Traits and Distorted Symptom Presentation: a Scoping Review

Are personality traits related to symptom overreporting and/or symptom underreporting? With this question in mind, we evaluated studies from 1979 to 2020 (k = 55), in which personality traits were linked to scores on stand-alone validity tests, including symptom validity tests (SVTs) and measures of socially desirable responding (SDR) and/or supernormality. As to symptom overreporting (k = 14), associations with depression, alexithymia, apathy, dissociation, and fantasy proneness varied widely from weak to strong (rs .27 to .79). For underreporting (k = 41), inconsistent links (rs − .43 to .63) were found with narcissism, whereas alexithymia and dissociation were often associated with lower SDR tendencies, although effect sizes were small. Taken together, the extant literature mainly consists of cross-sectional studies on single traits and contexts, mostly offering weak correlations that do not necessarily reflect causation. What this field lacks is an overarching theory relating traits to symptom reporting. Longitudinal studies involving a broad range of traits, samples, and incentives would be informative. Until such studies have been done, traits are best viewed as modest concomitants of symptom distortion.

Die differentielle Validität neuropsychologischer Testverfahren zum Nachweis nicht-authentischer Störungen

Ziel dieser Studie ist es, die Eignung unterschiedlicher neuropsychologischer Verfahren zur Diagnostik von nicht-authentischen Störungen zu ermitteln. Darüber hinaus soll untersucht werden, ob Beschwerdenvalidierungstests (BVT) eine höhere Validität gegenüber anderen neuropsychologischen Verfahren zum Nachweis von nicht authentischen Störungen aufweisen. Dazu wurden 59 Probanden untersucht, die zwischen 2003 bis 2013 forensisch-neuropsychologisch begutachtet wurden. Sie wurden hinsichtlich ihrer Authentizität ihrer neuropsychologischen Beschwerden beurteilt. Neben neuropsychologischen Tests wurden auch BVT eingesetzt. Es zeigte sich, dass die BVT hoch signifikant mit der gutachterlichen Gesamtbeurteilung korrelieren. Zwischen den neuropsychologischen Standardverfahren und der gutachterlichen Gesamtbeurteilung konnten keine signifikanten Zusammenhänge nachgewiesen werden. Es sind demnach nur diejenigen Verfahren, die speziell für den Nachweis von nicht-authentischen Störungen entwickelt worden, dazu geeignet, die Authentizität der Beschwerdenschilderung zu messen.

Neuropsychologische Diagnostik und Therapie

Neuropsychologische Befunde haben die Diagnostik und Therapie im Kindes- und Jugendalter in den letzten zehn Jahren erheblich beeinflusst. Am Beispiel von drei Anwendungsfeldern, Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen (ADHS), autistischen und Merkfähigkeitsstörungen, wird die klinische Relevanz des neuropsychologischen Ansatzes diskutiert. Vorgehensweisen wie das Neurofeedback (bei ADHS) oder die neuropsychologische Therapie von Gedächtnisstörungen zeigen neue Wege auf, die in ihrer empirischen Befundlage kritisch diskutiert werden.

Pain, Malingering, and Performance on the WAIS-III Processing Speed Index

Pain patients often report cognitive symptoms and many will include them in their claims of disability. The Processing Speed Index (PSI) of the WAIS-III was investigated as one aspect of cognitive functioning in six groups. Slight impairment was found for PSI and Digit Symbol subtest performance, but not for Symbol Search, in a Laboratory-induced Pain group and a Clinical Pain group. The lowest scores were found in a Simulator group instructed to fake cognitive impairment and a Clinical Pain group diagnosed as Malingering. Results suggest that PSI scores are only slightly reduced by laboratory-induced pain or chronic pain, and that unexpectedly low scores in the absence of significant/documented brain dysfunction suggest poor effort or deliberate misrepresentation.

The prevalence of cognitive malingering in persons reporting exposure to occupational and environmental substances

OBJECTIVE

Directly estimate the prevalence of cognitive malingering in persons claiming exposure to occupational and environmental substances.

METHODS

Retrospective review of 128 neuropsychological cases with financial incentive. Estimates were based on two methods: (1) clinical identification using the Slick, Sherman and Iverson criteria for malingered neurocognitive dysfunction (MND), and (2) statistical modeling based on patient performance on several individual psychometric indicators of malingering.

RESULTS

The prevalence based on the clinical method was 40%. The statistically based estimates ranged from 30% to more than 45% depending on model parameters. Different incentive parameters may influence prevalence.

CONCLUSIONS

Cognitive malingering in toxic exposure is common and must be adequately addressed in the clinical neuropsychological assessment of toxic exposure and in research on its neurocognitive effects or findings will likely over-estimate the degree of cognitive impairment and related disability.

Detection of Feigned Tactile Sensory Loss Using a Forced-Choice Test of Tactile Discrimination and Other Measures of Tactile Sensation

OBJECTIVE

Intentional exaggeration of disability is a risk in work injuries but is hard to reliably detect clinically. This study examined the accuracy of tactile sensory threshold and forced-choice discrimination measures in detecting feigned sensory loss.

METHODS

Participants (n = 80) were randomly assigned to one of four sensory loss groups: (1) none; (2) partial; (3) full; or (4) feigned. Sensory data were collected for the upper extremities.

RESULTS

Tactile thresholds greater than 0.5 g, discriminability less than 0.50, or forced-choice scores less than 90% were associated with a very low probability of false-positive errors.

CONCLUSIONS

Below-chance scores are definitive evidence that the sensory loss is intentionally feigned. Scores beyond cut-offs should raise the clinician's suspicion of malingering if there is no physical basis for sensory loss.

Malingering and Retrograde Amnesia: The Historic Case of the Collegno Amnesic

Assessment of feigned cognitive disorders is an important field of neuropsychology because of its applications to forensic settings. Strategies for detecting malingering in amnesia are available for anterograde amnesia. Less attention has been given to malingering in retrograde amnesia. The case of the 'Smemorato di Collegno' (The Collegno Amnesic) is probably the most famous case of malingered retrograde amnesia ever known in Italy. In 1926, a man who appeared to have lost all his autobiographical memories and identity spent nearly a year in the Collegno asylum of Turin without a name. He was later initially identified as Giulio Canella, Director of the 'Scuola Normale di Verona' who had disappeared during the war in 1916. He was suspected of later identified as being Mario Bruneri, a petty crook from Turin who played the part of an amnesic whose retrograde memory gradually returned. A lengthy investigation was required before this conclusion was reached. Several clinicians and renowned academics evaluated the case, but only Alfredo Coppola, diagnosed "malingered retrograde amnesia" using a method that was extremely innovative for the times. The aim of the present paper is to review the original cognitive evaluation and the strategies used for malingering detection in the "Collegno case". The outcome of the case is then discussed in the light of present-day forensic neuropsychology and the level of advancement of mental examination achieved in the 1920s in Europe is highlighted.

Malingered Neurocognitive Dysfunction in Neurotoxic Exposure: An Application of the Slick Criteria

Toxic torts are increasing across the country and often the results of the neuropsychological evaluation are crucial for defining damages. Therefore, the accurate differentiation of those damaged by toxic exposure from those exaggerating or fabricating deficits is important. However, there is little research on malingering in this context. Presented are four patients claiming cognitive deficits after apparent occupational neurotoxic exposure who were diagnosed as malingering using the Slick, Sherman, and Iverson criteria. The goals of this article were to (1) illustrate the application of the Slick Criteria; (2) discuss current knowledge about the neurological and neurocognitive effects of toxic substances and its impact on clinical decision-making; (3) discuss the application of the Slick Criteria, specifically, and malingering research, generally, to toxic exposure cases; and (4) propose a paradigm in which medical, toxicological and neuropsychology professionals coordinately evaluate cases of alleged neurotoxic chemical exposure.

Detecting malingered neurocognitive dysfunction using the reliable digit span in traumatic brain injury

This study assessed the effectiveness of Greiffenstein's Reliable Digit Span (RDS) score for the detection of malingered neurocognitive dysfunction. Participants were 54 traumatic brain injury patients referred for neuropsychological evaluation. Twenty-four met the Slick, Sherman, and Iverson criteria for at least probable malingered neurocognitive dysfunction. The control group was composed of 30 patients without external incentive and who thus did not meet the Slick criteria. All patients completed the digit span test as part of either the WAIS-R or WAIS-III. The RDS scores were calculated, and sensitivity, specificity, and predictive power were examined for several cutoffs. Classification accuracy for the RDS was excellent. Issues related to the clinical application of this technique are discussed.

Neuropsychologische Diagnostik bei Simulationsverdacht

Zusammenfassung: Vorstellung der Bremer Symptom-Validierung (BSV), einem variabel einsetzbaren Untersuchungsinstrument, für die Identifizierung nichtauthentischer mnestischer, ophthalmologischer und audiologischer Störungen in der Klinischen und der Forensischen Neuropsychologie sowie in der Medizin. Die BSV basiert auf dem Forced-choice-Prinzip und besteht aus 19 computergestützten Untertests. Zur Validierung wurden klinische “At-risk”-Probanden, Patienten mit neurologischen Störungen und gesunde Probanden getestet. Die Testauswertung erfolgt nach einem Cut-off-Wert, einer Blockanalyse sowie probabilistischen Berechnungen. Die BSV erfasst mit 95 %iger Sicherheit das Produzieren nichtauthentischer Fehler. In einem nächsten Schritt ist die Motivation für dieses Handeln zu ergründen, um Simulation, Aggravation und psychogene Störungen voneinander zu unterscheiden.