Potential for Bias in MMPI-2 Assessments Using the Fake Bad Scale (FBS)

Validation of the personality assessment inventory (PAI) cognitive bias (CBS) and cognitive bias scale of scales (CB-SOS) in a post-deployment veteran sample

Objective: The present study evaluated the function of four cognitive, symptom validity scales on the Personality Assessment Inventory (PAI), the Cognitive Bias Scale (CBS) and the Cognitive Bias Scale of Scales (CB-SOS) 1, 2, and 3 in a sample of Veterans who volunteered for a study of neurocognitive functioning. Method: 371 Veterans (88.1% male, 66.1% White) completed a battery including the Miller Forensic Assessment of Symptoms Test (M-FAST), the Word Memory Test (WMT), and the PAI. Independent samples t-tests compared mean differences on cognitive bias scales between valid and invalid groups on the M-FAST and WMT. Area under the curve (AUC), sensitivity, specificity, and hit rate across various scale point-estimates were used to evaluate classification accuracy of the CBS and CB-SOS scales. Results: Group differences were significant with moderate effect sizes for all cognitive bias scales between the WMT-classified groups (d = .52-.55), and large effect sizes between the M-FAST-classified groups (d = 1.27-1.45). AUC effect sizes were moderate across the WMT-classified groups (.650-.676) and large across M-FAST-classified groups (.816-.854). When specificity was set to .90, sensitivity was higher for M-FAST and the CBS performed the best (sensitivity = .42). Conclusion: The CBS and CB-SOS scales seem to better detect symptom invalidity than performance invalidity in Veterans using cutoff scores similar to those found in prior studies with non-Veterans.

Replication and cross-validation of the personality assessment inventory (PAI) cognitive bias scale (CBS) in a mixed clinical sample

Objective: This study is a cross-validation of the Cognitive Bias Scale (CBS) from the Personality Assessment Inventory (PAI), a ten-item scale designed to assess symptom endorsement associated with performance validity test failure in neuropsychological samples. The study utilized a mixed neuropsychological sample of consecutively referred patients at a large academic medical center in the Midwest. Participants and Methods: Participants were 332 patients who completed embedded and free-standing performance validity tests (PVTs) and the PAI. Pass and fail groups were created based on PVT performance to evaluate classification accuracy of the CBS. Results: The results were generally consistent with the initial study for overall classification accuracy, sensitivity, and cut-off score. Consistent with the validation study, CBS had better classification accuracy than the original PAI validity scales and a comparable effect size to that obtained in the original validation publication; however, the Somatic Complaints scale (SOM) and the Conversion subscale (SOM-C) also demonstrated good classification accuracy. The CBS had incremental predictive ability compared to existing PAI scales. Conclusions: The results supported the CBS, but further research is needed on specific populations. Findings from this present study also suggest the relationship between conversion tendencies and PVT failure may be stronger in some geographic locations or population types (forensic versus clinical patients).

Comparing Traumatic Brain Injury Symptoms Reported via Questionnaires Versus a Novel Structured Interview

OBJECTIVE

Mild traumatic brain injury (mTBI) symptoms are typically assessed via questionnaires in research, yet questionnaires may be more prone to biases than direct clinical interviews. We compared mTBI symptoms reported on two widely used self-report inventories and the novel Structured Interview of TBI Symptoms (SITS). Second, we explored the association between acquiescence response bias and symptom reporting across modes of assessment.

METHOD

Level 1 trauma center patients with mTBI (N = 73) were recruited within 2 weeks of injury, assessed at 3 months post-TBI, and produced nonacquiescent profiles. Assessments collected included the SITS (comprising open-ended and closed-ended questions), Rivermead Post Concussion Symptoms Questionnaire (RPQ), Sport Concussion Assessment Tool-3 (SCAT-3) symptom checklist, and Minnesota Multiphasic Personality Inventory-2 Restructured Form True Response Inconsistency (TRIN-r) scale.

RESULTS

Current mTBI symptom burden and individual symptom endorsement were highly concordant between SITS closed-ended questions, the RPQ, and the SCAT-3. Within the SITS, participants reported significantly fewer mTBI symptoms to open-ended as compared to later closed-ended questions, and this difference was weakly correlated with TRIN-r. Symptom scales were weakly associated with TRIN-r.

CONCLUSIONS

mTBI symptom reporting varies primarily by whether questioning is open- vs. closed-ended but not by mode of assessment (interview, questionnaire). Acquiescence response bias appears to play a measurable but small role in mTBI symptom reporting overall and the degree to which participants report more symptoms to closed- than open-ended questioning. These findings have important implications for mTBI research and support the validity of widely used TBI symptom inventories.

A Comparison of the Descriptive Information from the MMPI-2 and MMPI-2-RF

Do MMPI-2 or MMPI-2-RF profiles differ in how accurately they depict examinees? To explore this question, we examined differences in clinical descriptions of equivalent profiles from the two instruments. Fourteen valid MMPI-2 protocols from an archival private practice sample were scored as both the MMPI-2 and the MMPI-2-RF. The resulting 28 profiles were coded separately by four raters using the Midwestern Q-Sort. Examinee descriptions from the two instruments were compared in terms of their (a) similarity, operationalized by q-correlations between corresponding MMPI-2 and MMPI-2-RF ratings; (b) descriptive validity, operationalized by correlations with q-sorts provided by the examinees' therapists; and (c) incremental descriptive validity, operationalized by incremental prediction of the therapist q-sorts by the MMPI-2 and MMPI-2-RF, one over the other. Descriptions from corresponding MMPI-2 and MMPI-2-RF score reports were highly intercorrelated. Ratings from both were valid predictors of therapist descriptions, and neither clearly outperformed the other in terms of incremental validity.

You'd Better Believe It: The Conceptual and Practical Challenges of Assessing Malingering in Patients With Chronic Pain

Chronic pain is a prevalent and costly condition, with many patients receiving income support and funded treatment. Given that pain cannot be assessed objectively, patients may be suspected of exaggerating their pain and disability to receive additional funding. Although numerous methods of detecting malingering have been suggested, it is unclear whether clinicians can reliably identify malingering in patients with chronic pain. The present focus article was developed to assess the theoretical basis and empirical support for proposed methods of detecting malingering in patients with chronic pain. Five approaches were identified: the evaluation of behavioral signs, effort testing, pen and paper measures, symptom validity tests, and combined methods. An examination of the literature revealed that proposed assessment tools have little theoretical basis or empirical support in patients with chronic pain. Additionally, assessment tools are inconsistent with advances in pain science and scores or observations are likely to be influenced by the typical features of chronic pain, including fear-avoidance and central sensitization. Clinicians should be aware that as yet neither subjective clinical opinions nor clinical detection methods can reliably identify malingering in patients with chronic pain. Perspective: There is interest in the development of assessment tools to detect malingering in patients with chronic pain. An evaluation of methods reveals theoretical and empirical limitations that undermine the usefulness of these approaches. As yet, there is no reliable way for clinicians to identify malingering in patients with chronic pain.

MMPI-2 Symptom Validity (FBS) Scale: psychometric characteristics and limitations in a Veterans Affairs neuropsychological setting

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Symptom Validity (Fake Bad Scale [FBS]) Scale is widely used to assist in determining noncredible symptom reporting, despite a paucity of detailed research regarding its itemmetric characteristics. Originally designed for use in civil litigation, the FBS is often used in a variety of clinical settings. The present study explored its fundamental psychometric characteristics in a sample of 303 patients who were consecutively referred for a comprehensive examination in a Veterans Affairs (VA) neuropsychology clinic. FBS internal consistency (reliability) was .77. Its underlying factor structure consisted of three unitary dimensions (Tiredness/Distractibility, Stomach/Head Discomfort, and Claimed Virtue of Self/Others) accounting for 28.5% of the total variance. The FBS's internal structure showed factoral discordance, as Claimed Virtue was negatively related to most of the FBS and to its somatic complaint components. Scores on this 12-item FBS component reflected a denial of socially undesirable attitudes and behaviors (Antisocial Practices Scale) that is commonly expressed by the 1,138 males in the MMPI-2 normative sample. These 12 items significantly reduced FBS reliability, introducing systematic error variance. In this VA neuropsychological referral setting, scores on the FBS have ambiguous meaning because of its structural discordance.

Comparison of Four MMPI-2 Validity Scales in Identifying Invalid Neurocognitive Dysfunction in Traumatic Brain Injury Litigants

Four Minnesota Multiphasic Personality Inventory-2 (MMPI-2) validity scales, the F Scale, Symptom Validity Scale (FBS), Henry-Heilbronner Index (HHI), and Response Bias Scale (RBS), were evaluated in 60 personal injury litigants who sustained a traumatic brain injury (TBI). Based on a modified Slick, Sherman, and Iverson ( 1999 ) diagnostic criteria for malingered neurocognitive dysfunction and utilizing test-effort measures embedded in standard neuropsychological testing, a group of 23 patients with probable invalid neurocognitive dysfunction (PI) and a comparable group of 37 patients with noninvalid neurocognitive dysfunction were identified and compared with respect to their MMPI-2 validity scale scores. Logistic regression analyses, receiver-operating characteristic curve and area under the curve analyses, as well as sensitivity, specificity, positive predictive value, and negative predictive value analyses all revealed that RBS performed better than F, FBS, and HHI in classifying PIs. The present results add to a number of recent studies that suggest that RBS is a useful predictor of symptom validity failure and probable neuropsychological malingering among litigating TBI patients. The study also encourages further research employing embedded test-effort measures in classifying invalid neurocognitive dysfunction per the Slick et al. diagnostic criteria.

Psychological testing and the assessment of malingering

This article discusses the prevalence of feigning in both criminal and civil settings and various psychological assessments useful in detecting feigning. The focus of this information is on the various psychological assessments available to assist clinicians in making a determination of whether or not an individual is feigning and concludes with the recommendations that multiple assessments are necessary to improve the sensitivity of detection methods.

Personality Assessment from the Nineteenth to the Early Twenty-First Century: Past Achievements and Contemporary Challenges

The historical basis of personality assessment that led to the development of today's approaches and applications is described. The modern era of personality assessment began in late nineteenth-century Europe. Early twentieth-century highlights included the development of projective techniques like the Rorschach and several early self-report inventories, culminating in the development of the most widely used measure, the Minnesota Multiphasic Personality Inventory (MMPI). The most recent 30-year period showed expansions into personnel screening; clinical assessment, including wide use in forensic settings; and therapeutic assessment. However, contemporary controversies are apparent with two of the most widely used measures, the Rorschach and the MMPI instruments. These controversies are described, including concerns about the Exner Comprehensive System for the Rorschach and the last five years of changes to the MMPI-2, including the introduction of the Restructured Clinical (RC) Scales, the adoption of the Fake Bad Scale (FBS) into the instrument, and the release of the MMPI-2 Restructured Form (MMPI-2-RF). Current challenges facing psychologists in personality assessment are highlighted.

The MMPI-2 Symptom Validity Scale (FBS) Not Influenced by Medical Impairment: A Large Sleep Center Investigation

The Symptom Validity Scale (Minnesota Multiphasic Personality Inventory—2—FBS [MMPI-2-FBS]) is a standard MMPI-2 validity scale measuring overstatement of somatic distress and subjective disability. Some critics assert the MMPI-2-FBS misclassifies too many medically impaired persons as malingering symptoms. This study tests the assertion of malingering misclassification with a large sample of 345 medical inpatients undergoing sleep studies that standardly included MMPI-2 testing. The variables included standard MMPI-2 validity scales (Lie Scale [L], Infrequency Scale [F], K-Correction [K]; FBS), objective medical data (e.g., body mass index, pulse oximetry), and polysomnographic scores (e.g., apnea/hypopnea index). The results showed the FBS had no substantial or unique association with medical/sleep variables, produced false positive rates <20% (median = 9, range = 4-11), and male inpatients showed marginally higher failure rates than females. The MMPI-2-FBS appears to have acceptable specificity, because it did not misclassify as biased responders those medical patients with sleep problems, male or female, with primary gain only (reducing sickness). Medical impairment does not appear to be a major influence on deviant MMPI-2-FBS scores.