Association of the MMPI-2 Restructured Form (MMPI-2-RF) Validity Scales with Structured Malingering Criteria

The current study examined the validity scales of the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF; Ben-Porath and Tellegen 2008) in relation to the structured malingering criteria developed to assess malingered neurocognitive dysfunction and pain-related disability. These criteria examined a sample of 251 individuals undergoing compensation-seeking evaluations, who completed a battery of response bias measures. The MMPI-2-RF over-reporting scales yielded large effect sizes in contrasting those in the probable/definite malingering groups from the incentive only groups. The largest effects were found for the Infrequent Responses and Gervais et al. (Assessment, 14, 196–208, 2007) Response Bias Scale, an experimental scale that can be scored on the MMPI-2-RF. Classification analyses were also utilized to examine various cut scores for the individual validity scales, as well as their use in combination. These results suggest that the MMPI-2-RF validity scales can be used to screen for malingering, as they exhibited good sensitivity at lower cutoffs. The implications of these results and their use in forensic evaluations are discussed.     

Malingered Posttraumatic Stress Disorder (PTSD) and the Effect of Direct Versus Indirect Trauma Exposure on Symptom Profiles and Detectability

Posttraumatic stress disorder (PTSD) is arguably prone to malingering due to its subjective and heterogeneous nature. Various factors can influence PTSD symptom profiles including trauma type and trauma exposure. However, it is unknown whether trauma exposure influences malingered PTSD symptom profiles. We used a malingering simulation design with trauma type controlled to compare (1) PTSD symptom profiles (Posttraumatic Stress Checliklist-5; PCL-5) at the syndrome, symptom cluster, and individual symptom levels and (2) symptom validity profiles (Structured Inventory of Malingered Symptomatology; SIMS) at the overall and subscale level, as a function of direct and indirect trauma exposure. Seventy-three participants were randomly assigned to either the direct (“witnessed” trauma) or indirect (“learned about” trauma) condition. Participants were coached about symptoms and instructed to simulate PTSD. PCL-5 profile analyses revealed that simulators in the direct exposure group reported greater overall PTSD severity. Significant differences were found on cluster D (changes in cognition and mood) and individual symptoms including intrusive thoughts, amnesia, difficulty experiencing positive emotions, and risk-taking. No differences were identified for any other symptom scores nor for the symptom validity profile, except for the SIMS total score (direct: M?=?33.0, SD?=?12.8, indirect: M?=?26.5, SD?=?13.9, t(71)?=?2.06, p?=?.043, d?=?.48). These findings indicate that trauma exposure can influence malingered PTSD profiles at the syndrome, symptom cluster, and individual symptom levels (small effects), but, with one exception for a summary score, it does not produce a detectable difference on symptom validity testing. This study may provide insight for clinicians into the how malingered PTSD profiles can manifest as a result of direct and indirect trauma exposure; however, further research is strongly indicated.     

MMPI-2 and MMPI-2-Restructured Form Validity Scales: Complementary Approaches to Evaluate Response Validity

Responsible forensic assessment is dependent on an appreciation for how validity scales differ from one another and function across different evaluation contexts. The primary goal of this review is to evaluate whether there is sufficient empirical support to provide expert testimony using MMPI-2 or MMPI-2-RF validity scales. Towards this goal, we briefly describe the development of MMPI-2 and MMPI-2-RF validity scales and review empirical studies that support interpretative strategies. We describe and illustrate with case examples how the respective sets of MMPI-2 and MMPI-2-RF validity scales utilize complementary strategies to detect over- and under-reporting of psychological, cognitive, and physical symptoms. Additionally, the review describes standards for expert psychological testimony and illustrates how MMPI-2 and MMPI-2-RF validity scales are particularly well suited to assess symptom validity and psychological status in secondary-gain settings.     

Utility of the Inventory of Legal Knowledge in detecting feigning

The Inventory of Legal Knowledge (ILK) is an instrument designed to detect feigning of competency-specific knowledge deficits. Available studies have suggested the ILK may require modification of its cut score to more accurately classify those who are feigning. In this study, the ILK’s concurrent validity and cut scores were tested using 100 college students in a simulation design. Students were randomly assigned to fake (n = 50) or honest (n = 50) groups. Those assigned to the faking group had significantly lower ILK scores than individuals responding honestly with a large effect size between the groups. Despite some promising results, utility estimates indicated an unacceptable level of false positives using the recommended cut score. Tentative recommendations are made in order to improve the efficacy of the ILK in detecting feigning legal knowledge.     

The Detection of Feigned Psychiatric Disorders Using the MMPI-2-RF Overreporting Validity Scales: An Analog Investigation

Individuals who are motivated to feign psychological problems to achieve a desired outcome (e.g., insanity defense) may overreport symptoms of psychopathology, with type of pathology being dependent on the setting. In the current investigation, we examined the utility of the overreporting validity scales (infrequent responses [F-r], infrequent psychopathology responses [F_P-r], infrequent somatic responses [Fs], and symptom validity [FBS-r]) on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (Ben-Porath and Tellegen 2008) to detect research participants instructed to simulate one of three mental disorders: major depressive disorder (MDD), schizophrenia (SCH), or post-traumatic stress disorder (PTSD). The restructured clinical (RC) and overreporting validity scale scores of bona fide psychiatric patients with a primary diagnosis of either MDD, SCH, or PTSD were compared to two groups of simulators—naïve (i.e., undergraduate students with no training in mental disorders) and sophisticated (i.e., individuals with advanced training in psychopathology or personal experience with the disorder asked to overreport symptoms). Examination of the RC Scale profiles revealed that the sophisticated simulators produced symptom profiles more similar to the profiles of the psychiatric patients than did the naïve simulators. For the overreporting validity scales, the sophisticated simulators were less likely to be detected as feigning compared to the naïve simulators; overall, the validity scales were able to distinguish patients from simulators and accurately classify most of the simulators regardless of their level of “symptom” sophistication. Examination and comparison of the validity scales revealed that across disorders and level of research participant symptom sophistication, the F_P-r scale best differentiated simulators from patients.     

Incremental validity of MMPI and MMPI-2 clinical scales in detecting malingering

The efficacy of the F scale and F-K index in detecting faking of a mental illness was investigated for both the MMPI and MMPI-2. A total of 72 undergraduate students completed the MMPI and 74 completed the MMPI-2 after receiving instructions to feign severe mental illness. Student responses were analyzed against MMPI (n=180) and MMPI-2 (n=76) data obtained from psychiatric inpatients diagnosed with severe mental illnesses. Multiple regression analysis of the validity scales and F-K index indicate that the F scale is the best predictor of malingering both for the MMPI (r=64) and MMPI-2 (r=.74) and the two samples combined (r=.71). The Si and D scales accounted for statistically significant, yet small, amounts of incremental validity. The presence of a “sawtooth” pattern did not add any incremental validity. Though an F scale cut-off score of T>109 resulted in an 85.9% classification accuracy rate, it appears that categorizing scores into one of five ranges results in better classification accuracy than a single cut-off score.     

A comparison of simulation and known groups in the detection of malingering on the MMPI-2

Three groups of 30 inmates, one instructed to respond honestly, one to fake being mentally ill, and one to fake schizophrenia after being educated to its symptoms, were administered the MMPI-2. These simulation groups were compared to two forensic evaluation groups of 30 pretrial defendants, one believed to be mentally ill and one suspected of malingering based on their psychiatric history, in order to compare the results of simulation with those of the forensic context. The results demonstrated that those instructed to feign psychiatric disorder and those suspected of malingering in the forensic context scored significantly higher on all MMPI-2 validity indicators than did those with a history of psychiatric treatment and those instructed to respond honestly, yet did not differ from each other. These findings suggest that the results of simulation designs are comparable to those obtained from forensic subjects. The F(p) Scale failed to add incrementally to F in discriminating the two defendant groups.     

Examining the use of the M-FAST with criminal defendants incompetent to stand trial

The Miller Forensic Assessment of Symptoms Test (M-FAST) was developed to provide evaluators with a brief, reliable, and valid screen for malingered mental illness. This study examined the initial validity of the M-FAST in a sample of 50 criminal defendants found incompetent to stand trial because of a mental illness. The M-FAST total score and items were compared with the Structured Interview of Reported Symptoms (SIRS) and the fake-bad indicators of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Results indicated good evidence of construct and criterion validity, demonstrated by t tests, receiver operating characteristics analysis, and high correlations between the M-FAST, SIRS, and the fake-bad indices on the MMPI-2. Tentative cut scores for the M-FAST total score and scales were examined and demonstrated high utility with the sample of criminal defendants incompetent to stand trial.     

Evaluation of an objective assessment technique for the detection of malingered memory deficits

Clinicians generally operate under the implicit assumption that their clients are being honest and putting forth their best effort on assessment procedures. However, clients may realize substantial secondary gains by appearing impaired. The present study evaluates an objective assessment procedure for the detection of malingered memory deficits. Results demonstrate that college students instructed to malinger memory impairment show different patterns of responding and can be clearly differentiated from students performing their best and from actual memory-impaired patients. Applying one of two scores derived from this test to a sample of 20 students instructed to malinger, 20 control subjects, and 20 memory impaired subjects performing their best resulted in a 100% hit rate for normal controls and memory-impaired subjects, and a 65% hit rate for experimental malingerers.This study was presented in a somewhat different form at the 10th Annual Conference of the National Academy of Neuropsychology; November, 1990; Reno. The test evaluated in this study is available to researchers upon request to the second author.     

Associations between MMPI-2-RF (Restructured Form) and Inwald Personality Inventory (IPI) Scale Scores in a Law Enforcement Preemployment Screening Sample

The MMPI-2 is widely used in assessments of police officer candidates. The MMPI-2-RF, composed of 338 of the 567 MMPI-2 items, is designed to measure the core clinical constructs assessed by the MMPI-2, but in a more psychometrically sound and efficient manner (Ben-Porath and Tellegen 2008/2011). Law enforcement comparison group data are embedded in the scoring software for the inventory, and reported in the User’s Guide for the MMPI-2-RF Police Candidate Interpretive Report (PCIR; Corey and Ben-Porath 2014). In the present concurrent validity study, conceptually based hypotheses regarding associations between MMPI-2-RF scales and scores on the Inwald Personality Inventory (IPI, Inwald et al. 1982; Hilson Research 2006), a test specifically designed to screen law enforcement officers, were tested with a sample of 277 male, full-time police officer candidates from four separate police departments of varying sizes examined after a conditional offer of employment was tendered. The majority of participants were Caucasian (69%), followed by African-American (27%), or Other/Mixed ethnicity (4%). Our hypotheses were largely borne out, lending support to the construct validity of the MMPI-2-RF and the ability of scores on the inventory to assess variables relevant to police candidate evaluations.     

The relationship between malingerers' intelligence and MMPI-2 knowledge and their ability to avoid detection

One of the most frequently administered psychometrics is the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Occasionally, those participants taking the MMPI-2 will malinger or exaggerate their symptoms. Several malingering detection devices are available, and a significant body of literature exists concerning their efficacy. However, little research is available considering those factors that facilitate successfully evading detection as a malingerer. Some of these studies have identified general intelligence and knowledge of the MMPI-2 as key variables in the likelihood of escaping detection as a malingerer. The extant research considered the utility of general intelligence and knowledge of the MMPI-2 as predictors in avoiding detection as a malingerer. To detect malingering, the two traditional detection devices were employed: the F-Scale and the F - K Index. Results indicate that intelligence and MMPI-2 knowledge contribute significantly to the likelihood of successfully escaping detection as a malingerer.     

Do Motivations for Malingering Matter? Symptoms of Malingered PTSD as a Function of Motivation and Trauma Type

Psychological disorders associated with traumatic events, such as post-traumatic stress disorder (PTSD), may be prone to malingering due to the subjective nature of trauma symptomology. In general, symptoms tend to be inflated when an external reward (i.e., compensation) is associated with the claim. The present study was designed to test whether malingered claims of PTSD symptoms differed as a function of the type of trauma being malingered (accident, disaster, sexual assault) and the motivation for malingering (compensation, attention, revenge, no motivation). Participants were randomly assigned into conditions, given malingering instructions, and then asked to complete three measures of trauma symptoms (Impact of Event Scale??Revised; Post-Traumatic Stress Disorder Checklist; Trauma Symptom Inventory). Results indicated that participants in the sexual assault condition produced higher symptom reports on nearly all scales. Revenge and compensation motivations yielded elevated symptom scores. Further, individuals rated high in fantasy proneness and dissociation produced elevated scores on atypical responding and most clinical scales. More research is needed to examine the extent to which different motivations and trauma types influence symptom reporting.     

Investigating Differences in Truthful and Fabricated Symptoms of Traumatic Stress over Time

False allegations of victimization typically are accompanied by malingered emotional symptomology to corroborate claims. This analog study was designed to compare truthful and fabricated symptom profiles on measures of post-traumatic stress (i.e., Revised Impact of Event Scale, Post-Traumatic Stress Disorder (PTSD) Checklist, Trauma Symptom Inventory) and levels of symptom consistency over time. Participants (undergraduate students) described their mental health symptoms for both traumas at time 1 (N?=?291), time 2 (N?=?252, 3 month), and time 3 (N?=?181, 6 months). Results indicated that fabricated traumas were associated with inflated symptom profiles. Validity scales were not effective at discerning symptom veracity, although reports could be discriminated somewhat by atypical responding and clinical scales. PTSD symptoms in malingerers also were reported more consistently over time. This research offers applicable information for identifying feigned traumatic stress.     

Detection strategies for feigned psychopathology: test development and effects of criminal charge simulation design on response styles

Feigned psychopathology detection strategy is needed for forensic settings in Thailand. This initial Thai version of the symptoms validity test (SVT-Th) was developed based on two global detection strategies including unlikely and amplified detection strategies proposed by Rogers. The participants were collected from populations of nonclinical undergraduate students and clinical psychiatric patients. Results of Study 1, confirmatory factor analysis (CFA) were used to determine the factor structures of the SVT-Th. The results of CFA supported 2-factorial model as proposed by Rogers. The SVT-Th was found to possess a high degree of internal consistency. Using a simulation designed in Study 2, the experimental group was asked to feign psychopathology to avoid criminal prosecution of homicide charges (simulator undergraduate students). The findings were compared with two control groups who were asked to reply to the questions honestly (honest undergraduate students and honest psychiatric patients). The results indicated that the SVT-Th were significantly distinguishable in the experimental group (classified as feigned response style) from the control groups (classified as honest response style). The area under the ROC curve showed high accuracy classification. The ROC curve determined the optimal cutoff score, sensitivity and specificity for the SVT-Th.     

Simulating amnesia and memories of a mock crime

Abstract

Defendants often feign (i.e. simulate) dissociative amnesia for their crimes. The Symptom Validity Test (SVT) may be used to detect such feigning. Some studies have shown that feigning amnesia for a mock crime has memory-undermining effects. In this study, we wanted to replicate the memory-undermining effects of simulated amnesia. We also examined whether such effects would occur when participants’ memories were evaluated with a SVT. Thirty participants committed a mock crime and then simulated amnesia for it. During a follow-up test, participants were instructed to perform as well as they could on a free recall test and a SVT. Their memory performance was compared with that of a control group (n=30). Although only a minority of simulating participants (7%) was detected by our SVT, the memory-undermining effect of simulating amnesia appeared to be a robust phenomenon. That is, ex-simulators displayed poorer free recall, more commission errors, and lower SVT scores relative to memory performance of honestly responding controls. However, at follow-up testing the poor memory of ex-simulators did not take the form of a real amnesia (i.e. random performance on SVT).     

Neuropsychological and Psychological Aspects of Malingered Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is an anxiety disorder that is frequently encountered in litigation, and as such, there is an increased risk for poor effort on cognitive tests, symptom exaggeration, or frank malingering. These are particularly problematic for accurate diagnosis. This article is divided into four sections. First, we address why individuals malinger PTSD as well as the challenges in detecting an invalid PTSD symptom presentation. Second, we discuss issues of cognitive functioning in PTSD and then the prevalence of and common patterns of poor effort on neuropsychological testing among individuals feigning PTSD. Third, we discuss psychological functioning in PTSD and then the prevalence and patterns of functioning on psychological measures of malingering in this population. Finally, recommendations for detecting invalid PTSD symptom presentations are provided.     

The Verifiability Approach to detection of malingered physical symptoms

Inspired by recent research showing that liars are reluctant to include verifiable details in their accounts, we explored in two studies (N?=?125; N?=?105) whether participants who report fabricated symptoms (‘malingerers’) present fewer verifiable details than participants who report genuine ill-health symptoms. In Study 1, participants were instructed to describe a typical day on which they had experienced a genuine or malingered symptom. Truth tellers’ statements included significantly higher proportions of verifiable details concerning the reported symptoms than malingerers’ statements. Compared with truth tellers, malingerers generated longer statements with more unverifiable details. In Study 2, we informed participants that their statements may be assessed for verifiable or checkable details. Malingerers often mentioned ‘false’ witnesses to provide checkable information and differences between malingerers and truth tellers in statement length, and checkable and uncheckable details were no longer significant. The utility and implications of the Verifiability Approach to detection of malingering are discussed.     

Moral Reminders Do Not Reduce Symptom Over-Reporting Tendencies

Is presenting patients with moral reminders prior to psychological testing a fruitful deterrence strategy for symptom over-reporting? We addressed this question in three ways. In study 1, we presented individuals seeking treatment for ADHD complaints (n = 24) with moral primes using the Mother Teresa Questionnaire and compared their scores on an index of symptom over-reporting (i.e., the Structured Inventory of Malingered Symptomatology, SIMS) with those of unprimed patient controls (n = 27). Moral primes slightly decreased SIMS scores, but the effect was not significant. In study 2, we took a different approach to activate moral categories: we recruited individuals seeking treatment for ADHD complaints and asked some of them to sign a moral contract (i.e., prime; n = 19) declaring that they would complete the tests in an honest way and compared their scores on the SIMS and standard clinical scales measuring self-reported psychopathology with those of unprimed patient controls (n = 17). Again, we found no convincing evidence that moral cues suppress symptom over-reporting. In study 3, we gave individuals from the general population (N = 132) positive, negative, or neutral moral primes and implicitly induced them to feign symptoms, after which they completed a brief validated version of the SIMS and an adapted version of the b Test (i.e., an underperformance measure). Again, primes did not affect over-reporting tendencies. Taken together, our findings illustrate that moral reminders are not going to be useful in clinical practice. Rather, they point towards the importance of studying contextual and individual difference factors that guide moral decision-making in patients and may be modified to discourage symptom over-reporting.     

Can APB 2000 Be Used to Discern Sincerity of Effort in Unimpaired Subjects from Maximal Performance in Subjects with Shoulder Pain?

The automated pegboard (APB 2000), which has been found to objectively quantify motor performance, was used to differentiate maximal motor performance among subjects with shoulder pain, healthy unimpaired subjects performing normally and also while feigning shoulder pain. Six participants with shoulder pain and 15 healthy unimpaired individuals participated. Individuals with shoulder pain were tested on the APB 2000 using their affected upper extremity. Unimpaired participants were instructed to perform normally on the test with randomly selected upper extremity and to feign shoulder pain with the other upper extremity. The two tests for the unimpaired participants were conducted 1 week apart. There were significant differences in mean performance time for normal, patient, and feigned performance, with 80, 111, and 149 sec for the three groups respectively (p < 0.0005). There was also considerable overlap in the three distributions of performance times. These preliminary findings suggest that the APB 2000 is able to distinguish performance time between these three groups. Whether it can be used to distinguish between maximal performance and submaximal performance in individuals suspected of submaximal performance requires further study.     

Antisocial features are not predictive of symptom exaggeration in forensic patients

Purpose

To investigate the predictive value of antisocial personality disorder (ASPD) and features of ASPD (i.e., lack of remorse, blame externalization, and deceitfulness) for symptom exaggeration.

Methods

A sample of forensic psychiatric patients (N = 57) was asked to complete several self‐report instruments (measuring symptom exaggeration, lack of remorse, blame externalization, and offense minimization) and a semi‐structured interview about their most recent offense. To quantify patients’ deceitfulness, the information collected via the semi‐structured interview was checked against the official records of patient's offenses. Additionally, patient's mental disorders and the extent to which patients denied their delinquency were determined by gathering clinician's judgement on this matter from patient records. The relation between symptom exaggeration and the potential predictors of symptom exaggeration was examined through correlational analyses and cross‐tabulation of prevalence rates of symptom exaggeration with prevalence rates of the potential predictors.

Results

Antisocial personality disorder was not a useful predicator of symptom exaggeration. Also, patients who showed little regret for their offenses, or tended to blame their offenses on external factors, or minimized their delinquency, or were inaccurate when reporting their delinquency, had similar levels of symptom exaggeration as those without these tendencies.

Conclusions

Neither ASPD nor antisocial traits, including lack of remorse, blame externalization, and deceitfulness, were meaningfully related to symptom exaggeration and therefore should have no place in the assessment of symptom validity or the detection of malingering. On the contrary; focusing on antisocial traits as indicators of symptom exaggeration is likely to result in large portions of misclassifications.