Malingering mental disorders: Clinical assessment

Malingering is the dishonest and intentional production of symptoms. It can cause considerable difficulty as assessment runs counter to normal practice, and it may expose clinicians to testing medicolegal situations. In this first part of a two-article review, we explore types of psychiatric malingering and their occurrence across a range of common and challenging scenarios, discussing presentations that may help delineate true from feigned illness. A framework is provided for undertaking an assessment where malingering is suspected, including recommendations on clinician approach, the use of collateral information, and self-evaluation of biases. The uses, and limitations, of psychometric tests are discussed, including ‘general’, malingering-specific and ‘symptom validity’ scales.

Learning Objectives

• Understand the challenges of determining ‘real’ from ‘malingered’ symptomatology across a range of psychiatric conditions

• Have a rational strategy for approaching a clinical assessment where malingering is suspected

• Appreciate the role and limitations of various psychometric tests that can be used in such assessments

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.

Teasing Apart Overclaiming, Overconfidence, and Socially Desirable Responding

Contamination with positivity bias is a potential problem in virtually all areas of psychological assessment. To determine the impact of positivity bias, one common approach is to embed special indicators within one’s assessment battery. Such tools range from social desirability scales to overconfidence measures to the so-called overclaiming technique. Despite the large literature on these different approaches and underlying theoretical notions, little is known about the overall nomological network—in particular, the degree to which these constructs overlap. To this end, a broad spectrum of positivity bias detection tools was administered in low-stakes settings ( N = 798) along with measures of the Big Five, grandiose narcissism, and cognitive ability. Exploratory factor analyses revealed six first-order and two second-order factors. Overclaiming was not loaded by any of the six first-order factors and overconfidence was not explained by either of the two second-order factors. All other measures were confounded with personality and/or cognitive ability. Based on our findings, overclaiming is the most distinct potential indicator of positivity bias and independent of known personality measures.

Differentiating offenders by index offense and personality inventories: the characteristics of adult probationers in Israel

The current study examines the differences between four groups of offenders (N = 230) according to the type of crime they committed: domestic violence, sex offenses, traffic violations, and nonspecific violence offenses. The study was conducted on the offenders undergoing treatment in the Israeli Adult Probation Service. A comparison between the groups included an examination of the differences in aggression levels, anxiety levels, and two Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scales-the Psychopathic Deviate (PD-4) and the Antisocial Practices (ASP) scales. The findings provide a glimpse of the features that characterize each group, in relation to each other and in relation to the body of literature. The domestic violence group differed from the other groups in most of the research variables. They were found to have low anxiety levels and high aggression levels. Together with other findings that pointed to antisocial practices and attitudes, this group constitutes a population that is violent and aggressive to a far greater extent compared with the other groups. Sex offenders were found to be a unique group that does not fit in the "classic offenders" category. They were found to have low aggression levels and high anxiety levels and their scores on PD-4 and ASP scales were low compared with the other groups. The traffic group was characterized with typically low levels of anxiety and high levels of physical aggression. This group also obtained high scores on ASP scale and the measure that examined confrontation with authority figures. Finally, study findings did not indicate characteristics that typify the nonspecific violence offenses.