rates (TPR) and false positive rates (FPR) for the various MMPI-2 validity scales [F, FB, F(p), FBS, F - K, Ds2] while we accounted for base rates of malingering in each sample. The Fake Bad scale (FBS) was the only validity measure that produced acceptable TPR and FPR or a significant correlation with malingering status.     

An examination of the ECST-R as a screen for feigned incompetency to stand trial

Psychological assessments of competency-to-stand-trial (CST) referrals must consider whether the defendants' impairment is genuine or feigned. This study addressed feigning on the Evaluation of Competency to Stand Trial--Revised (ECST-R), a standardized interview designed for assessing dimensions of CST and screening for feigned CST. In particular, this study examined the effectiveness of the ECST-R's Atypical Presentation (ATP) scales as screens for feigned incompetency. It examined ATP scales for (a) jail detainees (n=96) in simulation and control conditions and (b) inpatient competency cases (n=56) in clinical comparison and probable malingering groups. Comparisons of ATP scales yielded very large effect sizes for feigners when compared with jail controls (mean d=2.50) and genuine inpatient competency cases (mean d=1.83). Several cut scores were established with very few false negatives and robust sensitivity estimates. In summary, the ECST-R ATP scales appear to be homogenous scales with established clinical use as feigning screens in CST evaluations.     

Effect of symptom information and intelligence in dissimulation: an examination of faking response styles by inmates on the Basic Personality Inventory

This study employed the Basic Personality Inventory (BPI) to differentiate various types of dis-simulation, including malingered psychopathology and faking good, by inmates. In particular, the role of intelligence in utilizing symptom information to successfully malinger was examined. On admission to a correctional facility, 161 inmates completed the BPI under standard instructions and then again under instructions to fake good (n = 55) or to malinger psychotic (n = 35), posttraumatic stress disorder (n = 36), or somatoform (n = 35) psychopathology. Unlike symptom information, intelligence evidenced some support for increasing inmates' effectiveness in malingering, although there was no relationship between higher intelligence and using symptom information to successfully evade detection. Overall, the BPI was more effective in detecting malingered psychopathology than faking good. Implications for the detection of dissimulation in correctional and forensic settings are discussed.     

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.     

Presenting Evidence of Malingering to Courts: Insights from Decision Theory

The past decade has witnessed a significant increase in research on measures that help detect malingered performance on psychological tests conducted in forensic contexts. After reviewing the principles and procedures that have been used to design and evaluate these measures, we propose a new approach to the presentation of their results. We show how clinicians can use currently-available data and simple mathematical principles first discussed over two centuries ago (Bayes, 1763) to estimate the likelihood that an evaluee is feigning cognitive or emotional problems. Reanalyses of available data may permit professionals to present empirically-grounded probabilistic evidence about malingering in a host of commonly-encountered forensic situations.     

Cross-validation of the MMPI-2 in detecting malingered posttraumatic stress disorder

We attempted to cross-validate findings from a previous study (Elhai, Gold, Sellers, & Dorfman, in press) using a clinical sample of combat-related war veterans to distinguish genuine from malingered posttraumatic stress disorder (PTSD) on the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). The MMPI-2 scores of 124 male combat war veterans at the PTSD outpatient treatment program of a Veterans Affairs Medical Center were compared with those of 84 adult college students instructed and trained to malinger PTSD. MMPI-2 overreporting variables examined were F, F-Fb, F-K, F(p), Ds2, O-S, OT, and FBS. A stepwise discriminant analysis identified F. F-Fb, F-K, Ds2, O-S, and OT as the best malingering predictors. A predictive discriminant analysis yielded good hit rates for the model with impressive cross-validation results. We assessed cutting scores for the predictors of the model. We discuss clinical implications for using the MMPI-2 to distinguish malingered PTSD from combat-related PTSD.     

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.     

WAIS digit span-based indicators of malingered neurocognitive dysfunction: classification accuracy in traumatic brain injury

The present study determined specificity and sensitivity to malingered neurocognitive dysfunction (MND) in traumatic brain injury (TBI) for several Wechsler Adult Intelligence Scale (WAIS) Digit Span scores. TBI patients (n = 344) were categorized into one of five groups: no incentive, incentive only, suspect, probable MND, and definite MND. Performance of 1,063 nonincentive patients (e.g., cerebrovascular accident, memory disorder) was also examined. Digit Span scores included reliable digit span, maximum span forward both trials correct, maximum span forward, combined maximum forward and backward span, Digit Span scaled score, maximum span backward both trials correct, and maximum span backward. In TBI, sensitivity to MND ranged from 15% to greater than 30% at specificities of 92% to 98%. Patient groups with documented brain pathology had higher false-positive error rates. These results replicate previous known-groups malingering studies and provide valuable data supporting the WAIS Digit Span scores in detection and diagnosis of malingering.     

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.     

A Psychometric Study of Stereotypes: Assessment of Malingering in a Criminal Forensic Group

This research investigates the validity of the stereotype of insanity defendants as malingerers by analyzing the proportions of insanity defendants who exaggerate psychopathology at the pre- and postacquittal stages of the legal process and by assessing the severity of psychopathology among preacquittal defendants. We administered the Minnesota Multiphasic Personality Inventory (MMPI) to 49 insanity defendants evaluated for fitness to stand trial and/or sanity at the time of the alleged crime and to 52 subjects previously found not guilty by reason of insanity. Results indicated: (a) Contrary to the stereotype, a minority (14% to 41%) of insanity defendants clearly malingered, whereas 22% to 39% showed evidence of minimizing psychopathology. (b) Eighty-one percent of these subjects had MMPI profiles suggestive of psychosis, but relatively few showed evidence of primarily antisocial behavior. Thus, the malingering stereotype may be application to only a minority of insanity defendants and is specifically inapplicable to a substantial proportion who minimized psychopathology or showed evidence of psychosis consistent with the claim of insanity.     

A psychometric study of stereotypes: assessment of malingering in a criminal forensic group

This research investigates the validity of the stereotype of insanity defendants as malingerers by analyzing the proportions of insanity defendants who exaggerate psychopathology at the pre- and postacquittal stages of the legal process and by assessing the severity of psychopathology among preacquittal defendants. We administered the Minnesota Multiphasic Personality Inventory (MMPI) to 49 insanity defendants evaluated for fitness to stand trial and/or sanity at the time of the alleged crime and to 52 subjects previously found not guilty by reason of insanity. Results indicated: (a) Contrary to the stereotype, a minority (14% to 41%) of insanity defendants clearly malingered, whereas 22% to 39% showed evidence of minimizing psychopathology. (b) Eighty-one percent of these subjects had MMPI profiles suggestive of psychosis, but relatively few showed evidence of primarily antisocial behavior. Thus, the malingering stereotype may be application to only a minority of insanity defendants and is specifically inapplicable to a substantial proportion who minimized psychopathology or showed evidence of psychosis consistent with the claim of insanity.     

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.     

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.     

Feigning Schizophrenic Disorders on the MMPI--2: Detection of Coached Simulators

The Minnesota Multiphasic Personality inventory (MMPI) and, more recently, its revised version (the MMPI-2) have represented the "gold standard" in the psychometric assessment of malingering and other response styles. In this study, we provide a stringent test of the MMPI-2 validity indices and their ability to detect feigned schizophrenia in four groups of simulators (n = 72). Simulators were randomly assigned to one of four conditions: (a) coached on symptoms of schizophrenia, (b) coached on strategies for the detection of fakers, (c) coached on both symptoms and strategies, or (d) uncoached. Simulators were compared to subjects responding under an honest condition (n = 13) and a comparison group of schizophrenic inpatients (n = 37). We found knowledge of strategies alone allowed many simulators (i.e., one third or more, depending on the validity indices) to elude detection, In contrast, knowledge of the disorder appeared less useful to simulators in avoiding detection. Coaching on both strategies and symptoms was not as effective as strategies alone. Consistent with previous studies, uncoached simulators were detected with moderately high Ievels of accuracy.