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.