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.     

Alexithymia as a potential source of symptom over‐reporting: An exploratory study in forensic patients and non‐forensic participants

The traditional interpretation of symptom over‐reporting is that it indicates malingering. We explored a different perspective, namely that over‐reporting of eccentric symptoms is related to deficits in articulating internal experiences (i.e., alexithymia). Given that alexithymia has been linked to sleep problems and that fatigue may fuel inattentive responding to symptom lists, we administered measures of alexithymia (TAS ‐20) and symptom over‐reporting (SIMS ), but also sleep quality (SLEEP ‐50) to forensic psychiatric outpatients (n = 40) and non‐forensic participants (n = 40). Forensic patients scored significantly higher on all three indices than non‐forensic participants. In the total sample as well as in subsamples, over‐reporting correlated positively and significantly with alexithymia, with r s being in the 0.50–0.65 range. Sleep problems were also related to over‐reporting, but in the full sample and in the forensic subsample, alexithymia predicted variance in over‐reporting over and above sleep problems. Although our study is cross‐sectional in nature, its results indicate that alexithymia as a potential source of over‐reporting merits systematic research.     

An overview of malingering and deception in neuropsychiatric cases

Forensic practitioners must shoulder special responsibilities when evaluating over-stated pathology (e.g., malingering) as well as simulated adjustment. Such determinations may modify or even override other clinical findings. As a result, practitioners must be alert to their own misassumptions that may unintentionally bias their conclusions about response styles. Detection strategies for malingering—based on unlikely or markedly amplified presentations—are highlighted in this article. Given page constraints, assessment methods for feigning are succinctly presented with their applications to administrative, civil, and criminal referrals.     

TOMM Performances and Self-Reported Symptoms of Depression and Anxiety

The Test of Memory Malingering (TOMM) is the most frequently used symptom validity test (SVT) by neuropsychologists and appears to be robust in the context of a number of neurological and psychiatric conditions. The current study cross-validated and extended prior research by examining the relation between scores on self-report measures of depression and anxiety, independently and combined, and scores on the TOMM in an outpatient neuropsychology clinic. A total of 262 files were reviewed, 67 of which contained complete data on the TOMM, Beck Depression Inventory-II, and the State-Trait Anxiety Inventory. Results show that scores on self-report inventories of depression and anxiety are not significantly related to scores on the TOMM, cross-validating previous research. Extending prior research, current analyses demonstrate that TOMM scores are not significantly influenced by the combined relation of self-reported symptoms of depression and anxiety. Findings support the utility of the TOMM with patients reporting affective disturbances.     

A methodological review of “method skeptic” reports

The literature purporting to demonstrate that clinical neuropsychology is of limited validity in the forensic setting is reviewed critically and alternative interpretations are discussed. The methodological, procedural, conceptual, data analytical and survey/research design limitations are evaluated.Portions of this paper were presented at the 1992 annual meeting of the National Academy of Neuropsychology, Pittsburgh, Pennsylvania.     

罗夏墨迹测验中“装好”与诈病反应的研究与进展

传统观念认为罗夏测验具有投射测验的性质,因此受测者无法在其测验中故意“装好”和诈病。但相关研究发现,受测者的“装好”反应对于罗夏测验结果没有产生实质性的影响,不能改变罗夏测验的基本数据特征和结构汇总性量表;而诈病反应的研究结论不尽相同,受测者有可能造成罗夏测验变量得分的改变,伪装成相应精神病理症状。如果联合使用MMPI和罗夏测验,则可以精确地评估受测者的伪装反应。目前已有的研究存在被试取样单一、研究数量偏少、无法确定临界值等问题。罗夏测验“装好”和诈病反应研究还处于初步阶段,需要继续深入研究并建立专门的“装好”和诈病量表。     

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 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.     

“Yet there’s method in his madness …”: Dimensions of deception and dangerousness

Undiagnosed malingering (symptom overreporting or fabrication) can endanger mental health staff. This review paper presents a systematic and empirically based framework to assess symptom overreporting and violence potential. The first half reviews three models of malingering and their implications for violence potential. The first model proposes that people who malinger are attempting to cope with major mental disorders or organic deficits. The violence potential of these often overlooked disorders is explained. The second model describes how some people with character disorders overreport psychological symptoms and use violence to manage interpersonal relationships. The third model proposes that people who malinger are attempting to get their needs met in complex situations. Mishandling these often desperate people can result in a dangerous situation. The second half of this article focuses on conducting evaluations with potential malingerers, including ethical issues, assessment techniques, and treatment recommendations. Public policy implications are also addressed.