Detection of Malingered PTSD: An Overview of Clinical,Psychometric, and Physiological Assessment: Where Do We Stand?

ABSTRACT: Posttraumatic stress disorder (PTSD) is a condition that can be easily malingered for secondary gain. For this reason, it is important for physicians to understand the phenomenology of true PTSD and indicators that suggest an individual is malingering. This paper reviews the prevalence of PTSD for both the general population and for specific events, such as rape and terrorism, to familiarize evaluators with the frequency of its occurrence. The diagnostic criteria for PTSD, as well as potential ambiguities in the criteria, such as what constitutes an exposure to a traumatic event, are reviewed. Identified risk factors are reviewed as a potential way to help differentiate true cases of PTSD from malingered cases. The question of symptom overreporting as a feature of the disease versus a sign of malingering is discussed. We then examine how the clinician can use the clinical interview (e.g., SIRS, CAPS), psychometric testing, and the patient's physiological responses to detect malingering. Particular attention is paid to research on the MMPI and the subscales of infrequency (F), infrequency-psychopathology (Fp), and infrequency-posttraumatic stress disorder (Fptsd). Research and questions regarding the accuracy of self-report questionnaires, specifically the Mississippi Scale (MSS) and the Personality Assessment Inventory (PAI), are examined. Validity, usability, and cutoff values for other psychometric tests, checklists, and physiological tests are discussed. The review includes a case, which shows how an individual used symptom checklist information to malinger PTSD and the inconsistencies in his story that the evaluator detected. We conclude with a discussion regarding future diagnostic criteria and suggestions for research, including a systematic multifaceted approach to identify malingering.     

The Relationship Between Psychopathic Personality Features and Malingering Symptoms of Major Mental Illness

This study examined the relationship between psychopathy and malingering in a subsample of male prison inmates (n = 55) participating in a larger study of the clinical utility of various assessment measures in correctional settings. Participants' capacity to feign major mental illness successfully was evaluated using standard cutoff scores for the detection of malingering on a variety of instruments, including the Structured Inventory of Malingered Symptomatology (SIMS; G. P. Smith & G. O. Burger, 1997), the Structured Interview of Reported Symptoms (SIRS; R. Rogers, R. M. Bagby, & S. E. Dickens, 1992), and the Personality Assessment Inventory (PAI; L. Morey, 1991). Psychopathic traits were assessed via the Psychopathic Personality Inventory (PPI; S.O. Lilienfeld & B. P. Andrews, 1996). Correlations between the malingering indices and the PPI were low (–.14 to .14) and not statistically significant. These findings fail to support the clinical intuition that individuals with higher levels of psychopathy are likely to be more adept at malingering.     

Clinical presentation of malingerers diagnosed by experienced forensic psychologists

Little is known about the incidence of malingering or the diagnostic criteria for malingering employed by forensic clinical psychologists conducting pretrial evaluations for the criminal justice system. The clinical presentations of 39 criminal defendants diagnosed as malingering psychotic symptoms were contrasted with 25 defendants diagnosed as genuinely psychotic. The incidence of diagnosed malingering was 8% in a series of 314 consecutive evaluations. Malingerers differed from psychotics on 14 of 24 clinical presentation variables, including measures of general presentation, affect, hallucinations, delusions, and formal thought disorder. Results indicate consistent clinical features associated with the diagnosis of malingered psychosis.A summary of this study was presented at the 1988 Annual Convention of the American Psychological Association in Atlanta, Georgia. We very much appreciate the contribution made by the six forensic clinical psychologists at the Michigan Center for Forensic Psychiatry who volunteered to participate in this study.     

Screening for Malingering in a Correctional Setting

This study outlines the development of the Screening SIRS, an abbreviated version of the Structured Interview of Reported Symptoms (SIRS), for use as a screening measure of malingering in a correctional setting. Seventy-five inmates complaining of psychological impairment were tested for malingering. A subset of the participants was given both the original SIRS and the Screening SIRS as a separate test with the test order counterbalanced; the remainder were given the original SIRS and a derived classification was determined by extracting the Screening SIRS scale scores. Using Receiver Operating Characteristic analyses, classification based on the Screening SIRS was significantly better than chance. With a sensitivity of 87% and specificity of 73%, the Screening SIRS was highly predictive of classifications based on the original SIRS. These findings have instrumental implications in correctional settings where identification of possible malingerers through a screening procedure may facilitate optimal allocation of resources.     

Use of the MMPI-2 Restructured Clinical (RC) Scales in Detecting Criminal Malingering

The purpose of the present study was to assess the effects of criminal malingering on the MMPI-2 Restructured Clinical (RC) scales. Sixty undergraduate students were given the MMPI-2 twice. One administration was conducted according to the MMPI-2 manual, and the other was given with a special set of malingering instructions specific to a prison setting. The two MMPI-2 profiles for each participant were scored for both the Basic and RC scales. Eight participants were eliminated from the data analysis due to validity (VRIN or TRIN) concerns. Data from the remaining 52 participants were analyzed using a 2 × 2 repeated measures ANOVA. Results showed that, as expected, the participants achieved higher MMPI-2 scores in the malingering condition. Also, participants achieved higher scores overall on the Basic scales and a significant interaction showed that participants achieved higher scores on the Basic Scales in the malingering condition than on the RC scales in that condition. These results supported prior research, indicating that malingerers produce elevated RC profiles. However, the present results also suggest that the Basic scales may be more effective in actually detecting malingerers, mainly due to the much lower ceiling on the RC scaled scores. Further implications of these findings for research and clinical work are also discussed.     

A Critical Analysis of the MND Criteria for Feigned Cognitive Impairment: Implications for Forensic Practice and Research

Forensic neuropsychology continues to grapple with critical determinations of response styles, including the assessment of malingering. The development of the Malingered Neurocognitive Dysfunction (MND) model has been highly influential for both feigning research and neuropsychological practice. In striving to be a comprehensive model of malingering, MND proposes complex criteria for ascertaining possible, probable, and definite levels. In its critical review, this article suggests the possibility of an MND bias towards the over-classification of malingering. It also examines the limits of MND research to adequately test the MND model. The conceptual and empirical limitations of MND are discussed with reference to theory and neuropsychological practice.     

论知识产权法中动漫角色之界定与保护

二十一世纪是东西方文化不断交流、融合的时代。由于我国动漫产业落后,使得我国在面对西方强势文化的侵袭时有些无能为力。我们需要通过对动漫角色的法律保护研究,建立符合我国国情需要的动漫角色法律保护体系,为中国的动漫产业保驾护航,此举对大力发展“创意文化”产业亦具有非常重要的现实意义。本文借鉴国内外有关学说和判例,参考国内已有研究成果,介绍了商品化权领域中的“角色”、动漫角色与虚构角色的联系,即动漫角色是虚构角色三种类型中的一种以及美国对虚构角色的界定理论,深入讨论动漫角色的配音是否属于动漫角色、动漫角色与真实人物的界限、两个动漫角色界定的问题,并对美国、日本在动漫角色保护方面进行比较和分析。     

The role of intelligence on performance on the Inventory of Legal Knowledge (ILK)

Previous research has shown that individuals with intellectual disabilities perform in the feigning range on malingering measures even when other data suggest that they are performing optimally. However, few studies to date have gone beyond intellectual disabilities and studied the full range of intelligence. Additionally, there are no data available examining the relationship between intelligence and performance on the Inventory of Legal Knowledge (ILK). The relationship between intelligence and performance on malingering tests is important because individuals with intellectual deficits may be incorrectly identified as malingering on these tests. The current study used a sample of state psychiatric hospital residents, adjudicated incompetent to proceed, and a sample of undergraduate university students to examine the relationship between intelligence and performance on the ILK. Results indicated three items on the ILK are correlated with intelligence and total scores were moderately correlated. Participants were further broken into groups using categorical ranges of Intelligence Quotient (IQ). Results were mixed regarding the relationship between ranges of IQ and performance on the ILK. Future directions and implications of this study are discussed.     

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.     

A Comparison of Forensic and Nonforensic Malingerers: A Prototypical Analysis of Explanatory Models

Explanatory models of malingering strive to understand the primary motivation underlying attempts to feign. Rogers, Sewell, and Goldstein (1994) provided empirical support for the conceptualization of pathogenic, criminological, and adaptational models. In the current study, a prototypical analysis of 221 forensic experts results in a slightly refined formulation: the adaptational model was decomposed into its two broad dimensions (cost–benefit analysis and adversarial setting). An important finding is that the factor structure for the explanatory models remained stable when applied to both forensic and nonforensic cases. As a first investigation, significant differences were observed in prototypical cases of malingering by the category of referral (forensic or nonforensic) and by type of feigning (mental disorders, cognitive impairment, and medical syndromes). Surprisingly, the feigning of medical syndromes appeared to play a relatively prominent role in both forensic and nonforensic cases and to be influenced by the apparent adversarial context of the assessment. Finally, important gender differences were observed, especially with nonforensic prototypical cases of malingering.     

The detection of simulated amnesia

Claims of amnesia are frequently raised in criminal and civil cases. There is a consensus in the legal community that amnesia is easily faked and practically impossible to disprove, and that many who claim to be amnesic are malingering. The present studies compared, on a variety of memory tasks, subjects instructed to simulate amnesia with subjects who had memory impairments due to brain damage. The simulators displayed patterns of performance different from those of memory-impaired subjects. These results suggest that lay-people have inaccurate beliefs about the cognitive features of amnesia, and do not distinguish among etiologically distinct amnestic disorders. Tasks that exploit lay-people's inaccurate beliefs about amnesia appear promising for the detection of malingering.     

计算机动态姿势图识别伪装平衡功能障碍

目的 建立本实验室用动态姿势图识别非器质性或伪装平衡功能障碍的客观方法.方法 对104例正常受试者行动态姿势图检查后指导其伪装平衡功能障碍再进行动态姿势图检查,将伪装前后的平衡分进行配对t检验;应用以往研究提示伪装的7条标准对本实验的50例伪装前后的姿势图表现(包括原始曲线)进行判别,按照90％的敏感性选取并建立本实验...     

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.     

Classification algorithm using halftone features of counterfeit bills and CNN

With recent advancements in image processing and printing technology, home printers have improved in performance and grown more widespread. As such, they have been increasingly used in counterfeiting and forgery. Most counterfeit bills in Korea have been created using home scanners and printers. The identification of printer model is thus necessary to rapidly track down criminals and solve crimes. Household printers can be largely divided into inkjet and laser printers. These two types of printers print halftone textures instead of continuous images. This study proposed a technique of printer classification based on halftone textures that can be observed in printed documents. Since halftone textures are expressed as periodic lattices, the images were transformed via FFT, which is highly effective at expressing periodicity. ResNet, known for its superior gradient flow, was used for training. The experiment was conducted on 12 color laser jets and 2 inkjets. Scans of bills printed by each printer were used, and halftone texture analysis was performed on these images for printer model classification. Each image was cropped into several parts; one of the cropped parts was analyzed. The analysis showed that laser printers could be 100% distinguished from inkjet printers. An accuracy of 98.44% was achieved in make classification. When 50 cropped images were used instead of a single image, the technique achieved 100% accuracy in model classification. The proposed technique is non-destructive; it offers high accessibility and efficiency as it can be performed using a scanner alone, without requiring additional optical equipment.     

Daubert,Cognitive Malingering,and Test Accuracy

Daubert v. Merrell Dow Pharmaceuticals (1993) held that trial judges should permit expert scientific testimony only when the reasoning or methodology underlying the testimony is scientifically valid, and ... properly can be applied to the facts in issue. Vallabhajosula and van Gorp (V&vG, 2001) have suggested that when the Daubert standard is applied to tests for malingered cognitive deficits, courts should deem admissible only results that meet this mathematical standard: assuming a pretest probability of .3, a positive score on the malingering test should yield a posttest probability of at least .8. This paper shows that V&vG's criterion may lead to misunderstandings about the kind of information malingering measures provide. After reviewing cases that have discussed both the Daubert decision and malingered cognitive deficits, this paper uses data from the Test of Memory Malingering (T. N. Tombaugh, 1996) to provide a general characterization of the mathematical properties of malingering measures. The paper then describes how pretest knowledge about malingering is combined with knowledge about a test's performance to generate a posttest probability of malingering. The results can help mental health experts respond to Daubert-inspired challenges to conclusions based on malingering measures.     

伪装创伤后应激障碍的识别

创伤后应激障碍的鉴定是近年来司法精神病学实践中经常遇到的问题,其中如何识别诈病者也相应地成为业内人员关注的焦点之一。但是由于此障碍所涉及的创伤性事件多种多样,症状表现纷繁复杂,且信息来源主观性成分较大,同时又易有其他多种精神疾患与之共病,因而要作出完全正确的诊断或鉴定结论相当困难。本文通过对大量文献资料的归纳整理,分析了国内外在有关伪装创伤后应激障碍的表现特点、识别方法和测试手段等领域开展的研究现状,期望能为精神疾病司法鉴定中处理相关问题提供一定的帮助和参考。     

Expression as Realization: Speakers’ Interests in Freedom of Speech

I argue for the recognition of a particular kind of interest that one has in freedom of expression: an interest served by expressive activity in forming and discovering one’s own beliefs, desires, and commitments. In articulating that interest, I aim to contribute to a family of theories of freedom of expression that find its justification in the interests that speakers have in their own speech or thought, to be distinguished from whatever interests they may also have as audiences or third parties for speech. Although there are many differences among such speaker-centered theories, a core commitment that most share is that expressive liberty plays a fundamental role in securing or constituting some form of individual self-realization. My account is a defense and elaboration of what I take to be one specific (but not exclusive) way in which the nature of such self-realization should be understood. In my proposal, self-realization is sometimes internally related to the very activity of expression, viz, expressing ourselves is one way in which we come to form and know our own minds.     

Competency to stand trial: a conceptual model for its proper assessment

The assessment of competency to stand trial is frequently fraught with conceptual confusion resulting from a failure to properly apply the data of the clinical examination to the relevant legal criteria. A basic question scheme that encompasses (1) the defendant's psychiatric status, (2) the effects of that status on his functioning, and (3) his apparent ability to participate in legal proceedings, is introduced to clarify the evaluation of fitness to stand trial. The way in which combinations of answers to three "basic questions" generate a scheme that clarifies the difficulties encountered in most competency evaluations is shown. Eight paradigm cases are generated. Five of these (competence, incompetence, mentally ill but competent, malingering, and impaired but competent) are frequently straightforward. However, the three possibilities in which a defendant meets criteria entailed by two of the three questions are inherently subject to controversy. These situations (circumscribed psychosis related to the charges, malingering in the context of mental illness, and functional deficits in the context of minor mental illness) are discussed in detail and illustrated with case material.     

Simulation of brain damage: assessment and decision rules

The possibility of fabricated or exaggerated organic deficits is a frequent concern in both civil and criminal forensic cases. Additionally, organic deficits may exist, but be incorrectly attributed to a claimed cause. Exaggeration or fabrication can apply to primary cognitive or emotional effects of brain damage or to secondary emotional effects. These categories of deficits, and their relationship to physical brain damage, must be clearly understood in order to comprehensively evaluate the possibility of malingering. This includes evaluation of different forms of consistency between (1) behaviors during evaluation, (2) claimed deficits and known organic syndromes, (3) behavior or claims during evaluation and actual life-functioning, and (4) test performance and known principles of cognitive functioning. Psychometric procedures and clinical strategies are described which can substantially aid in assessing consistency and distinguishing between honest and exaggerated self-reports. Limitations of available assessment techniques are described and a general decision model for evaluation of dissimulation of organic deficits is presented.