Screening for feigned psychiatric symptoms in a forensic sample by using the MMPI-2 and the structured inventory of malingered symptomatology

Assessing Negative Response Bias Using Self-Report Measures: New Articles, New Issues

In psychological injury and related forensic evaluations, two types of tests are commonly used to assess Negative Response Bias (NRB): Symptom Validity Tests (SVTs) and Performance Validity Tests (PVTs). SVTs assess the credibility of self-reported symptoms, whereas PVTs assess the credibility of observed performance on cognitive tasks. Compared to the large and ever-growing number of published PVTs, there are still relatively few validated self-report SVTs available to professionals for assessing symptom validity. In addition, while several studies have examined how to combine and integrate the results of multiple independent PVTs, there are few studies to date that have addressed the combination and integration of information obtained from multiple self-report SVTs. The Special Issue of Psychological Injury and Law introduced in this article aims to help fill these gaps in the literature by providing readers with detailed information about the convergent and incremental validity, strengths and weaknesses, and applicability of a number of selected measures of NRB under different conditions and in different assessment contexts. Each of the articles in this Special Issue focuses on a particular self-report SVT or set of SVTs and summarizes their conditions of use, strengths, weaknesses, and possible cut scores and relative hit rates. Here, we review the psychometric properties of the 19 selected SVTs and discuss their advantages and disadvantages. In addition, we make tentative proposals for the field to consider regarding the number of SVTs to be used in an assessment, the number of SVT failures required to invalidate test results, and the issue of redundancy when selecting multiple SVTs for an assessment.

Psychometric Performance of the Miller Forensic Assessment of Symptoms Test (M-FAST) in Veteran PTSD Assessment

This study examined the psychometric properties of a widely used measure of symptom exaggeration, the Miller Forensic Assessment of Symptoms Test (M-FAST, Miller, 2001), in a sample of 209 (83.7% male) trauma-exposed veterans (57.9% probable current posttraumatic stress disorder; PTSD). M-FAST total scores evidenced acceptable internal consistency, but several subscales showed poor internal consistency. Factor analytic and item-response theory analyses identified seven poorly performing items. Comparisons with other measures of psychopathology and response validity (including subscales from the Minnesota Multiphasic Personality Inventory-2 Restructured Form) revealed that M-FAST scores were highly correlated with indices of psychopathology while less strongly associated with measures of symptom over-reporting. Empirically and clinically-derived (using a follow-up testing-the-limits procedure) revised M-FAST scores failed to improve the measure's psychometric performance. Results raise concerns about the validity of the M-FAST for identifying malingering in veterans with PTSD and carry implications for access to care and forensic evaluations in this population.

Detecting malingering mental illness in forensics: Known-Group Comparison and Simulation Design with MMPI-2, SIMS and NIM

BACKGROUND

Criminal defendants may often exaggerate psychiatric symptoms either to appear non-accountable for their actions or to mitigate their imprisonment. Several psychometric tests have been proposed to detect malingering. These instruments are often validated by Simulation Design (SD) protocols, where normal participants are explicitly requested to either simulate a mental disorder or respond honestly. However, the real scenarios (clinical or forensic) are often very challenging because of the presence of genuine patients, so that tests accuracy frequently differs from that one obtained in well-controlled experimental settings. Here we assessed the effectiveness in criminal defendants of three well-known malingering-detecting tests (MMPI-2, SIMS and NIM) by using both Known-Group Comparison (KGC) and Simulation Design (SD) protocols.

METHODS

The study involved 151 male inmates. Participants to the KGC protocol were all characterized by a positive psychiatric history. They were considered as genuine patients (KGC_Controls) if they had some psychiatric disorders already before imprisonment and scored above the cutoff of SCL-90-R, a commonly used test for mental illness, and as suspected malingerers (KGC_SM) if they were diagnosed as psychiatric patients only after imprisonment and scored below the SCL-90-R cutoff. Participants to SD protocol had no history of psychiatric disease and scored below the SCL-90-R cutoff. They were randomly assigned to either group: Controls (requested to answer honestly, SD_Controls) and simulated malingerers (requested to feign a psychiatric disease, SD_SM). All participants were then submitted to MMPI-2, NIM and SIMS.

RESULTS

Results showed that while MMPI-2, SIMS and NIM were all effective in discriminating malingerers in the SD, SIMS only significantly discriminated between KGC_Controls and KGC_SM in the Known-Group Comparison. Receiver Operating Characteristic (ROC) curves analysis confirmed the better sensitivity of SIMS with respect to the other tests but raised some issues on SIMS specificity.

DISCUSSION

Results support the sensitivity of SIMS for the detection of malingering in forensic populations. However, some specificity issues emerged suggesting that further research and a good forensic practice should keep into account multiple measures of malingering, including psychometric data, clinical and social history and current clinical situation. These methodological constraints must be kept in mind during detection of malingering in criminal defendants reporting psychiatric symptoms.

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.

A pilot study on the Chinese Minnesota Multiphasic Personality Inventory-2 in detecting feigned mental disorders: Simulators classified by using the Structured Interview of Reported Symptoms

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is often used in forensic psychological/psychiatric assessment. This was a pilot study on the utility of the Chinese MMPI-2 in detecting feigned mental disorders. The sample consisted of 194 university students who were either simulators (informed or uninformed) or controls. All the participants were administered the Chinese MMPI-2 and the Structured Interview of Reported Symptoms-2 (SIRS-2). The results of the SIRS-2 were utilized to classify the participants into the feigning or control groups. The effectiveness of eight detection indices was investigated by using item analysis, multivariate analysis of covariance (MANCOVA), and receiver operating characteristic (ROC) analysis. Results indicated that informed-simulating participants with prior knowledge of mental disorders did not perform better in avoiding feigning detection than uninformed-simulating participants. In addition, the eight detection indices of the Chinese MMPI-2 were effective in discriminating participants in the feigning and control groups, and the best cut-off scores of three of the indices were higher than those obtained from the studies using the English MMPI-2. Thus, in this sample of university students, the utility of the Chinese MMPI-2 in detecting feigned mental disorders was tentatively supported, and the Chinese Infrequency Scale (ICH), a scale developed specifically for the Chinese MMPI-2, was also supported as a valid scale for validity checking.

The SIMS Screen for feigned mental disorders: the development of detection-based scales

Time-efficient screens for feigned mental disorders (FMDs) constitute important tools in forensic assessments. The Structured Inventory of Malingered Symptomatology (SIMS) is a 75-item true-false questionnaire that has been extensively studied as an FMD screen. However, the SIMS scales are not based on established detection strategies, and only its total score is utilized as a feigning screen. This investigation develops two new feigning scales based on well-established detection-strategies: rare symptoms (RS) and symptom combinations (SC). They are studied in a between-subjects simulation design using inpatients with partial-malingering (i.e., patients with genuine disorders asked to feign greater disabilities) conditions. Subject to future cross-validation, the SC scale evidenced the highest effect size (d=2.01) and appeared the most effective at ruling out examinees, who have a high likelihood of genuine responding.

The temperament and character of korean male conscripts with military maladjustment-a preliminary study

OBJECTIVE

Recently, an increasing number of Korean male conscripts have been retiring because of military maladjustment despite the presence of qualifying medical and psychological screening tests in the Korean army. These problems suggest the presence of a common personality problem. To further examine this possibility, the present study used Cloninger's psychobiological model to investigate the temperament and character of soldiers suffering from military maladjustment.

METHODS

Seventy-nine maladjusted male conscripts and eighty-seven controls enrolled at the 1596th unit from April 2011 to June 2012 participated in the present study. To measure participant personality, we used the Korean version of the Temperament and Character Inventory, Revised-Short. We used logistic regression analysis to examine the association between TCI-RS scores and risk of military maladjustment.

RESULTS

The maladjustment group had a lower rank, socioeconomic status, education level, and a shorter duration of military service than the control group. The harm avoidance and self-transcendence scores were significantly higher in the maladjustment group, with lower scores for reward dependence, persistence, self-directedness, and cooperativeness scores. However, of these measures, only low cooperativeness was associated with an increased risk of military maladjustment.

CONCLUSION

These results suggest that a low level of cooperativeness can predict military inadequacy. Maladjusted male conscripts may have different personality characteristics from normals. To validate our results, further follow-up or cohort studies with a larger sample will be required.

Diagnostic utility of the Structured Inventory of Malingered Symptomatology for identifying psychogenic non-epileptic events

The Structured Interview of Malingered Symptomatology (SIMS) is a self-report instrument that asks patients whether they experience atypical or implausible symptoms. The instrument has not been evaluated in an epilepsy population, and the potential for it to accurately distinguish between patients with psychogenic non-epileptic events (PNEE) and epileptic event groups has not been established. The SIMS was administered to patients in long-term video-EEG monitoring of these patients, 91 with PNEE and 29 with epilepsy were included in this study. Structured Interview of Malingered Symptomatology total scores as well as neurological and affective subscales were found to be predictors of group membership. Sensitivity and specificity across several different base rates of PNEE as well as maximum level likelihood ratios are presented. The findings not only demonstrate the utility of marked score elevations in differentiating PNEE from epilepsy but also point to considerable caution in interpreting mild elevations. Implications for the utility of this instrument in epilepsy evaluations are discussed.

A Comparative Analysis of MMPI-2 Malingering Detection Models Among Inmates

There are several strategies, or models, for combining the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) validity indicators to detect malingered psychiatric symptoms. Some scholars have recommended that an elevated F (Infrequency) score should be followed by the inspection of Fp (Infrequency—Psychopathology), whereas a recent meta-analysis indicated that Fp and Ds (Gough’s Dissimulation Scale) should be examined. For correctional settings, one model of malingering suggests that F, Fp, and F - K (Gough’s Dissimulation Index) should be inspected for one or more elevated scores. Although a large body of research has examined malingering detection with the MMPI-2, this research has typically focused on the contributions of individual validity indicators to differentiate malingered from genuine psychiatric symptoms. Therefore, the current study compared these models of malingering detection on the MMPI-2. Inmate simulators were contrasted with inmates who were hospitalized for psychiatric treatment. Results from classification and logistic regression analyses supported the sequential use of F and Fp in malingering detection.

The Test Validation Summary

Common rates employed in classificatory testing are the true positive rate (TPR), false positive rate (FPR), positive predictive power (PPP), and negative predictive power (NPP). FPR and TPR are estimated from research samples representing populations to be distinguished by classificatory testing. PPP and NPP are used by clinicians to classify test takers into populations. PPP and NPP depend on the base rate (BR) of population members in the clinician's sample. The authors introduce the test validation summary (TVS) as a means to report within a single graph the FPR and TPR and the ranges of PPP and NPP across all potential sample BRs for any chosen cut score. The authors investigate how the TVS has other applications, including the estimation of local BR for the condition of interest and the estimation of standard errors for FPR and TPR when estimated across multiple independent validation studies of the classificatory test.

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.

Measuring symptom exaggeration in veterans with chronic posttraumatic stress disorder

Veteran subjects with chronic, combat-related posttraumatic stress disorder (PTSD) are frequently used as research subjects in the study of PTSD. However, questions have consistently been raised regarding PTSD symptom exaggeration in veteran populations due to the relationship between PTSD symptoms and disability payments within the Veterans Affairs (VA) system. We used a variety of standardized forensic instruments frequently utilized in measuring symptom exaggeration - including the MMPI-2, the Structured Interview for Reported Symptoms (SIRS), the Structured Inventory of Malingered Symptomatology (SIMS), and the Miller Forensic Assessment Test (MFAST) - to examine symptom report in a group of veterans presenting for treatment at a VA residential PTSD treatment program. The majority of Vietnam veteran subjects in our study (53%) exhibited clear symptom exaggeration by SIRS criteria. Within the entire subject group, total SIRS scores correlated significantly with reported PTSD symptom severity as measured by the Clinician Administered PTSD Scale (CAPS).

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.

Detection of Malingering in Psychiatric Unit and General Population Prison Inmates: A Comparison of the PAI, SIMS, and SIRS

In this study, we compared the utility of three instruments, the Personality Assessment Inventory (PAI; Morey, 1991), the Structured Inventory of Malingered Symptomatology (Smith & Burger, 1997), and the Structured Interview of Reported Symptoms (SIRS; Rogers, Bagby, & Dickens, 1992) to detect malingering among prisoners. We examined 4 inmate samples: (a) prisoners instructed to malinger, (b) "suspected malingerers" identified by psychiatric staff, (c) general population control inmates, and (d) psychiatric patients. Intercorrelations among the measures for the total sample (N = 115) were quite high, and receiver operating characteristic analyses suggested similar rates of overall predictive accuracy across the measures. Despite this, commonly recommended cut scores for these measures resulted in widely differing rates of sensitivity and specificity across the subsamples. Moreover, although all instruments performed well in the nonpsychiatric samples (i.e., simulators and controls), classification accuracy was noticeably poorer when attempting to differentiate between psychiatric patients and suspected malingerers, with only 2 PAI indicators significantly discriminating between them.

Identification of Feigned Mental Retardation Using the New Generation of Malingering Detection Instruments: Preliminary Findings

A recent Supreme Court decision--Atkins v. Virginia, 536 U.S. 304 (2002)--prohibiting the execution of mentally retarded (MR) defendants may have raised the attractiveness of feigning this condition in the criminal justice system. Unfortunately, very few published studies have addressed the detection of feigned MR. The present report compared results from tests of intelligence, psychiatric feigning, and neurocognitive faking in a group of 26 mild MR participants (MR) and 25 demographically matched community volunteers asked to feign MR (CVM). Results showed that the CVM suppressed their IQ scores to approximate closely the level of MR participants. WAIS-III and psychiatric malingering measures were relatively ineffective at discriminating feigned from genuine MR. Although neurocognitive malingering tests were more accurate, their reduced specificity in MR participants was of potential concern. Revised cutting scores, set to maintain a Specificity rate of about .95 in MR clients, were identified, although they require cross-validation. Overall, these results suggest that new cutting scores will likely need to be validated to detect feigned MR using current malingering instruments.

Base Rates of Negative Response Bias and Malingered Neurocognitive Dysfunction among Criminal Defendants Referred for Neuropsychological Evaluation

Several studies reveal the prevalence of negative response bias (NRB) in civil forensic settings, but little NRB base rate information is available for criminal forensic neuropsychological settings. We reviewed the published literature on neuropsychological NRB in the civil setting. We then present data from 105 criminal defendants serially referred for neuropsychological assessment to determine the prevalence of NRB. The rate of NRB using one positive indicator was 89.5%. The rate was 70.5% when using two or more positive indicators and 53.3% for three or more indicators. Based on the Slick, Sherman, and Iverson (1999) classification for malingered neurocognitive dysfunction (MND), 19% were Valid, 26.7% were Possible MND, 32.4% were Probable MND, and 21.9% were Definite MND. The combined rate of probable and definite MND was 54.3%. Results suggest rates of neuropsychological NRB and malingering in criminal forensic settings are higher than in civil forensic settings.

Relationships Among Victoria Symptom Validity Test Indices and Personality Assessment Inventory Validity Scales in a Large Clinical Sample

The purpose of this study was twofold: (1) to examine the relationships among measures of cognitive symptom exaggeration (i.e., response accuracy and response latency) and (2) to examine the relationship between measures of cognitive and psychopathological symptom exaggeration. It was expected that Victoria Symptom Validity Test (VSVT) accuracy and latency measures would be significantly correlated, with invalid responders demonstrating longer response latencies. VSVT scores were also expected to correlate significantly with the Negative Impression Management (NIM) and Infrequency (INF) subscales of the Personality Assessment Inventory (PAI). VSVT and PAI data were collected from 300 patients during routine clinical neuropsychological evaluations. Results indicated that VSVT accuracy and latency measures were significantly and moderately correlated, and both types of VSVT scores were significantly, but modestly, related to NIM, but not INF. These findings suggest that VSVT response latencies may supplement accuracy scores in identifying patients who are exerting suboptimal effort on cognitive measures. These findings further suggest that measures of cognitive symptom validity only partially overlap with measures of psychopathological symptom exaggeration.

An evaluation of malingering screens with competency to stand trial patients: a known-groups comparison

The assessment of malingering is a fundamental component of forensic evaluations that should be considered with each referral. In systematizing the evaluation of malingering, one option is the standardized administration of screens as an initial step. The current study assessed the effectiveness of three common screening measures: the Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001), the Structured Inventory of Malingered Symptomatology (SIMS; Widows & Smith, 2004), and the Evaluation of Competency to Stand Trial-Revised Atypical Presentation Scale (ECST-R ATP; Rogers, Tillbrook, & Sewell, 2004). Using the Structured Interview of Reported Symptoms (SIRS) as the external criterion, 100 patients involved in competency to stand trial evaluations were categorized as either probable malingerers (n=21) or nonmalingerers (n=79). Each malingering scale produced robust effect sizes in this known-groups comparison. Results are discussed in relation to the comprehensive assessment of malingering within a forensic context.

Symptom overreporting and recovered memories of childhood sexual abuse

The authenticity of recovered memories is a much debated issue. Surprisingly, no study has systematically looked at symptom overreporting in people claiming recovered memories of childhood sexual abuse (CSA). In a first sample we administered the Structured Inventory of Malingered Symptomatology (SIMS) to individuals who said they had recovered CSA memories (n=66), individuals who said their CSA had always been accessible (continuous CSA memory group; n=119), and controls who said they had no CSA experiences (n=83). In a second sample individuals reporting recovered (n=45) or continuous (n=45) CSA memories completed the Morel Emotional Numbing Test (MENT). Our aim was to compare these groups with regard to their tendency to overreport symptoms. The results indicate that people with recovered memories do not score higher on the SIMS and the MENT than other CSA survivors suggesting that symptom overreporting is not typical for people reporting recovered memories.

Lie detection: historical, neuropsychiatric and legal dimensions

Lying and deception are behaviors that have been studied and discussed extensively in the scientific, philosophical and legal communities for centuries. The purpose of this article is to provide a general overview of the literature and thinking to date about deception, followed by an analysis of the efficacy and evolution of lie detection techniques. The first part explores the definitions of lying, from animal behaviorists' perspectives to philosophical theories, along with demographics and research about the prevalence of lying and characteristics of those who lie. This is followed by a discussion of possible motivations for lying, moral arguments about the legitimacy of or prohibition against lying, and developmental theorists' explanations for the growth of a human being's capacity to lie. The first section provides an introduction for the second part, a historical and critical review of lie detection techniques. Early methods, such as phrenology and truth serums are contrasted with more modern-day approaches, such as polygraphy and functional MRIs. Conclusions are drawn about whether technology has really advanced the art of detecting deception. Finally, the article enters a discussion about the law's response to lie detection methods and to deception in general. United States landmark cases, at both the state and federal level, are critiqued with regard to their impact on the admissibility into court of lie detection methods as evidence. Just as the scientific community has been wary of embracing many of these methods, so has the legal community. Through a review of the legal, scientific and pseudo-scientific issues surrounding deception, a greater understanding is reached of the complexity of this universal and morally loaded behavior.

Comparability of the MMPI-2 F(p) and F scales and the SIRS in clinical use with suspected malingerers

Relationships among Structured Interview of Reported Symptoms (SIRS) scores and Minnesota Multiphasic Personality Inventory--2 (MMPI-2) F(p) and F scores were examined for 63 suspected malingerers evaluated at either of two psychiatric facilities. Despite differences between facilities in terms of seriousness of subjects' offenses, mean scores on the malingering tests were similar. Cutting scores for F(p) and F resulting in substantial correspondence between these scales and the SIRS were derived. Use of the cut score for F(p) proposed by Arbisi and Ben-Porath (1995) resulted in less agreement with the SIRS than did a lower cut score. No substantial difference between F(p) and F in each scale's overall agreement with the SIRS was observed. A principal components analysis of the SIRS primary scales produced two factors, interpreted as Overreporting of Symptoms and Implausible Symptoms. F(p) was observed to correlate significantly with Implausible Symptoms but not with Overreporting of Symptoms; F was significantly correlated with both factors.

Detection of feigned mental disorders: a meta-analysis of the MMPI-2 and malingering

The validity of test data from multiscale inventories is dependent on self-reports that may be easily distorted by malingering. In examining the Minnesota Multiphasic Personality Inventory-2's (MMPI-2) role in the assessment of feigning, this review provides a conceptual analysis of the detection strategies underlying the MMPI-2 validity scales. The conceptual analysis is augmented by comprehensive meta-analysis of 65 MMPI-2 feigning studies plus 11 MMPI-2 diagnostic studies. For the rare-symptoms strategy, Fp (Cohen's d = 2.02) appears especially effective across diagnostic groups; its cut scores evidence greater consistency than most validity indicators. The data supported the F as an effective scale but questioned the routine use of Fb. Among the specialized scales, Ds appeared especially useful because of its sophisticated strategy, consistent cut score, and minimalfalse-positives. General guidelines are offeredfor specific MMPI-2 validity scales in the assessment of malingering with specific diagnoses.