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.     

The detection of malingered mental illness

Clinical approaches to the detection of malingering are examined from the perspectives of both the general practitioner and forensic examiner. Specific strategies for identifying malingering patients is presented with particular attention to psychoses and post-traumatic stress disorders.     

The utility of the MMPI-2 malingering discriminant function index in the detection of malingering: a study of criminal defendants

This study examined the utility of the Minnesota Multiphasic Personality Inventory-2's (MMPI-2) malingering discriminant function index (M-DFI), recently developed by Bacchiochi and Bagby, in the detection of malingering in a forensic sample. Criminal defendants were divided into "malingering" and "not malingering" groups using the structured interview of reported symptoms (SIRS) criteria proposed by Rogers. Logistic regression analysis (LRA) revealed that the MMPI-2 infrequency (F) scale had the best predictive utility of the traditional infrequency scales. Although the M-DFI did significantly differentiate the malingering from the not malingering groups, it did not add significantly to the predictive utility of the MMPI-2 F scale. Receiver operating characteristics analyses demonstrated acceptable sensitivity and specificity for the MMPI-2 F scale, but poor sensitivity for the M-DFI scale. The results are discussed in terms of the utility of the M-DFI in detecting malingering and problems of extending the findings of simulation studies to the forensic context.     

The detection of malingering in neuropsychological assessment

Although malingering, or the manipulation of data by the patient, is a problem commonly faced by neuropsychologists, there has been little systematic investigation of this problem. This paper reviews the literature on the detection of malingering in assessment instruments commonly used by clinical neuropsychologists. Criticism of previous research is discussed, and suggestions are made both for future research and for clinical practice.     

The meaning of malingering data: further applications of Bayes' theorem

A previous Behavioral Sciences and the Law article (Mossman & Hart, 1996) asserted that information from malingering tests is best conceptualized using Bayes' theorem, and that courts therefore deserve Bayesian interpretations when mental health professionals present evidence about malingering. Mossman and Hart gave several examples of estimated Bayesian posterior probabilities, but they did not systematically address how one constructs confidence intervals for these estimates. This article explains how the usually imperfect nature of humanly created diagnostic tests mandates Bayesian interpretations of test results, and describes methods for generating confidence intervals for posterior probabilities. Sample calculations show that Bayesian reasoning is quite feasible and would not require investigators to expend unusual efforts when constructing and validating malingering instruments. Bayesian interpretations most accurately capture what malingering tests do: provide information that alters one's beliefs about the likelihood of malingering.     

The susceptibility of the Rorschach to malingering: a critical review

Empirical studies of malingering on the Rorschach are reviewed. Results from these studies are to this point inconsistent and inconclusive. Although several indices are related to malingering in individual studies, no specific malingering pattern has been found that replicates across studies. A methodological problem specific to this literature is discussed and future research designs are recommended.     

The Susceptibility of the Rorschach to Malingering: A Critical Review

Empirical studies of malingering on the Rorschach are reviewed. Results from these studies are to this point inconsistent and inconclusive. Although several indices are related to malingering in individual studies, no specific malingering pattern has been found that replicates across studies. A methodological problem specific to this literature is discussed and future research designs are recommended.     

Expert testimony on malingering: The admissibility of clinical procedures for the detection of deception

The detection of malingering in the legal context frequently requires the use of psychiatric and psychological expert testimony. These experts may rely on certain clinical techniques in order to detect deception. This article addresses the problem of the admissibility in evidence of clinical procedures used by these experts. The scientific reliability and effect on constitutional rights of procedures such as hypnosis, polygraphy, “truth” drugs, and psychological tests is examined.     

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.     

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.     

Neurological malingering

The detection of malingering in terms of neurologic signs and symptoms is described, including malingered coma, simulated deafness, feigned blindness, feigned weakness, and diminished sensation. While neurologic malingering is not an actual diagnosis, it is best detected through medical procedures. To identify malingering, the physician must demonstrate that the malingered sign or symptom is not caused by a diagnosable order and is instead clearly a consequence of the subject's volition.     

Psychopathy and malingering of psychiatric disorder in criminal defendants

Because the use of deception is an important clinical characteristic of psychopathy, there is intuitive appeal to the idea that psychopathy and malingering are associated. There is, however, very little research showing that psychopaths are more likely to malinger. We classified a sample of criminal defendants as high, moderate, or low in psychopathy, based on PCL-R scores, and compared their scores on indices typically used to detect malingering on the MMPI-2, the PAI and the SIRS. The high psychopathy group scored significantly higher on the MMPI-2 F and F-K; the PAI NIM, and the SIRS, but not the MMPI-2 Fb, F(p), or the PAI RDF or Mal, lending some support for the DSM-IV recommendation that malingering should be considered whenever there is a diagnosis of antisocial personality disorder. Logistic regression analysis (LGA) revealed that Factor I but not Factor II of the PCL-R significantly discriminated malingerers from nonmalingerers with 75% correct classification. However, receiver operating characteristic (ROC) analysis revealed that psychopathy ratings had poor sensitivity and specificity in the detection of malingering. Calculation of the percentages of those exceeding accepted cut-offs on each of the malingering measures revealed that a high percentage of severe psychopaths did not attempt to feign psychiatric disorder. The results suggest that psychopathy is not a clinically useful indictor of malingering. The results are discussed in terms of confirmatory bias and the impact such a bias could have on the evaluation of criminal defendants.     

Malingering of psychological disorders

Differences between clinical and forensic approaches to evaluating individuals for malingering are discussed. Several important studies are discussed relative to malingering in clinical evaluations, objective and projective psychological testing, and neuropsychological assessment procedures.     

Detection of feigned cognitive impairment: The two-alternative forced-choice method compared with selected conventional tests

A two-alternative forced-choice test, two putative malingering tests, and four neuropsychological tests were administered to 105 prison inmates (51 males and 54 females) and 108 university students (54 males and 54 females) in one of three conditions: naive faking, coached faking, and control. Six of the seven tests differentiated faking subjects from controls, but only the forced-choice test differentiated between naive and coached faking. Even though only 11% of the faking subjects performed below the level of chance on the forced-choice test, this test was more sensitive than other tests in distinguishing between faking subjects and controls. The putative malingering tests were the least sensitive measures. The most salient difference between inmates and students was that faking inmates did not respond to a bogus difficulty manipulation in the forced-choice test. The results indicate that the forced-choice method is a sensitive means of detecting dishonest performance even when scores do not fall below chance.     

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.     

An investigation of the relationship between psychopathic traits and malingering on the psychopathic personality inventory

This study employed a repeated-measures simulation design to examine (a) the specific effects of malingering on a recently developed measure of psychopathy, the Psychopathic Personality Inventory (PPI), and (b) the broader association between psychopathic traits and dissimulation. One hundred and forty-three participants completed the PPI twice (both under standard instructions and with instructions to feign psychosis), and also completed post-test questionnaires assessing their attitudes toward engaging in malingering across several hypothetical settings. When attempting to feign psychosis, participants produced elevated scores on a validity scale designed to identify deviant responding, and use of a cross-validated cutoff score with this scale produced high sensitivity and specificity rates across the honest and malingering conditions. Furthermore, PPI scores (in the honest condition) were significantly correlated with a willingness to engage in dissimulation across various hypothetical forensic/correctional scenarios. Results are discussed in terms of the "fakability" of the PPI, as well as the relationship between psychopathic personality features and malingering more generally.     

Evading detection on the MMPI-2: does caution produce more realistic patterns of responding?

Studies on MMPI and MMPI-2 malingering indexes often sacrifice generalizability in an attempt to control internal validity. This study improves external validity while still maintaining internal validity by providing graduate student participants with a realistic context for malingering on the MMPI-2 (n=94) and MMPI (n=30). Contextual parameters include a realistic life predicament, psychological knowledge, an incentive, the presence versus absence of a specific diagnosis, and a caution to be realistic. This study found that cautioning participants not to overexaggerate their responses significantly improves their ability to evade detection on the MMPI-2 and MMPI. Standard malingering indexes (Infrequency, F; Back Side, F, Fb; F-Correction, F-K; and Infrequency-Psychopathology, F(p)) were insufficiently sensitive in identifying simulators using common cutoff scores for these cautious simulators.     

Solving the measurement invariance anchor item problem in item response theory

The efficacy of tests of differential item functioning (measurement invariance) has been well established. It is clear that when properly implemented, these tests can successfully identify differentially functioning (DF) items when they exist. However, an assumption of these analyses is that the metric for different groups is linked using anchor items that are invariant. In practice, however, it is impossible to be certain which items are DF and which are invariant. This problem of anchor items, or referent indicators, has long plagued invariance research, and a multitude of suggested approaches have been put forth. Unfortunately, the relative efficacy of these approaches has not been tested. This study compares 11 variations on 5 qualitatively different approaches from recent literature for selecting optimal anchor items. A large-scale simulation study indicates that for nearly all conditions, an easily implemented 2-stage procedure recently put forth by Lopez Rivas, Stark, and Chernyshenko (2009) provided optimal power while maintaining nominal Type I error. With this approach, appropriate anchor items can be easily and quickly located, resulting in more efficacious invariance tests. Recommendations for invariance testing are illustrated using a pedagogical example of employee responses to an organizational culture measure. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Validity of the M Test: simulation-design and natural-group approaches

The utility of the M Test (Beaber, Marston, Michelli, & Mills, (1985) as a screening measure for malingering was assessed using simulation-design (subjects asked to fake mental illness) and natural-group (forensic assessment cases suspected of malingering) approaches. A total of 318 subjects from community, clinical, and correctional settings completed the M Test under instructions to respond honestly or to simulate a major mental disorder. A factor analysis of the M Test items supported the original rationally based scale assignment, and the scales were found to have adequate internal reliability. To examine the predictive validity of the M Test, results revealed that sensitivity using the cutting scores suggested by Beaber et al. (1985) was much higher for simulating subjects (79.8%) than for the suspected malingerers (40.0%). The findings emphasize the danger of exclusive reliance on simulation studies for validating measures of malingering. It was concluded that, in its present form, the M Test does not constitute a good screening measure for assessing malingering.     

Practical guidelines in the use of symptom validity and other psychological tests to measure malingering and symptom exaggeration in traumatic brain injury cases

The detection of malingering or symptom exaggeration has become an essential component in forensic neuropsychological evaluations, particularly in cases involving personal injury claims. Symptom Validity Tests refer to those measures that can be utilized to detect test performance that is so poor that it is below the level of probability, oftentimes even among brain-damaged populations. This article outlines legal standards for expert testimony in regard to forensic neuropsychological personal injury evaluations. The article provides an outline of specific Symptom Validity Tests and Indicators, and reviews literature supporting test sensitivity and validity. In addition, the use of symptom checklists and questionnaires is discussed, as well as the appropriate use of Symptom Validity Tests and Indicators to establish the presence or absence of malingering or symptom exaggeration.