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.     

Evaluating the gold standard: a review and meta-analysis of the Structured Interview of Reported Symptoms

The Structured Interview of Reported Symptoms (SIRS; Rogers, Bagby, & Dickens, 1992) is often touted as the gold standard of measures of feigning. This label likely arises in part out of the impressive accuracy rates reported in the extensive validation research that preceded its publication. However, since its publication, researchers not only have continued to investigate the measure's utility but have expanded the study of the SIRS to include novel populations, different study methodologies, and abbreviated versions. The current review examines 26 studies using the SIRS to identify feigning, evaluating both its effectiveness at differentiating feigners from genuine responders and the potential impact of moderating variables. Meta-analyses revealed that research published since the initial validation studies demonstrate higher sensitivity but lower specificity rates than those reported in the SIRS manual. Studies in which feigners were composed of simulators yielded higher classification rates than studies sampling actual suspected malingerers. Furthermore, genuine patient samples were significantly more likely than nonclinical samples to be misclassified as feigning. Abbreviated versions of the SIRS also demonstrated equivalent accuracy with the standard measure. The implications of these findings for clinical practice are discussed.     

Detection of Feigned Psychosis with the Structured Inventory of Malingered Symptomatology (SIMS): A Study of Coached and Uncoached Simulators

The aim of the present study was to investigate the efficacy of the Structured Inventory of Malingered Symptomatology (SIMS) to detect feigned psychosis in naïve, informed, and coached participants. Sixty undergraduate students were administered the SIMS and a number of filler questionnaires and asked to fill out the questionnaire honestly (controls; n = 15) or instructed to malinger psychosis because they were standing trial for a serious offense. Before they completed the SIMS, instructed malingerers either received no further information (naïve malingerers; n = 15), some information about psychotic symptoms (informed malingerers; n = 15), or some information about psychosis and a warning not to exaggerate symptoms (coached malingerers; n = 15). Even in the group of coached malingerers, the SIMS had acceptable sensitivity and specificity rates. These findings suggest that the SIMS may be of value in forensic assessments.     

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.     

Deterring malingered psychopathology: The effect of warning simulating malingerers

The utility of a warning to deter malingering on measures of personality and psychopathology was examined. Sixty‐seven first year psychology students were randomly assigned to one of three conditions: unwarned malingerers, warned malingerers, and controls. Participants in the two malingering groups were given a financial incentive to simulate believable psychological impairment. Warned malingerers received an additional warning that the tests could detect malingering and that detection would result in loss of course credit. Controls received standardized test instructions. It was hypothesized that the malingering incentive would be sufficient to induce malingering, but that a deterrence theory warning would have a subsequent deterrent effect. Between‐groups analyses indicated that the warning used in this study significantly altered test performance on the Personality Assessment Inventory (PAI) and revised Symptom Checklist 90 (SCL‐90‐R). Warned malingerers scored significantly lower (faked less) than unwarned malingerers on the majority of the psychopathology scales and frequently approximated control group performances. These results support the effectiveness of a warning to complement existing malingering detection methods. Copyright © 2009 John Wiley & Sons, Ltd.     

Correspondence between self-report and interview-based assessments of antisocial personality disorder

Antisocial personality disorder (ASPD) is associated with suicide, violence, and risk-taking behavior and can slow response to first-line treatment for Axis I disorders. ASPD may be assessed infrequently because few efficient diagnostic tools are available. This study evaluated 2 promising self-report measures for assessing ASPD--the ASPD scale of the Personality Diagnostic Questionnaire-4 (PDQ-4; S. E. Hyler, 1994) and the Personality Assessment Inventory (PAI; L. Morey, 1991, 2007)--as well as the ASPD module of the Structured Clinical Interview for DSM-IV Axis II (SCID-II; M. B. First, R. L. Spitzer, M. Gibbon, J. B. W. Williams, & L. S. Benjamin, 1997). The measures were administered to 1,345 offenders in court-mandated residential substance abuse treatment programs and prisons. PDQ-4 and PAI scores related strongly to SCID-II symptom counts (rs = .67 and .51, respectively), indicating these measures convey useful clinical information about the severity of offenders' ASPD pathology. The dimensional association between the measures was relatively invariant across gender, race, and site, although differences in mean scores were observed. Levels of agreement of the SCID-II with the PDQ-4 (kappa = .31) and PAI (kappa = .32) in classifying participants as ASPD was limited. Alternative thresholds for both self-report measures were identified and cross-validated.     

Validity rates of the Personality Assessment Inventory and the Minnesota Multiphasic Personality Inventory-2 in a VA Medical Center Setting

In this study, we compared protocol validity rates between the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and the Personality Assessment Inventory (PAI; Morey, 1991) in a veteran population. Veterans (N=472) were administered both instruments as part of routine psychological evaluations. Profile validity was based on previously published criteria. When applying primary validity indicators, inpatients produced significantly fewer invalid PAI profiles (37%) than MMPI-2 profiles (63%). We found similar results among outpatients for which we considered 47% of MMPI-2 profiles invalid compared to only 21% of PAI profiles. When applying both primary and supplementary validity indicators, both inpatients and outpatients continued to produce fewer invalid PAI profiles than MMPI-2 profiles. We discuss factors that may be related to the differences in validity rates.     

Personality Assessment Inventory (PAI) Profiles of Male Veterans With Combat-Related Posttraumatic Stress Disorder

The Personality Assessment Inventory (PAI; L. C. Morey, 1991) is a promising tool for the assessment of Posttraumatic Stress Disorder (PTSD), but few studies have examined the PAI profiles of individuals with the diagnosis. In this study, the PAI was administered to 176 combat veterans with PTSD. Results showed significant elevations on scales measuring depression, somatic complaints, anxiety, anxiety-related disorders, schizophrenia, and negative impression management. The Traumatic Stress subscale was the highest point in the mean score profile and was moderately correlated with several established measures of PTSD. Veterans with and without comorbid major depression differed on PAI scales assessing depression, anxiety, and warmth. Analysis of two-point codetypes for the PAI and the MMPI-2 revealed substantial heterogeneity in symptom endorsement on both instruments, suggesting that there may be no clear PTSD profile on either instrument. Results provide a reference point for future work with the PAI in PTSD samples.     

Risk factors for institutional misconduct among incarcerated women: an examination of the criterion-related validity of the Personality Assessment Inventory

Although widely researched in male offender samples, relatively little is known about the clinical utility of the Personality Assessment Inventory (PAI; Morey, 1991) among female prisoners. In this study, we examined the utility of various theoretically relevant PAI scales to predict 3 types of institutional misconduct (general, aggressive/defiant, and covert infractions) in a sample of 113 female inmates incarcerated for at least 1 year. The Antisocial Features (ANT) scale was the most consistent and effective predictor of misbehavior, with limited evidence to suggest that other PAI scales could demonstrate any incremental validity beyond this measure. More important, ANT continued to be associated with institutional misconduct even after controlling for criminal background variables such as prior convictions and a history of violence.     

Unidimensionality of the Brief Symptom Inventory (BSI) in Adult and Adolescent Inpatients

This study investigated the factor structure of the Brief Symptom Inventory (BSI; Derogatis, 1992) for adult and adolescent psychiatric inpatients. The BSI was administered to 217 adults and 188 adolescents at admission, and discharge from a private psychiatric hospital. Principal components factor analyses revealed that most variance among dimension scores was accounted for by one unrotated factor. Factorial invariance was evident across adult and adolescent samples for admission and discharge scores. Our findings are consistent with previous research on the BSI and Symptom Checklist-90-R (Derogatis, 1977), suggesting that both instruments measure primarily a unidimensional construct of general psychological distress.     

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.     

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.     

Convergent and discriminant validity of three measures of depressive personality disorder

Sixty-eight outpatients from a veterans' administration psychiatry clinic and community mental health center were assessed with 3 measures of depressive personality disorder (DPD)-the Diagnostic Interview for Depressive Personality Disorder (Gunderson, Phillips, Triebwasser, & Hirschfeld, 1994), the Depressive Personality Disorder Inventory (Huprich, Margrett, Barthelemy, & Fine, 1996), and the Structured Clinical Interview for DSM-IV Axis II Disorders (First, Gibbon, Spitzer, Williams, & Benjamin, 1997a)-to evaluate their convergent and discriminant validity. Evidence supporting the measures' validity was mixed. The rate of convergence of depressive personality diagnoses across 3 measures was less than optimal, but the degree of intercorrelation among the measures was strong. Although depressive personality scores had moderate levels of intercorrelations with other personality disorders, the degree of intercorrelation decreased substantially after controlling for depressive symptoms. I conclude that further work is needed to strengthen the validity of measures of DPD.     

The concurrent validity of three self-report measures of borderline personality

The recent accumulation of self-report measures of borderline personality disorder (BPD) affords the opportunity to evaluate both the construct validity of the concept and the quality of these measures. This study examines the relationship among three recently developed self-report instruments for assessing BPD from the Personality Assessment Inventory (PAI; Morey, 1991), the MMPI Personality Disorders Scales (MPD; Morey, Waugh, & Blashfield, 1985), and the Bell Object Relations Inventory (BORI: Bell, Billington, & Becker, 1986). Data on the three measures were provided by 119 undergraduate subjects from a southeastern university. A correlational analysis addresses the convergence of these measures of BPD, their divergence from measures of different but related traits, and their independence from variance due to method. Application of the Campbell-Fiske (1959) criteria indicates adequate convergence for all the BPD measures but a lack of discriminant validity for the BORI scales. The fit of the data to a structural model of construct validity is tested using confirmatory factor analysis, and these results are consistent with the hypothesis of a latent borderline trait factor independent of measurement method factors. In sum, the construct validity of the borderline personality concept using self-report methodologies receives support, and a strong association between borderline personality and paranoid phenomena is also suggested.     

Minnesota Multiphasic Personality Inventory (MMPI)-derived psychopathology subtypes among former prisoners of war (POWs): Replication and extension

Psychopathology and symptom patterns identified among former prisoners of war (POWs) by Sutker, Winstead, Goist, Malow, and Allain (1986) were replicated in an independent sample of 51 former POWs with similar personal backgrounds and military experiences. Data collection instruments included the Minnesota Multiphasic Personality Inventory (MMPI), self-report measures of anxiety and depression, and a structured clinical interview including a POW Trauma Index. Two prototypic MMPI profile patterns were identified using modal profile analysis (Skinner & Lei, 1980). Both were highly similar in shape and elevation to those reported in the previous investigation. Multiprofile-multisample analysis produced prototypic profile patterns which were accurate representations of profiles identified in separate analyses of the derivation and replication samples (r's .96). Representing unique constellations of clinical features, profile subtypes were associated differentially with confinement stress severity, postservice adjustment, and nature and extent of stress-induced symptomatology.     

A comparison of the PAI and MMPI-2 as predictors of faking bad in college students

Both the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher et al., 2001) and Personality Assessment Inventory (PAI; Morey, 1991) offer a large set of scales devoted to the identification of response styles. This study directly compared the effectiveness of the 2 inventories as indicators of overreporting. The 2 measures were administered to 52 college students instructed to fake bad under conditions describing either a forensic (n = 24) or psychiatric (n = 28) setting as well as to 432 psychiatric patients. Results indicated that the MMPI-2 F - K index and Fp Scale were the best single indicators of a faking bad response style and that the MMPI-2 scales were the better indicators as a set. However, the PAI scales demonstrated a significant level of incremental validity over the MMPI-2 indicators in every analysis conducted. The findings suggest that either inventory offers an effective approach to the detection of overreporting, and administering both inventories can enhance the accuracy of prediction further.     

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.     

Assessment of accused juvenile sex offenders in Germany: a comparison of five different measures

The present study examines the relationship between risk and protective factors among young alleged sexual offenders (N = 66) in pre-trial and pre-treatment settings. For risk assessment purposes, the Screening Tool for the Assessment of Young Sexual Offenders' Risk (STAYSOR), the Structured Assessment of Violence Risk in Youth (SAVRY), and the Structured Assessment of Protective Factors for violence risk (SAPROF) were used. Psychopathological indicators measured with the Basis Raads Onderzoek (BARO) and the German adaption of the Reynolds Adolescent Adjustment Screening Inventory (RAASI) were used to examine the relationship between the risk assessment scales and instruments measuring risk-relevant psychopathological constructs. Risk and protective factors were significantly negatively correlated. Psychopathological measures were positively correlated with risk factors and negatively with protective factors. Although further studies on the predictive validity of the instruments are needed, the results of the present explorative pilot study indicate that the use of all five instruments may be clinically meaningful for the assessment of young persons who are at risk of sexual offending.     

Maximizing internal and external validity in MMPI malingering research: a study of a military population

The authors investigated the effectiveness of various commonly used Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1943) indices of exaggeration and malingering in detecting suspected malingering in a military sample of 121 enlisted men. To maximize external validity, only men undergoing psychological evaluation were used as participants. Forty-one participants were identified as suspected malingerers through multiple criteria and were contrasted with schizophrenic-spectrum and clinic outpatient groups. To improve internal validity, the 41 suspected malingering participants were asked to retake the test without exaggerating. Results revealed that there were many false positives and fewer, but nonetheless many, false negatives with standard malingering indices. It appeared that the Gough Dissimulation scale (Gough, 1947) might hold the most promise as a measure of malingering, but other scales are also useful. Individual comparisons between different samples and implications for MMPI-2 (Butcher et al., 1989) are presented.     

Predicting physically violent misconduct in prison: A comparison of four risk assessment instruments

Violence in correctional facilities is an important issue for both prisoners and prison staff. Risk assessment instruments have demonstrated their accuracy in predicting the risk of (re) offending and institutional violence in psychiatric settings, but less is known about their ability to predict violent misconduct in prison. The present study applied four risk assessment instruments (Structured Assessment of Protective Factors for violence risk, Historical Clinical Risk Management‐20, Psychopathy checklist – Revised, and Violent Risk Appraisal Guide) to 52 violent offenders in a Swiss prison in order to evaluate the instruments' predictive validities. Outcomes were instances of physically violent, other and any misconduct as recorded in prison files during the 12 months following the prisoners' assessments. Approximately 15% of offenders committed physically violent misconduct and approximately 42% committed any misconduct. The results show that mainly dynamic assessment tools are as good predictors of physically violent misconduct as mainly static assessment tools. Targeting dynamic factors could increase the effectiveness of interventions to reduce the risk of physical violence in prison.