Malingering presentation for forensic evaluations

Malingering presentation Yuki and Karin

1. Malingering What is it and how do you know? A review of some commonly used instruments and assessments. Yuki J.M. Acs and Karin Celosse PF717 Forensic Assessment Fall 2014

2. Classic movie example of malingering

3. Definitions and origins Plain English Definition: Oxford English Dictionary (Verb, no object) To exaggerate or feign illness in order to escape duty or work. Back-formation from malingerer , apparently from French malingre , perhaps formed as mal- 'wrongly, improperly' + haingre 'weak', probably of Germanic origin.

4. Medical definitions (because we all want to be able to bill for our services, right?) ICD-9 V65.2 Person feigning illness Applies to malingerer, peregrinating patient; disease synonym of drug-seeking behavior ICD-10 Z76.5 Malingerer Applies to person feigning illness with obvious motivation; excludes factitious disorder, peregrinating patient

5. The clinical definition according to the DSM … malingering is defined as “…the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives. .. ” malingering should be “strongly suspected if any combination of the following is noted”: medico-legal context of presentation, marked discrepancy between self-reported stress or disability and objective findings , lack of cooperation during diagnostic evaluation or with prescribed treatment, or presence of antisocial personality disorder .

6. Operative definition Meyer and Deitsch (1996) suggested that it is often appropriate to broaden the concept of malingering to any type of response that distorts the production of an accurate record . However, Rogers (1997) identified false positive rate of nearly four times as many bona fide patients mis -categorized as malingerers.

7. A better operative definition Feigning ≠ Malingering Feigning refers to exaggerating or fabricating psychological problems or symptoms, regardless of intent. Malingering is the conscious choice to intentionally exaggerate or fabricate psychological problems or for external gain. DeClue (2002)

8. Distinguishing between malingering and factitious DO

9. Distinguishing one from another Factitious disorder and malingering are often linked, because both involve the feigning or production of symptoms absent any underlying pathology. In factitious disorder , the motivation is presumed to be unconscious and is related to the desire to assume the sick role. In contrast, malingering is viewed as the intentional production (or reporting) of symptoms for secondary gain , e.g. evading criminal prosecution or receiving financial compensation. (McDermott et al., 2008)

10. When do we evaluate for malingering? Forensic Individuals are evaluated for malingering in both civil and criminal situations. Civil: usually personal injury, worker’s comp, or disability benefits. Criminal : be found incompetent to stand trial, reduce sentence, avoid death penalty, reduce or avoid incarceration)

11. So how do we evaluate malingering? According to research completed by Rogers (2008) we can assess for malingering through various instruments, depending upon the presentation: Rare symptoms (Symptoms rarely reported by genuine patient)s: MMPI-2 Fp , SIRS RS, PAI NIM , M -FAST UH Quasi-rare symptoms (Symptoms rarely reported by normals ): MMPI -2F and Fb Improbable symptoms (Symptoms that are fantastic or absurd): SIRS IA, MCMI-III VI Symptom combinations (Symptoms that are common but rarely occur together): SIRS SC, M-FAST RC Indiscriminant endorsement of symptoms (Endorsement of excessive proportion of symptoms): SIRS SEL Severity of symptoms (Excessive number of symptoms endorsed as unbearable or extreme): SIRS SEV, M-FAST ES Obvious symptoms (Excessive number of clear symptoms of mental disorder endorsed): SIRS BL Reported vs. observed symptoms (Discrepancies between self-reported and observed symptoms): SIRS RO, M-FAST RO Erroneous stereotype symptoms (Endorsement of symptoms erroneously thought to be reported by patients with mental disorders): MMPI -2 Ds, PSI EPS

12. MMPI- 2 Minnesota Multiphasic Personality Inventory 2nd Edition , Fp MMPI -2 Infrequency Psychopathology F MMPI -2 Infrequency Scale Fb MMPI -2 Back Page Infrequency Scale Ds MMPI -2 Dissimulation Scale SIRS Structured Interview of Reported Symptoms : RS SIRS Rare Symptoms Scale, IA SIRS Improbable or Absurd Scale, SC SIRS Symptom Combination Scale, SEL SIRS Symptom Selectivity Scale , SEV SIRS Symptom Severity Scale, BL SIRS Blatant Symptom Scale, RO SIRS Reported vs. Observed Symptoms Scale, PAI Personality Assessment Inventory NIM PAI Negative Impression Management Scale M- FAST Miller Forensic Assessment of Symptoms Test: UH M -FAST Unusual Hallucinations Scale, RC M -FAST Rare Symptom Combination Scale, ES M -FAST Extreme Symptom Scale, RO M -FAST Reported vs. Observed Symptoms Scale, MCMI- III Millon Clinical Multiaxial Inventory, 3rd Edition , VI MCMI -III Validity Index, PSI Psychological Screening Inventory , EPS PSI Erroneous Stereotypes Scale

13. MMPI-2 and malingering MMPI-2 Minnesota Multiphasic Personality Inventory 2nd Edition Fp MMPI -2 Infrequency Psychopathology, F MMPI -2 Infrequency Scale, Fb MMPI -2 Back Page Infrequency Scale Ds MMPI -2 Dissimulation Scale

14. SIRS (structured interview of reported symptoms) 172-item structured interview which takes approximately 30–45 minutes to administer. The SIRS contains eight primary and five supplementary scales: rare symptoms, symptom combinations, improbable or absurd symptoms, blatant symptoms, subtle symptoms, severity of symptoms, selectivity of symptoms, reported vs. observed symptoms (primary scales ) direct appraisal of honesty, defensive symptoms, overly specific symptoms, symptom onset and resolution, and inconsistency of symptoms (supplementary scales).

15. PAI Personality Assessment Inventory NIM PAI Negative Impression Management Scale The PAI NIM scale is a measure of response exaggeration in the original PAI and is composed of infrequently endorsed items and items associated with a very unfavorable self presentation.

16. Evaluation of Competency to Stand Trial - Revised (ECST-R) Contains the following six scales: Consult with Counsel (CWC, 6 items); Factual Understanding of the Courtroom Proceedings (FAC, 6 items); Rational Understanding of the Courtroom Proceedings (RAC, 7 items); and Atypical Presentation (ATP, 28 items) . The ATP scale can be used to screen for possible feigning in order to inform determination of malingering

17. Items are rated according to :

18. Effort Testing When the referral question deals with intellectual and memory impairment, a number of tests aimed at assessing response style can be used, including Test of Memory Malingering (TOMM) Validity Indicator Profile (VIP) Word Memory Test (WMT)

19. These measures can contribute to the detection of malingering. These instruments employ a two-alternative forced choice design that allows identification of “worse than chance performance,” which is considered to be highly indicative of malingering.  In addition, comparative test scores significantly below those obtained by impaired persons are also considered indicative of an attempt to appear more impaired than is actually the case.

20. M alingering Case study:

21. References: Aguerrevere , L. E., Greve , K. W., Bianchini , K. J., & Ord , J. S. (2011). Classification accuracy of the Millon Clinical Multiaxial Inventory – III modifier indices in the detection of malingering in traumatic brain injury, 33(5), 497–504. doi:10.1080/ 13803395.2010.535503 Ahmadi , K., Lashani , Z., Afzali , M. H., Tavalaie , S. A., & Mirzaee , J. (2013). Malingering and PTSD : Detecting malingering and war related PTSD by Miller Forensic Assessment of Symptoms Test ( M-FAST ) . American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Berry , D. T. R., & Nelson, N. W. (2010). DSM-5 and Malingering: a Modest Proposal. Psychological Injury and Law, 3(4), 295–303. doi:10.1007/s12207-010-9087- 7 Boccaccini , M. T., Murrie , D. C., Duncan, S. A., & Penitentiary, U. S. (2006). Screening for Malingering in a Criminal – Forensic Sample With the Personality Assessment Inventory, 18(4), 415–423. doi:10.1037/1040- 3590.18.4.415 DeClue , G. (2002). Feigning ≠ Malingering: A case study. Behavioral Sciences and the Law, 20, 717-726 . Farkas , M. R., Rosenfeld, B., Gorp , W. Van, & Ph , D. (2006). Do Tests of Malingering Concur ? Concordance Among Malingering Measures, 671, 659–671. doi:10.1002/ bsl Flowers , K. A., Bolton, C., & Brindle, N. (2008). Chance Guessing in a Forced-Choice Recognition Task and the Detection of Malingering, 22(2), 273–277. doi:10.1037/0894- 4105.22.2.273 Jelicic , M., Ceunen , E., Peters, M. J. V, & Merckelbach , H. (2011). Detecting Coached Feigning Using the Test of Memory Malingering ( TOMM ) and the Structured Inventory of Malingered Symptomatology ( SIMS ) Ã , 67(9), 850–856. doi:10.1002/jclp. 20805

22. References, continued. Kucharski , L. T., Toomey, J. P., Fila, K., & Duncan, S. (2007). Detection of Malingering of Psychiatric Disorder With the Personality Assessment Inventory : An Investigation of Criminal Defendants Mcdermott , B. E., Ph , D., Sokolov , G., & D, M. (2009). Malingering in a Correctional Setting : The Use of the Structured Interview of Reported Symptoms in a Jail Sample, 765(September), 753–765. doi:10.1002/ bsl McDermott, B., Leamon , M., Feldman, M., Scott, C. (2008) Factitious disorder and malingering. The American Psychiatric Publishing Textbook of Psychiatry (5th ed.). American Psychiatric Publishing: Arlington, VA. Memory, A. W., & Study, T. (2013). Detection of Malingered Neurocognitive Dysfunction Among Patients with Acquired Brain Injuries, 29(4), 253–262. doi:10.1027/1015-5759/a000154 Meyer, R. & Deitsch , S. (1996). The Clinician’s Handbook: Integrated diagnostics, assessment, and intervention in adult and adolescent psychopathology (4th ed.). Allyn & Bacon: Needham Heights, MA. Missouri, W., Health, M., & City, K. (2008). Diagnostic Accuracy of the MMPI – 2 Malingering Discriminant, 90(4), 392–398. doi:10.1080/00223890802108204 Rogers, R. (1997). Clinical Assessment of Malingering and Deception (2nd ed., pp. 1–19). New York, NY: Guilford. Vitacco , M. J., Rogers, R., Gabel, J., & Munizza , J. (2007). An evaluation of malingering screens with competency to stand trial patients: a known-groups comparison. Law and Human Behavior, 31(3), 249–60. doi:10.1007/s10979-006-9062-8