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.

The detection of malingered posttraumatic stress disorder with MMPI-2 fake bad indices

This investigation explored the effect of posttraumatic stress disorder (PTSD) simulation on Minnesota Multiphasic Personality Inventory-2 (MMPI-2) responses, to detect malingered from genuine PTSD. Sixty-four adult PTSD outpatients at a child sexual abuse (CSA) survivor treatment program were compared with 85 adult college students instructed and trained to malinger PTSD. MMPI-2 overreporting indices examined were F, F-Fb, F-K, F(p), Ds2, O-S, OT, and FBS. A stepwise discriminant analysis identified F(p), F-K, and O-S as the best malingering predictors. A predictive discriminant analysis yielded good hit rates for the model, with impressive cross-validation results. Cutoff scores were assessed for the model's predictors. Clinical implications for detecting malingered PTSD using the MMPI-2 are discussed.

Pain patient profile and the assessment of malingered pain

This study investigated whether a pain sample and pain simulators could be distinguished on the Pain Patient Profile (P3). Forty patients with a pain condition completed the P3 under normal instructions, while 20 students responded under instructions to feign a pain disorder but to attempt to avoid detection. The simulators did not differ on the P3 Validity Scale compared with the pain group, but scored significantly higher than the pain group on the P3 clinical scales (Depression, Anxiety, Somatization). The simulators were more likely to obtain an abnormal score (T score > 55) on all of the clinical scales. The Depression scale had highest positive and negative predictive power and correctly classified 80% of the participants. The P3 may be a useful screening tool for assessing those feigning pain but requires further research.

Validity rates of the MMPI-2 and PAI in a rural inpatient psychiatric facility

This study examines the validity rates of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Personality Assessment Inventory (PAI) profiles in a rural inpatient population. The validity scales of 90 MMPI-2 and 90 PAI profiles were analyzed using published criteria for determining validity. Random responding, positive impression management, and negative impression management were also evaluated. The PAI had a higher number of valid profiles compared with the MMPI-2. Evidence suggests the primary source of the invalid profiles within the MMPI-2 is a higher level of endorsement of relatively rare statements. The substitution of the Infrequency-Psychopathology scale (Fp) for the Infrequency scale (F) on the MMPI-2 substantially reduced the number of invalid profiles. Contrary to expectations, the PAI did not demonstrate lower levels of invalid profiles due to random responding. Rates of invalid profiles for each scale are provided.

Apparent symptom overreporting in combat veterans evaluated for PTSD

Psychometric studies have consistently shown that combat veterans evaluated for posttraumatic stress disorder (PTSD) appear to overreport psychopathology as exhibited by (a) extreme and diffuse levels of psychopathology across instruments measuring different domains of mental illness, and (b) extreme elevations on the validity scale of the MMPI-MMPI-2, in a "fake-bad" direction. The phenomenon of this ubiquitous presentational style is not well understood at present. In this review we describe and delineate the assessment problem posed by this apparent symptom overreporting, and we review the literature regarding several potential explanatory factors. Finally, we address conceptual and practical issues relevant to reaching a better understanding of the phenomenon, and ultimately the clinical syndrome of combat-related PTSD, in both research and clinical settings.

Relationship between symptom over-reporting and pre- and post-combat trauma history in veterans evaluated for PTSD

We examined the prevalence of pre- and post-combat traumatic events in the histories of 129 combat veterans referred to be evaluated for PTSD and examined the impact of these non-combat traumatic events on self-reported psychiatric symptoms. Participants were consecutive referrals to a Veterans Affairs outpatient post-traumatic stress disorder (PTSD) clinic who completed structured interviews, self-report measures (e.g., Minnesota Multiphasic Personality Inventory-2; MMPI-2), and a trauma history questionnaire as part of their routine clinical evaluations. Findings show that non-combat trauma was prevalent in this sample, with 65% (21% pre-combat) reporting physical assaults and 12% (11% pre-combat) reporting sexual assaults. Overall, history of sexual or physical assaults did not appear to be systematically related to reported symptom level. However, chi square analyses revealed a consistent over-representation of veterans who reported sexual trauma in the category suggestive of response exaggeration (i.e., MMPI-2 F-K validity index > or = 13). Finally, a hierarchical regression equation predicting F-K scores was computed, but accounted for only 15.9% of the variance in F-K. Presence of sexual assault history was the only predictor associated with a more pronounced response set suggestive of exaggeration or deception. These findings tentatively indicate that if history of sexual or physical assault has an impact on symptom reporting in combat veterans evaluated for PTSD, it is of modest magnitude.

Detecting exaggeration and malingering in neuropsychological assessment

Magnification of symptoms or nonoptimal effort on neuropsychological tests, within the context of head injury litigation, can have several independent or related underlying causes. Therefore, detecting exaggeration does not automatically indicate that the individual is malingering. This article reviews the evaluative and differential diagnostic process and provides the clinician with suggestions regarding assessment methods. A forensic evaluation that does not include careful consideration of possible negative response bias should be considered incomplete.

Are the MMPI subtle subscales subtle measures of their scales?

This study investigated the ability of the MMPI Wiener-Harmon subtle subscales (on scales D. Hy, Pd, Pa, and Ma) to serve as subtle or unobtrusive measures of their scales. Forty outpatients completed the MMPI under standard instructions, followed by a fake-good or fake-bad instructional set. First, we investigated the paradoxical effect found in the MMPI faking literature (in which, overall, the subtle subscale T-scores change in a direction opposite of the faking instructions) and found that not every subtle subscale shows this effect. Secondly, the subtle subscale T-scores achieved under faking conditions showed no significant relationship to their respective full-scale T-scores achieved under standard conditions. Therefore, our results do not support the Wiener-Harmon subtle subscales as subtle measures of their scales.

Compensation-seeking and extreme exaggeration of psychopathology among combat veterans evaluated for posttraumatic stress disorder

We extended the work of Smith and Frueh (1996) by evaluating whether combat veterans classified as "extreme exaggerators" were more likely to be compensation-seeking, and to report greater levels of psychopathology across self-report instruments than "nonexaggerators." Of 119 veterans who completed the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) at an outpatient posttraumatic stress disorder (PTSD) clinic, 26 (22%) and 17 (14%) were identified as extreme exaggerators using two MMPI-2 validity indicators with stringent cutoffs (F-K > or = 22; F(p) > or = 8). These veterans were much more likely to be compensation seeking and scored much higher on self-report measures of various psychological symptoms than nonexaggerators, despite having lower rates of PTSD diagnoses and similar rates of other comorbid diagnoses. Findings suggest that the validity indices of the MMPI-2 can play a critical role, as a screening instrument, in identifying veterans who may be exaggerating their psychopathology to gain disability compensation.

Profile validity standards for MMPI and MMPI-2 F scales

Although numerous indices of validity have been developed for the MMPI and MMPI-2, interest in the F scale and its variants continues, especially among practicing clinicians. The use of the binomial for assessing standards for random answering and possibly for judgments of malingering offers another approach for the interpretation of F-scale scores. The theoretical binomial distribution and Monte Carlo data are in accord. Cut-off scores of 24 for the MMPI and 23 for the MMPI-2 suggest random responses, and scores of 40 and 37, respectively, suggest clinical interpretation rather than randomness of responding.

The R-CRAS and insanity evaluations: a re-examination of construct validity. Rogers Criminal Responsibility Assessment Scales

Insanity evaluations are characterized by continued professional debate and the paucity of empirical research. To address the latter, the construct validity of the Rogers Criminal Responsibility Assessment Scales (R-CRAS; Rogers, 1984) was examined via an extensive re-analysis of 413 insanity cases. A series of six separate discriminant analyses was examined to address major components of insanity evaluations. These analyses yielded highly discriminating patterns (M hit rates of 94.3%) and accounted for substantial proportion of the variance (M=63.7%). In general, predicted relationships between individual variables and the discriminant functions were supported. We also addressed the usefulness of the R-CRAS additional variables for the assessment of insanity. We found that these variables contributed substantially to the determination of criminal responsibility. Finally, we pose important and polemical issues for forensic experts conducting evaluations of criminal responsibility.

The PAI and feigning: A cautionary note on its use in forensic-correctional settings

Indicators of feigned PAI profiles were derived from comparisons of simulators instructed to feign and genuine patient groups. Concerns are raised regarding whether these indicators are applicable to forensic and correctional populations and can be cross-validated with a known-groups comparison. Compiling data on 57 malingerers and 58 genuine patients from two forensic and correctional sites, three primary indicators of feigning, Negative Impression (NIM) scale, Malingering Index, and the Rogers Discriminant Function (RDF) were investigated. Results suggested that the RDF was not applicable to forensic referrals. However, NIM 77T appeared to be a useful screen for forensic samples. In addition, convergent evidence of feigning was found across designs (simulation and known-groups) and samples (non-forensic and forensic) for extreme elevations on NIM (>/=110T) and Malingering Index (>/=5).

Minor head trauma

This article reviews the persisting difficulty and the importance of the diagnosis of minor head trauma. The diagnosis has been complicated by pervasive disagreement regarding diagnostic criteria. This is primarily a result of the fact that evidence for actual injury is hard to obtain in minor cases because most symptoms tend to be subjective and have high base rates in the normal, uninjured population. At the same time, the diagnostic decision has important implications for patients in terms of treatment, expectancy for future function and lifestyle, and compensation for injuries. Decision theory leads us to the awareness of diagnostic errors. In addition to correct determination, the clinician can make an error of not diagnosing an injury when it has in fact occurred or making a positive diagnosis where there is no injury. The optimal strategy is to set the cutoff at the midpoint of these two error probabilities. The clinician may be willing to make one error rather than the other depending on the cost and bias involved. The second error is more likely to be made when the clinician stands as a strong advocate for the patient and willing to provide any help necessary to encourage treatment, give patients a rationale for understanding their symptoms, and help them obtain compensation for injuries. This can also lead to significant overdiagnosis of injury. The first error is more likely to be made when the clinician recognizes the potential for increasing costs to the health-care industry, the court system, and increasing personal injury claims. He or she may also recognize the vulnerability to the risk for symptom invalidity, the perpetuation of patient symptoms through suggestion, and the need for a biologic explanation for life stressors and preexisting emotional and personality constraints. It can be argued that the most objective diagnostic opinion, uninfluenced by the above biases, should ultimately be in the best interest of the patient, the clinician, legal consultants, and society. Based on the findings in this chapter, at least four symptom constellations can be identified. These have differing probabilities for residual symptoms of minor head trauma and include the following: 1. These patients' symptoms clearly meet the criteria from Table 2. This includes several findings from 1 to 10 of Table 1, together with abnormal neuropsychologic testing on the AIR, General Neuropsychological Deficit Scale, or other indicators of diminished cortical integrity. This group of patients shows a very strong probability of having experienced a brain injury and for showing residual symptoms of minor head trauma. 2. These patients have experienced concussional symptoms (e.g., headache, mild confusion, and balance and visual symptoms) that were documented at the time of injury but sustained no or brief (< 15 seconds) LOC or PTA and, therefore, do not qualify for the diagnosis in Table 2. They may still have several symptoms from Table 1, including objective findings from neuroscanning and variable neuropsychologic testing, especially in measures of attention and delayed recall. This group also shows a high probability for residual, unresolved concussional, and related symptoms. 3. These patients may have shown evidence of concussional symptoms at the time of injury, with no or brief LOC, PTA, or other symptoms from Table 1 (1-10). They continue to show persistent symptoms after 6 months to 1 year. With this group, there is a strong probability that emotional, motivational and premorbid personality factors are either causing or supporting these residual symptoms. 4. In these patients, clearly identifiable postconcussive symptoms at the time of injury are not easy to identify, and perhaps headache is the only reported symptom. There was no LOC or PTA, and virtually none of symptoms 1 to 10 in Table 1 are observed. These patients show strong evidence of symptom invalidity on MMPI-2 or other measures, and marked somatoform, depression, anx

Feigning psychopathology among adolescent offenders: validation of the SIRS, MMPI-A, and SIMS

Clinical decision rules for the assessment of feigning and related response styles have not been systematically investigated in adolescent populations. For instance, evaluations of feigning on the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) involve cutting scores extrapolated from adult studies with the MMPI/MMPI-2. Such extrapolations are unwarranted because (a) adolescents perform differently than adults on MMPI/MMPI-2 validity scales and (b) the MMPI-A validity and clinical scales are substantively different than the MMPI/MMPI-2. Given the dearth of adolescent data, this study examined the clinical usefulness of three measures in the assessment of feigning: MMPI-A, Structured Interview of Reported Symptoms (SIRS), and Screening Index of Malingered Symptoms (SIMS). Employing a within-subjects analogue study on 53 dually diagnosed adolescent offenders, we found that commonly used MMPI-A scales (F, F1, and F2) were ineffective, but that F-K > 20 appeared promising. For the SIRS, classification of feigning based on adult criteria yielded moderate positive predictive poser and superb negative predictive power. As a screen, the SIMS proved to be moderately effective in identifying feigned protocols. Finally, two-stage discriminant analysis offered initial support of the incremental validity of a combined SIRS and MMPI-A evaluation of adolescent feigning.