Symptom validity testing of feigned dissociative amnesia: A simulation study

Abstract

It has been argued that Symptom Validity Testing (SVT) has limited sensitivity in correctly identifying feigned autobiographical memory loss (e.g., dissociative amnesia) because malingerers would easily understand that below change performance on the SVT implies feigned memory loss. The current study tested this assumption in a sample of undergraduate students (N = 20) who committed a mock crime and then were instructed to feign complete amnesia for this event. Next, they had to answer 15 forced-choice questions that always contained the correct answer and an equally plausible alternative. Results show that a nontrivial minority of participants (40%) performed below chance. As well, understanding the SVT rationale appeared not to be related to random behaviour. Taken together, the results indicate that SVT procedures might be helpful in identifying feigned dissociative amnesia.     

Detecting Feigned PTSD Using the Personality Assessment Inventory

Research generally supports the use of the Personality Assessment Inventory (PAI; Morey 1991) to detect feigned PTSD, although this support has been somewhat mixed. There is also evidence that coaching individuals on the presence of PAI validity indicators may not affect their ability to avoid detection as feigners (Bagby et al. in Journal of Personality Assessment 78:69–86, 2002), although this question has not been specifically addressed with regard to PTSD. Additionally, a new PAI validity indicator, the Negative Distortion Scale (NDS), was developed that may have utility in detecting feigned PTSD, but this has not been tested. The purpose of this study was to further test the operating characteristics of the PAI validity indicators to detect feigned PTSD among naïve and coached respondents and to examine the newly developed NDS for this purpose. Individuals with genuine PTSD were compared to individuals instructed to feign PTSD on PAI validity indicators. Results suggest that: (a) coaching had minimal influence on the ability of the PAI to detect feigned PTSD, (b) the PAI validity indicators all significantly differentiated genuine from feigned PTSD, and (c) the NIM and NDS indicators were particularly effective for detecting feigned PTSD.     

等速技术检测膝关节伪装瘫痪的可靠性

目的评估等速技术对健康青年志愿者配合及伪装膝关节运动的重测可靠性。方法 30名健康青年志愿者在30°/s角速度下间隔45min执行2次向心全力配合及半力、随机力量伪装膝关节屈伸运动,对2次测试的峰力矩(peak torque,PT)值进行统计学分析。结果全力测试的相对可靠性ICC值(0.892~0.956)大于半力和随机力量的ICC值(0.246~0.481),并且全力的绝对可靠性各参数数值均小于半力和随机力量。结论在配合条件下,等速技术对健康青年膝关节PT的检测具有良好的可靠性,并高于伪装条件下的可靠性。     

DSM-5 and Malingering: a Modest Proposal

The DSM criteria for identifying malingering are reviewed and found to be flawed on both conceptual and practical grounds. Alternative models for diagnosing feigned psychiatric, physical, and neuropsychological symptoms are presented. A number of useful features of these systems are highlighted for potential contributions to modified DSM criteria. It is recommended that the present DSM text on malingering be replaced with feigned psychiatric, physical, or neuropsychological symptoms and suggestions for developing criteria for this condition are made.     

Detecting Feigned Attention-Deficit/Hyperactivity Disorder (ADHD): Current Methods and Future Directions

Feigned attention-deficit/hyperactivity disorder (ADHD) in adults is a significant issue in clinical settings, particularly regarding academic accommodations and access to controlled substances by university students. This article discusses the definitions, base rates, external incentives, psychometric detection strategies, and ethical implications of feigned ADHD. ADHD is characterized by a pattern of developmentally inappropriate inattentive, overactivity, and/or impulsivity, often persisting into adulthood. Estimates of the prevalence of non-credible ADHD in university settings range from 25 to 50%. Feigned ADHD may be detected with symptom and performance validity measures. The existing empirical research has failed to produce a clear psychometric solution to this important differential diagnosis. Identifying feigned ADHD is a difficult task, possibly because of the highly transparent, face-valid diagnostic criteria, and an atypical malingering strategy that evades established detection methods. Performance validity tests remain the best available method for identifying non-credible presentation during psychological evaluations of ADHD. Future practice recommendations should consider educational policy, diagnostic criteria, and psychometric research, including the development of self-report measures that reliably differentiate between genuine and feigned ADHD.     

Feigning incompetency to stand trial

The vulnerability of competency to stand trial instruments to malingering was previously unexamined. In this study, the Georgia Court Competency Test (GCCT) was administered to offenders asked to feign incompetency; their results were compared to controls and pretrial defendants (both competent and incompetent). Offenders appeared to be able to simulate incompetency and tended to score lower on the GCCT than their truly incompetent counterparts. For the detection of simulators, a newly developed Atypical Presentation scale for the GCCT showed promise. In addition, several strategies were explored that included simulators' failure of very simple items (i.e., floor effect) and variable success on items of increasing difficulty (i.e., performance curve). Optimal cutting scores are presented for forensic clinicians to screen defendants for feigned incompetency.     

Forensic Applications of the Miller Forensic Assessment of Symptoms Test (MFAST): Screening for Feigned Disorders in Competency to Stand Trial Evaluations

Forensic evaluations must systematically assess malingering and related response styles. In the criminal forensic domain, competency to stand trial evaluations are the most common referrals. Effective screens for feigned incompetency would be valuable assets for forensic evaluations. This study evaluates the effectiveness of the Miller Forensic Assessment of Symptoms Test (MFAST) as a screen for feigned incompetency. Using a simulation design, the MFAST was tested on jail and competency-restoration samples. Most notably, recommended MFAST cut score (6) was useful for the identification of feigning cases in competency evaluations. Recommendations for forensic practice, including the advantages and disadvantages of systematic screens, are discussed.     

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.     

Overlooking Feigning Behavior May Result in Potential Harmful Treatment Interventions: Two Case Reports of Undetected Malingering

Clinicians tend to overestimate their ability to recognize feigning behavior in psychiatric patients, especially if it concerns patients who have been admitted for observation. Feigning can be either externally motivated (e.g., for financial compensation, known as malingering) or internally motivated (e.g., to assume the “sick role,” known as factitious disorder). Persistent presentation of severe symptoms is usually associated with the factitious disorder. We present two patients with strong external incentives who consistently and convincingly feigned severe psychiatric symptoms during a protracted period of inpatient observation in a specialized center; both were engaged in a procedure for medical asylum. The first case presented with the clinical picture of a psychotic depression with severe motor symptoms, and the second case showed symptoms of a chronic post-traumatic stress disorder with secondary psychotic symptoms. Both cases were thoroughly investigated but feigning was overlooked, and unnecessary and harmful treatment interventions were given. To prevent iatrogenic damage, we recommend a critical attitude that takes malingering as an option into account in settings where patients are often involved in high stake legal procedures. A clinical sign that might indicate feigning is therapy-resistant symptoms. To rule out feigning a comprehensive, multimethod approach is required, but an active stance toward collateral information is essential. Specialized psychological tests may be useful for preliminary screening, but for their use in culturally diverse populations as in refugee mental health more research is needed.     

Detection System for Malingered PTSD and Related Response Biases

This article consists mostly of an appendix on the detection of feigned/malingered PTSD that was justified after analysis of extant malingering detection systems and then presented in Young (2014a) as a long table. The submission reviewers at the journal had considered it appropriate that, although it had been published in book format, it is opened up to peer-review commentary to deal with errors of omission and commission, thereby leading to relevant changes, if any, before further use other than as a guide to assessments in the area. In this regard, we solicit reviews, comments, criticisms, suggestions for change, and so on, with a response (rebuttal) to follow. The present malingered PTSD detection system constitutes the first in the field. It incorporates multiple corrections and additions relative to the extant systems on which it is based (MND, Malingered Neurocognitive Dysfunction; MPRD, Malingered Pain-Related Disability; respectively, Slick, Sherman, & Iverson, 1999; Bianchini, Greve, & Glynn, 2005). It includes very specific rules and procedures both for testing and considering inconsistencies/discrepancies in the file history. Therefore, it is comprehensive and lengthy, or takes about ten times as long to present in tabular format as the MND and MPRD systems on which it is based, (portions in italics indicate what is new to the system). It was constructed to permit the creation of equivalent systems for neurocognition and pain, presented in Young (2014a). The system is useful to mental health professionals not well-versed in psychological testing because, aside from its testing component, it includes extensive procedures for evaluating inconsistencies/discrepancies in examinee files. The system needs evaluation of its reliability and validity, as well as clinical utility.     

Use of the SIRS in Compensation Cases: An Examination of Its Validity and Generalizability

The Structured Interview of Reported Symptoms (SIRS; Rogers et al., Structured interview of reported symptoms (SIRS) and professional manual, 1992) is a well-validated psychological measure for the assessment of feigned mental disorders (FMD) in clinical, forensic, and correctional settings. Comparatively little work has evaluated its usefulness in compensation and disability contexts. The present study examined SIRS data from 569 individuals undergoing forensic neuropsychiatric examinations for the purposes of workers’ compensation, personal injury, or disability proceedings. Using bootstrapping comparisons, three primary groups were identified: FMD, feigned cognitive impairment (FCI), genuine-both (GEN-Both) that encompasses both genuine disorders (GEN-D) and genuine-cognitive presentation (GEN-C). Consistent with the SIRS main objective, very large effect sizes (M Cohen’s d = 1.94) were observed between FMD and GEN-Both groups. Although not intended for this purpose, moderate to large effect sizes (M d = 1.13) were found between FCI and GEN-Both groups. An important consideration is whether SIRS results are unduly affected by common diagnoses or clinical conditions. Systematic comparisons were performed based on common disorders (major depressive disorder, PTSD, and other anxiety disorders), presence of a cognitive disorder (dementia, amnestic disorder, or cognitive disorder NOS), or intellectual deficits (FSIQ < 80). Generally, the magnitude of differences on the SIRS primary scales was small and nonsignificant, providing evidence of the SIRS generalizability across these diagnostic categories. Finally, the usefulness of the SIRS improbable failure-revised (IF-R) scale was tested as a FCI screen. Although it has potential in ruling out genuine cases, the IF-R should not be used as a feigning screen.

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.     

Production of intoxication states by actors--acoustic and temporal characteristics

This paper is the second of a series; the first has been published (J Forensic Sci, 1998;43:1153-62). The goal in the initial pair of experiments was to determine if speakers (actors) could effectively mimic the speech of intoxicated individuals and also volitionally reduce the degradation to their speech that resulted from severe inebriation. To this end, two highly controlled experiments involving 12 actor-speakers were carried out. It was found that, even when sober, nearly all of them were judged drunker (when pretending) than when they actually were severely intoxicated. In the second experiment, they tried to sound sober when highly intoxicated; here most were judged less inebriated than they were. The goal of this second paper is to identify some of the speech characteristics that allowed the subjects to achieve the cited illusions. The focus here is on four paralinguistic factors: fundamental frequency (F0), speaking rate, vocal intensity, and nonfluency level. For the simulation of intoxication study, it was found that F0 was raised along with increased intoxication but raised even more when this state was feigned. A slowing of speaking rate was associated with increasing intoxication, but this shift also was greater when the speaker simulated intoxication. The most striking contrast was found for the nonfluencies; they were doubled for actual intoxication, but quadrupled when intoxication was simulated. On the other hand, the shifts exhibited by the subjects when they attempted to sound sober were not as clear cut. Indeed, no systematic relationships were found here for either F0 or vocal intensity. Both speaking rate and the number of nonfluencies shifted appropriately, but these changes were not statistically significant. In sum, discernable suprasegmental relationships occurred for both studies (but especially the first); further, it is predicted that useful cues also will be found embedded in the segmentals (the sounds of speech).     

Simulation of an attack by self-mutilating cuts and stab wounds

Self-inflicted cut or stab wounds may be used by the injured to make credible a feigned assault. In such cases the alleged traces of the crime are found on the body and the clothing of the informant. Occasionally the very pattern of the injuries points to self-infliction. For example the following findings may be indicative of self-infliction: a greater number of very superficial wounds, wounds parallel or grouped, mostly located on the left side of the body (in right-handers) or symmetry in arrangement, intact clothing or lack of correspondence between wounds and damage of clothing, absence of typical defence and protection injuries. In the light of 4 cases observed from the material at hand, special features of the lesion appearance are shown and possible motives for the deed discussed.     

The Minnesota Multiphasic Personality Inventory-2 Restructured Form and Posttraumatic Stress Disorder: Forensic Applications and Considerations

This paper reviews the empirical literature on the use of the Minnesota Multiphasic Personality Inventory-2 Restructured Form (RF; Ben-Porath and Tellegen 2008; Tellegen and Ben-Porath, 2008) scales for the assessment of posttraumatic stress disorder (PTSD) and PTSD comorbidity and discusses the use of the instrument in forensic contexts. We focus on prior work that has examined the association between the RF scales and PTSD, PTSD comorbidity, and the utility of the RF validity scales for detecting feigned symptoms of PTSD. We conclude that though the MMPI-2 RF scales show expected patterns of association with PTSD, their most useful application in the forensic arena may be in the identification of comorbid personality-based psychopathology, and in detecting symptom overreporting. We recommend that the MMPI-2 RF be used in the context of a comprehensive assessment that includes an exhaustive record review, detailed history with an emphasis on past trauma, and structured diagnostic interviews.     

Psychometric Markers of Genuine and Feigned Neurodevelopmental Disorders in the Context of Applying for Academic Accommodations

The article reviews systemic and context-specific challenges of psychoeducational assessment using two case studies: a 19-year-old woman with feigned attention-deficit/hyperactivity disorder and a 50-year-old man with genuine dyslexia. These cases demonstrate that providing a thorough evaluation of performance validity is an essential component of determining eligibility for academic accommodations in both clinical and higher education settings. At the same time, discounting failure on certain performance validity tests may be necessary to protect against false positive errors. In addition, empirically based test selection and interpretation has the potential to enhance the clinical confidence during differential diagnosis. Examining the internal consistency of a given neurocognitive profile provides valuable clinical information to determine both the credibility of the overall presentation and applying established diagnostic criteria. Although clinical research has yet to identify definitive markers of non-credible neurocognitive profiles, a multivariate approach to performance validity assessment that combines empirically validated indicators and sound clinical judgment can improve detection rates while simultaneously protecting against false positive errors.     

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.     

Factitious Disorder in a Patient Claiming to be a Sexually Sadistic Serial Killer

Factitious disorder involves the conscious simulation of psychological or physiological symptoms of illness, for the purpose of fulfilling the unconscious desire to be taken care of or to assume the “sick role.” Typically patients with factitious disorder simulate conditions that are designed to arouse feelings of empathy in care providers with the intention to engage them in caretaking. However, patients might also simulate conditions that arouse revulsion or rejection and still meet full diagnostic criteria for factitious disorder. In this case report, we present a patient who fabricated an elaborate history of being a sexually sadistic serial killer with homicidal ideation with the intention of obtaining personal attention, nurturance, and empathy from his psychotherapist. However, given the nature of his feigned condition, the patient frightened the very person whom he sought to engage in caretaking.     

A Clinical Comparison,Simulation Study Testing the Validity of SIMS and IOP-29 with an Italian Sample

The Inventory of Problems–29 (IOP-29) was recently introduced as a brief, easy-to-use measure of non-credible mental and cognitive symptoms that may be applied to a wide variety of contexts or clinical conditions. The current study compared its validity in discriminating bona fide versus feigned (via experimental malingering paradigm) psychopathology against that of the Structured Inventory of Malingered Symptomatology (SIMS). Specifically, 452 Italian adult volunteers participated in this study: 216 were individuals with mental illness who were asked to take the SIMS and IOP-29 honestly, and 236 were nonclinical participants (experimental simulators) who took the same two tests with the instruction to feign a psychopathological condition. Two main, broad categories of symptom presentations were investigated: (a) psychotic spectrum disorders and (b) anxiety, depression, and/or trauma-related disorders. Data analysis compared the effect sizes of the differences between the patients and experimental simulators, as well as the AUC and classification accuracy statistics for both the SIMS and IOP-29. The results indicate that the IOP-29 outperformed the SIMS, with the differences between the two tools being more notable within the psychotic (IOP-29 vs. SIMS: d?=???1.80 vs. d?=???1.06; AUC?=?.89 vs. AUC?=?.79) than within the anxiety, depression, and/or trauma related subgroup (IOP-29 vs. SIMS: d?=???2.02 vs. d?=???1.62; AUC?=?.90 vs. AUC?=?.86). This study also demonstrates that the IOP-29, with its single cutoff score, is generalizable culturally and linguistically from the USA (English) to Italy (Italian).     

Differentiating Factitious from Malingered Symptomatology: the Development of a Psychometric Approach

Psychometric symptom validity assessment is becoming increasingly part and parcel of psychological and neuropsychological assessments. An unresolved and rarely addressed issue concerns the differentiation between factitious and malingered symptom presentations: present-day symptom validity tests can assess whether an examinee presents with noncredible symptomatology, but not why an examinee does so. We explored this issue by developing the Symptom and Disposition Interview (SDI); a symptom validity test that incorporates strategies intended to gauge internal incentives associated with factitious disorder. The merits of the SDI were explored and compared to a traditional symptom validity test (the Structured Inventory of Malingered Symptomatology) in two analogue studies, each with factitious and malingering conditions (n = 24–30 per condition) and a clinical control group (n = 34, n = 40). Overall, the results were positive: The SDI was as effective in detecting feigned symptom presentations as a traditional symptom validity test and superior in differentiating factitious from malingered symptom presentations. We conclude that the SDI is not ready for clinical use, but that psychometric approaches to the assessment of factitious symptomatology, such as the SDI, appear sufficiently promising to warrant future research.