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Background: Factitious disorder (FD) is an under-recognized and under-diagnosed mental condition. Healthcare professionals often have challenges to diagnose and treating the disorder. As a result, needless and endless medical resources are recommended to assess and evaluate those affected. FD may present as a physical condition, a psychological disorder, or maybe both depending on the prominent symptoms. However, there is a strong correlation between having FD and psychiatric symptoms. Main Text: FD occurs in early adulthood, with a mean age of onset of 25 years in both genders, although with differing demographic features. The lifetime prevalence of FD imposed on oneself in clinical settings is 1.0%, 0.1% in the overall population (ranging between 0.007% and 8.0%) and occurs more in female health care professionals. FD may make up 0.6%–3.0% of psychiatric referrals, and it accounts for 3-5% of doctor-patient contacts. In actuality, 1-2% of hospital admissions and an average of 6-8% of all psychiatric admissions have been underreported. The study aimed to highlight the signs and symptoms of FD identified in a psychiatry department of a multispecialty center and to increase the awareness of health practitioners. A critical review of the literature was done with an emphasis on psychological symptoms. PubMed, Mendeley, and Google Scholar were thoroughly searched and full-text publications of journals from 2010-2021 were included. Conclusion: FD is a diagnostic puzzle that necessitates adequate, prompt medical attention as well as social support because of the potentially fatal consequence. A stronger patient-therapist relationship can strengthen the patient's conscious self-control to minimize the symptoms; therefore the healthcare provider has to be open-minded. For the diagnostic enigma to be removed and for ease of treatment, additional research, increasing awareness among medical professionals and the general public, accurate evaluation, diagnosis, and psychotherapy should be encouraged. These case studies will contribute to the knowledge base of FD and improve the quality of care.

Although there is an abundance of research on stand-alone and embedded performance validity tests and stand-alone symptom validity tests (SVTs), less emphasis has been placed on embedded SVTs. The goal of the current study was to examine the ability of embedded indicators within the Patient Competency Rating Scale (PCRS) to separately detect invalid cognitive and/or emotional/affective symptom responding.Participants included 299 veterans assessed in a VA medical center epilepsy monitoring unit from 2013-2017 (mean age = 48.8 years,In ANOVAs, SVT-C was significantly associated with all PCRS indices, while SVT-E was only significantly associated with the PCRS total, emotional, and interpersonal competency indices. Although the PCRS-T ≤ 90 had the strongest classification of SVT-C and SVT-E (specificities: .90, sensitivities: .44 to .50), PCRS index scores showed suggestive evidence of domain specificity, with PCRS-ADL ≤22, PCRS-C ≤ 20, and PCRS-CADL ≤45 best classifying SVT-C (specificities: .92, sensitivities: .33) and the PCRS-E ≤ 18 best classifying the SVT-E group (specificity: .93, sensitivity: .40).Results suggest the PCRS may be used to obtain clinically useful information while including embedded indicators that can assess cognitive and/or emotional/affective symptom invalidity.

Background/Objective: Whiplash-Associated Disorders (WAD) are one of the most complex conditions to evaluate because several of its symptoms are not observable with current diagnostic methods and cannot be quantified or evaluated correctly. No method is currently available to assess the risk of malingering in the aforementioned condition efficiently. Our aim is to study the capacity of several biopsychosocial psychometric self-report instruments, such as the Brief Pain Inventory (BPI), the Cervical Disability Index (NDI), the SF-36 Health Questionnaire, the Beck Anxiety and Depression Inventories (BDI-II and BAI), or the Brief Illness Perception Questionnaire (BIPQ), to discriminate between patients diagnosed with WAD following a vehicle accident and non-clinical participants with malingering instructions. Method: A simulation design was used with 630 participants: 200 non-clinical controls with honest responding condition, 201 instructed malingerers, and 229 WAD clinical outpatients. Results: Our results showed an AUC range of .60 to .90, with the highest value being that of the BPI (.90), followed by the NDI (.88), and the lowest value that of the BIPQ (.60), followed by the BAI (.71). Conclusions: Overall, the BPI, the NDI, and SF-36 can correctly discriminate between groups with a good specificity (> 90%), while the BAI, BDI, and BIPQ showed a lower capacity, with a high rate of false positives in the case of the BDI and of false negatives in the other two. Practical and research implications are discussed.

Evaluators of examinees in forensic contexts must consider the potential for falsified or exaggerated psychiatric symptoms and/or cognitive deficits. A number of validated assessment tools assist evaluators in identifying those examinees who feign impairment; however, no comprehensive method has been established for consolidating data from multiple tests, interviews, behavioral observations, and collateral sources. The current pilot study preliminarily examined the interrater reliability and validity of a new forensic assessment tool, the Feigning Evaluation INtegrating Sources (FEINS), developed to guide evaluators in the comprehensive assessment of feigning by adding structure to the collection of relevant data. Fifty-eight male pretrial defendants undergoing restoration of competency to stand trial at a state forensic psychiatric center participated in the study. Results provided preliminary support for reliability in scoring the FEINS, construct validity, and predictive validity. FEINS items that assessed clinical presentation, and those that guided the use of test data, were more useful than items capturing historical/demographic data. Structured professional judgments developed using the FEINS appeared to be more accurate in predicting competency evaluators' perceptions of feigning than both unstructured clinical judgment (i.e., referring psychologist's perception of feigning) alone and test data alone, using hierarchical multiple regressions. Findings suggest that the FEINS may have practical utility in guiding clinical opinions regarding feigning across psychiatric, cognitive, and psycholegal/functional domains. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objective: There is increased concern for malingering in ADHD evaluations due to presence of incentives such as accommodations and medications. Although several validity tests are available to classify malingering in non-ADHD populations, there is no test with proven effectiveness to detect feigned ADHD. This study investigated the ability of the MARS Symptom Validity Index 4 (MARS SV-index 4) and two published validity tests (the Word Memory Test [WMT] and Clinical Assessment of Attention Deficit-Adult [CAT-A] Infrequency scale) to detect malingered ADHD. Method: The participants consisted of 68 young adults, 34 with ADHD. Participants completed the MARS, CAT-A, and WMT validity measures. Results: The MARS SV index-4 demonstrated higher sensitivity rates for simulated malingering (61.8%) at close to optimal specificity (88.2%) compared to two published tests (which had sensitivity 90%). Conclusion: The MARS shows good ability to detect feigned ADHD and appears to be useful for adult ADHD assessments.

Objective Individuals with early-onset dysexecutive Alzheimer’s disease (dAD) have high rates of failed performance validity testing (PVT), which can lead to symptom misinterpretation and misdiagnosis. Method The aim of this retrospective study is to evaluate rates of failure on a common PVT, the test of memory malingering (TOMM), in a sample of clinical patients with biomarker-confirmed early-onset dAD who completed neuropsychological testing. Results We identified seventeen patients with an average age of symptom onset at 52.25 years old. Nearly fifty percent of patients performed below recommended cut-offs on Trials 1 and 2 of the TOMM. Four of six patients who completed outside neuropsychological testing were misdiagnosed with alternative etiologies to explain their symptomatology, with two of these patients’ performances deemed unreliable based on the TOMM. Conclusions Low scores on the TOMM should be interpreted in light of contextual and optimally biological information and do not necessarily rule out a neurodegenerative etiology.

When patients fail symptom validity tests (SVTs) and/or performance validity tests (PVTs), their self-reported symptoms and test profiles are unreliable and cannot be taken for granted. There are many well-established causes of poor symptom validity and malingering is only of them. Some authors have proposed that a cry for help may underlie poor symptom validity. In this commentary, we argue that cry for help is a (1) metaphorical concept that is (2) difficult to operationalize and, at present, (3) impossible to falsify. We conclude that clinicians or forensic experts should not invoke cry for help as an explanation for poor symptom validity. To encourage conceptual clarity, we propose a tentative framework for explaining poor symptom validity.

In psychological injury and related forensic evaluations, two types of tests are commonly used to assess Negative Response Bias (NRB): Symptom Validity Tests (SVTs) and Performance Validity Tests (PVTs). SVTs assess the credibility of self-reported symptoms, whereas PVTs assess the credibility of observed performance on cognitive tasks. Compared to the large and ever-growing number of published PVTs, there are still relatively few validated self-report SVTs available to professionals for assessing symptom validity. In addition, while several studies have examined how to combine and integrate the results of multiple independent PVTs, there are few studies to date that have addressed the combination and integration of information obtained from multiple self-report SVTs. The Special Issue of Psychological Injury and Law introduced in this article aims to help fill these gaps in the literature by providing readers with detailed information about the convergent and incremental validity, strengths and weaknesses, and applicability of a number of selected measures of NRB under different conditions and in different assessment contexts. Each of the articles in this Special Issue focuses on a particular self-report SVT or set of SVTs and summarizes their conditions of use, strengths, weaknesses, and possible cut scores and relative hit rates. Here, we review the psychometric properties of the 19 selected SVTs and discuss their advantages and disadvantages. In addition, we make tentative proposals for the field to consider regarding the number of SVTs to be used in an assessment, the number of SVT failures required to invalidate test results, and the issue of redundancy when selecting multiple SVTs for an assessment.

Self-inflicted skin disorders are artefact diseases inflicted by the use of multiple different means, for various different purposes. They account for about 2% of dermatology patient visits, and include disorders with a denied or hidden pathological behavior (factitious disorders) and disorders with a non-denied and nonhidden pathological behavior (compulsive disorders). In turn, factitious skin disorders are subdivided into 2 groups: factitious disorders without an external incentive (considered in a preceding work) and factitious disorders with external incentives. In the second eventuality, the simulator is motivated by illicit intent, wishing to evade civil duties or a prison sentence, for instance, or to exploit situations of an occupational nature, and is fully aware of his action and his intention. Apart of the two groups of pathomimic artefacts and malingering, some self-inflicted dermatoses are due to behavioral disorders involving compulsive habits (tics, psychological excoriations). The great majority of subjects suffering from the latter disturbances are quick to confess their urge to self-inflict lesions. The management, including both psychiatric and dermatological assessment, concludes this second part of the work regarding the self-inflicted cutaneous diseases.

Summary Seen as a crucial historical step in the development of ‘modern’ institutional healthcare, eighteenth-century British naval medicine has traditionally been studied from the point of view of the state and of physicians and surgeons: naval sailors’ attitudes towards health, medicine and their own bodies remain virtually unexplored. Using official and personal sources, this article sketches a ‘patient’s history’ of late-eighteenth- and early-nineteenth-century British ratings. Aiming to counterbalance Foucauldian interpretations, it highlights some of the ways in which individuals, even when apparently most powerless, confined in ships far from home, and controlled by rigidly disciplined institutions, could take responsibility for their health, successfully or otherwise, within, against or alongside the system. If the unprecedented administrative requirements of the French Wars strengthened and standardised top-down medical authority, they also brought opportunities for evasion and negotiation. This complicates established narratives of the relationship between modern medicine, the armed forces and power.

Validity evaluation is fundamental in neuropsychological assessment in adults, with increasing interest among pediatric neuropsychologists. Although some measures exist, given time constraints placed on clinicians, and children's limited sustained attention, development of less time-consuming measures is beneficial. We explored the use of the Temporal Memory Sequence Test (TMST), a new performance validity test, in clinically referred children. One minor adaptation included reading the instructions and labels to non-fluent readers. Participants were 68 consecutive clinically referred children and adolescents, aged 6-18 years, with neurological (

The Self-Report Symptom Inventory (SRSI) was developed to expand the toolbox of self-report instruments available to detect symptom overreporting. Such instruments, today known as symptom validity tests, play a crucial role in both forensic evaluations and in a range of clinical referral questions. The SRSI was originally designed in the German language; items were selected from a larger pool on the basis of empirical results. Scores on the Structured Inventory of Malingered Symptomatology served as external criterion for the item selection procedure and empirical cut-score determination (gold standard). The SRSI is composed of five subscales describing potentially genuine symptoms and five pseudosymptoms subscales. Ten different language test versions have been developed so far. The article describes the background of the construction of the scale, the main empirical results with the SRSI, the conditions of use, and the limits of applicability. With research ongoing in several countries and with a variety of language versions, a larger body of empirical evidence can be expected to accumulate in the coming years.

To determine if the number of participants with psychiatric disorders increased in association with failures on symptom validity tests (SVTs) and a performance validity test (PVT) in Veterans admitted for evaluation of possible seizures.The 254 participants were Veterans undergoing inpatient video-EEG monitoring for the diagnosis of possible seizures. DSM-IV psychiatric disorders were diagnosed with the SCID IV. Symptom exaggeration was assessed with the MMPI-2-RF and performance validity with the TOMM.On the MMPI-2-RF, 27.6%-32.7% showed symptom exaggeration. Participants who exaggerated on the MMPI-2-RF were more often diagnosed with psychiatric disorders. The TOMM was failed by 15.4% of the sample. Participants who failed the TOMM were more often diagnosed with an Axis I disorder but not with a personality disorder. The MMPI-2-RF was invalid in more cases than the TOMM, but 7.9% of the sample generated a valid MMPI-2-RF and an invalid TOMM.The correlational design does not allow conclusions about cause and effect. The invalid groups may have had a higher rate of psychopathology. The number of participants with psychiatric disorders increased in association with symptom exaggeration and performance invalidity. Symptom exaggeration was more frequent than performance invalidity, but the TOMM made a unique contribution to identification of invalidity. The routine clinical use of SVTs and PVTs is supported. The results also suggest the need for caution in diagnosing psychiatric disorders when there is symptom exaggeration or performance invalidity, because diagnostic validity is dependent on the accuracy of symptom reporting.

This systematic review was performed to summarize existing research on the symptom validity scales within the Trauma Symptom Inventory–Second Edition (TSI-2), a relatively new self-report measure designed to assess the psychological sequelae of trauma. The TSI-2 has built-in symptom validity scales to monitor response bias and alert the assessor of non-credible symptom profiles. The Atypical Response scale (ATR) was designed to identify symptom exaggeration or fabrication. Proposed cutoffs on the ATR vary from ≥ 7 to ≥ 15, depending on the assessment context. The limited evidence available suggests that ATR has the potential to serve as measure of symptom validity, although its classification accuracy is generally inferior compared to well-established scales. While the ATR seems sufficiently sensitive to symptom over-reporting, significant concerns about its specificity persist. Therefore, it is proposed that the TSI-2 should not be used in isolation to determine the validity of the symptom presentation. More research is needed for development of evidence-based guidelines about the interpretation of ATR scores.

Background Malingering is a common and challenging clinical presentation in emergency departments (EDs). Objective This study describes characteristics and outcomes among patients diagnosed as malingering in a psychiatric emergency service. Methods Index psychiatric ED encounters were identified for all adult patients seen during a 27-month period. Mortality data were obtained for patients from the state public health authority, and repeat ED visits for self-harm were obtained from the state hospital association. Patients with a diagnosis of malingering were compared with those without a malingering diagnosis using correlative statistics and multivariable analyses. Results Of 4710 encounters analyzed, 236 (5%) had a malingering diagnosis. No patients diagnosed as malingering died of suicide within 365 days of discharge, compared with 16 (0.4%) nonmalingering patients. Self-harm outcomes were available for 2689 encounters; 129 (5%) had a malingering diagnosis. Malingering was significantly associated with a repeat ED visit for self-harm within 365 days in multivariable analyses (adjusted odds ratio 2.52; 95% confidence interval 1.35–4.70); p Conclusions No psychiatric emergency service patients diagnosed as malingering died by suicide after discharge. New clinical approaches must balance malingering patients’ apparent low suicide risk with their other substantial comorbidities and risk for self-harm.

Psychometric symptom validity instruments (SVTs) can be vulnerable to coaching, which can negatively affect their performance. Our aim was to assess the impact that different types of coaching may have on the sensitivity of the Structured Inventory of Malingered Symptomatology (SIMS).A simulation design was used with 232 non-clinical adults divided into five experimental simulation conditions and 58 patients with anxious-depressive symptomatology derived from a traffic accident. All simulators received a basic scenario and, in addition, the second group was instructed on the symptomatology, the third was warned about the risk of exaggerating the presentation, the fourth received a combination of the two previous groups and the fifth received specific training on SVTs.The discriminative ability of the SIMS was higher in the basic and symptom information groups, and it decreased significantly in the specific training group on SVTs.SIMS seems not to be severely impacted by a variety of symptom coaching styles, although test coaching diminished its performance.

This project involves developing cut-off scores using the MMPI-2 to differentiate DID malingerers from genuine DID patients.

BACKGROUND AND PURPOSE Functional motor disorders (FMDs) are frequent and highly disabling conditions. Despite the substantial advances in FMDs diagnosis, mechanisms and treatments, their tangible application to care of patients with FMDs is yet to be established. We aimed to identify the main real-life gaps and barriers in FMDs care, faced by both patients and physicians, in two different European countries, Italy and Czechia. METHODS A cross-cultural study was performed. RESULTS Both patients and physicians are face practical difficulties and pay a high price for the poor management of FMDs as a result of outdated classifications and insufficient education. This, in turn, has led to inadequate access to care and the existence of common misbeliefs regarding symptom severity or even suspicion of malingering. FMDs need to be integrated into national healthcare systems and in research priorities so that substantial cost savings can be achieved and appropriate care provided to patients. CONCLUSIONS We found multiple serious real-life unmet needs in FMD care, ranging from terminology and classification to poor recognition in national healthcare priorities. Based on these findings, we intend to mark the beginning of a collaborative project among researchers even in other different European settings to promote coordinated development efforts and goals in the evolving field of FMDs in clinical and research practice.

BACKGROUND Attenuation of vision may be due to underlying organic condition or due to functional visual disorder or malingering if secondary gain is associated. Causes of pathological vision loss include advanced primary open angle glaucoma, hereditary macular dystrophies and optic neuropathies. Problem in establishing diagnosis is faced where superimposition of organic and functional visual loss is there. Distinction between functional visual loss and pathological visual loss is made by thorough and careful examination of the patient by applying basic rules and tools of ophthalmology in which examining surgeon is well versed, but patient is unaware. During routine practice, every ophthalmologist encounters patients with nonorganic vision loss. The purpose of the article is to demonstrate how to distinguish between normal visual function without missing any organic visual loss. Examination of such patients requires number of tests including baseline visual acuity, pupillary reactions, slit lamp examination of anterior segment, fundus examination, visual field analysis, optical coherence tomography, visual evoked potential and electroretinography. By proving integrity and functioning of visual system, diagnosis of functional visual loss can be confirmed. Once the conclusive diagnosis is established, it is to be revealed with caution to the patient/patient’s attendant as it can lead to medico legal issues. Here, we present series of cases who presented to us in a tertiary care center of North India during a period of six months in the year of 2019 where case 1 and case 2 presented with decreased vision due to underlying pathological condition, case 3 presented with reduced vision due to functional visual disorder. Case 4, 5 and 6 provided decisive evidence of malingering. KEY WORDS Fogging, Hysterical Visual Loss, Malingering, Menace Reflex, Optokinetic Nystagmus.

OBJECTIVE Using embedded performance validity (PVT) comparisons, Erdodi et al. suggested that Grooved Pegboard (GPB) T-score cutoffs for either hand (≤ 29) or both hands (≤ 31) could be used as additional embedded PVTs. The current study evaluated the relationship between these proposed cutoff scores and established PVTs (Medical Symptom Validity Test [MSVT]; Non-Verbal Medical Symptom Validity Test [NV-MSVT], and Reliable Digit Span [RDS]). METHOD Participants (N = 178) were predominately Caucasian (84%) males (79%) with a mean age and education of 41 (SD = 11.7) and 15.8 years (SD = 2.3), respectively. Participants were stratified as "passing" or "failing" the GPBviaErdodi's proposed criteria. "Failures" on the MSVT, NV-MSVT, and RDS were based on conventional recommendations. RESULTS Moderate correlations between GPB classification and a condition of interest (COI; i.e. at least two failures on reference PVTs) were observed for dominant (χ2 (1, n = 178) = 34.72, ϕ = .44, p < .001), non-dominant (χ2 (1, n = 178) = 16.46, ϕ = .30, p = .001), and both hand conditions (χ2 (1, n = 178) = 32.48, ϕ = .43, p < .001). Sensitivity, specificity, and predictive power were generally higher than Erdodi et al.'s initial findings. CONCLUSION These findingsprovide supportfor the clinical utility of the GPB as an additional embedded PVT. More specifically, dominant and both hand cutoffs were found to be more robust measures ofnon-genuine performance in those without motor deficits. While promising, sensitivity continues to be low; therefore, it is ill-advised to use the GPB as a sole measure of -performance validity.

Abstract. Early research on trauma employing the Rorschach found it to be an ideal instrument, with its red, black, gray, and vibrant colors, to elicit trauma content. Two patterns of Rorschach responses emerged: the constricted pattern, where the evaluee kept to a form-based, avoidant approach to the blot, as if defending against the memories of the trauma, and a flooded pattern, where morbid and aggressive images paralleled that of psychosis. The Rorschach as an instrument continues to demonstrate high sensitivity to the experience of trauma, and research since 2005 has added complexity and additional validation for the use of the Rorschach in the evaluation of the effects of trauma.

Objective In concussion populations, suboptimal task engagement detected by performance validity tests (PVTs) has been associated with poorer neuropsychological scores and greater post-concussive symptoms (PCS). This study examined if Pass/Fail status on the Test of Memory Malingering—TOMM Trial 1—differentiated the neurocognitive, emotional, and behavioral profile of pediatric patients with concussion. Method This study utilized archival data from 93 patients (mean age = 14.56 and SD = 2.01) with a history of concussion who were assessed at ~5–6 weeks post-injury (mean days = 40.27 and SD = 35.41). Individuals were divided into “Pass” and “Fail” groups based on TOMM Trial 1 performance. The testing battery included ACT, CPT-II and III, HVLT-R, WJ-III and IV ACH, ImPACT, BASC-2, and BRIEF. Results The overall pass rate on Trial 1 was 70% (mean = 46.04 and SD = 4.55). Findings suggested that a passing score on Trial 1 may be associated with adequate performance across the remaining two trials of the TOMM. The Fail group scored significantly lower across attention, memory, and processing speed measures when compared with the Pass group. On rating scales, significantly more concerns were endorsed with the Fail group for attention and executive functioning relative to the Pass group. Parents generally endorsed significantly more concerns for executive functioning when compared with their children’s self-reported symptoms. There was a trend for the Fail group to report more PCS; however, they did not significantly differ from the Pass group for depression, anxiety, or somatization. Conclusions This study highlights the importance of utilizing PVTs when evaluating concussion recovery.

Objective To cross-validate RAVLT performance validity cut-offs and the RAVLT/RO discriminant function in a large neuropsychological sample. Method RAVLT scores and the RAVLT/RO discriminant function were compared in credible (n = 100) and noncredible (n = 353) neuropsychology referrals. Results Noncredible patients scored lower than credible patients on RAVLT scores and the RAVLT/RO discriminant function. With cut-offs set to ≥90% specificity, highest sensitivities were observed for the discriminant function (cut-off ≤.064; 55.8%), recognition total (cut-off ≤9; 53.1%), the recognition combination score (≤10; 47.7%), and total learning across trials (cut-off ≤31; 45.3%). Individuals with histories of learning difficulties were over-represented in the 10% of credible patients exceeding cut-offs. When these individuals were removed, cut-offs could be tightened while still maintaining at least 90% specificity, and thereby increasing sensitivity (e.g., recognition total cut-off ≤10, 65% sensitivity; RAVLT/RO discriminant function cut-off ≤.176, 58% sensitivity). When three of the most sensitive, non-overlapping scores were considered in combination, 17% of credible patients failed ≥1 of the three cut-offs, while 3% failed two, and only 1% failed all three. In contrast, in the noncredible sample, more than two-thirds failed one or more of the three cut-offs, nearly half failed ≥2, and nearly a quarter failed all three. Conclusions RAVLT PVT cut-offs and the RAVLT/RO discriminant function achieve approximately 50% sensitivity, and approach 65% sensitivity when cut-offs specific to samples without histories of learning problems are employed, confirming that RAVLT cut-offs and the RAVLT/RO discriminant function continue to be valuable techniques in the identification of performance invalidity.

Background: The Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001) is a widely used but controversial instrument promulgated to measure malingering. Its use is encouraged by publications which are methodologically flawed such as the recent meta-analysis by Detullio et al. (2019). In this study, we examine which of M-FAST’s 25 items are most frequently endorsed by veterans with posttraumatic stress disorder (PTSD). Method: Using tabular data published by Wolf’s team in 2020, we identified from a clinical perspective, the 7 M-FAST items endorsed by the highest proportions of 121 US combat veterans with a probable current diagnosis of PTSD. Since the M-FAST diagnostic cutoff is 6 or more points and each endorsed item counts as one point, the 7 most frequently endorsed M-FAST items provide a clinical profile, via their content, as to which items are most frequently involved in misdiagnosing veterans as malingerers. Results and Discussion: Item 2 (“feeling depressed most of the time”) was endorsed by 67.8%, Item 23 (“feeling that I don’t really matter”) by 56.2%, Item 20 (formication) by 28.9%, and Item 17 (phantosmia, i.e., “false sensation of an odor”) by 24.0%. Formication and phantosmia are legitimate neuropsychological symptoms that may occur with whiplash injuries and head trauma or exposure to toxic chemicals in combat. Item 21 (“at times hearing music coming from nowhere”) endorsed by 22.3% may describe spontaneous intrapsychic activity of musically inclined persons. Item 14 (“Sometimes it seems as if someone controls my symptoms, turning them on and off”) endorsed by 20.7% may reflect the unpredictable fluctuation of frequency and severity of PTSD symptoms. Item 1 (“restlessness while seated”) endorsed by 19.8% is scored in the M-FAST as a discrepancy between the patient reporting that he “often” feels restless, and the examiner’s observation that no such nonverbal behavior during the brief M-FAST interview was noted. Restlessness is a post-concussive symptom that is not necessarily always present, such as during the M-FAST interview. Conclusions: All 7 most frequently endorsed items by combat veterans are neither exclusive to malingerers nor pathognomonic of malingering. They form a pattern of legitimate medical symptoms fallaciously scored and interpreted in the M-FAST’s system as indicators of malingering.

Forensic practitioners face continuing challenges in differentiating factitious presentations from malingering, which may be particularly salient in civil forensic cases. In striking contrast to malingering, very little research has studied factitious psychological presentations (FPPs). To address this virtual void, the Inventory of Self and Interpersonal Problems (I-SIP) was developed with two primary scales to address motivations: Factitious (FACT) and Antisocial Characteristics (ANT-C). The I-SIP was tested on 80 inpatients under both genuine and feigning (factitious or malingering) conditions. As predicted, factitious feigners evidenced a dramatic spike on the FACT scale that clearly differentiated it from the other conditions with 90% or higher accuracy. In addition, a ratio between the two primary scales improved the specificity between factitious and malingered presentations. Professional implications are discussed, including the use of the I-SIP as a preliminary alert for factitious presentations.

Objective: Pupil dilation patterns are outside of conscious control and provide information regarding neuropsychological processes related to deception, cognitive effort, and familiarity. This study examined the incremental utility of pupillometry on the Test of Memory Malingering (TOMM) in classifying individuals with verified traumatic brain injury (TBI), individuals simulating TBI, and healthy comparisons. Method: Participants were 177 adults across three groups: verified TBI (n = 53), feigned cognitive impairment due to TBI (SIM, n = 52), and heathy comparisons (HC, n = 72). Results: Logistic regression and ROC curve analyses identified several pupil indices that discriminated the groups. Pupillometry discriminated best for the comparison of greatest clinical interest, verified TBI versus simulators, adding information beyond traditional accuracy scores. Simulators showed evidence of greater cognitive load than both groups instructed to perform at their best ability (HC and TBI). Additionally, the typically robust phenomenon of dilating to familiar stimuli was relatively diminished among TBI simulators compared to TBI and HC. This finding may reflect competing, interfering effects of cognitive effort that are frequently observed in pupillary reactivity during deception. However, the familiarity effect appeared on nearly half the trials for SIM participants. Among those trials evidencing the familiarity response, selection of the unfamiliar stimulus (i.e., dilation-response inconsistency) was associated with a sizeable increase in likelihood of being a simulator. Conclusions: Taken together, these findings provide strong support for multimethod assessment: adding unique performance assessments such as biometrics to standard accuracy scores. Continued study of pupillometry will enhance the identification of simulators who are not detected by traditional performance validity test scoring metrics. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

You have probably heard the story. On the afternoon of 3 August 1943, while his 7th US Army battled the Germans across northern Sicily, Lieutenant General George S. Patton Jr. stopped outside Nicosia to visit the 15th Evacuation Hospital. The hard-pressed 1st Infantry Division's commander, Brigadier General Clarence R. Huebner had only recently warned him that "the front lines were getting thinner" because numerous soldiers malingered in the field hospitals to avoid combat.

This is a registration of a protocol for a scoping review on malingering psychopathology on the Rorschach task

A lack of empathy is closely related to antisocial behavior and criminal offending. Which is why, sentencing decisions, for instance, depend in part on how much empathy an offender expresses during trial, or addressing empathy deficits is a critical component of many offender intervention programs. An accurate assessment of empathy is therefore crucial within the justice system. Yet, only little research has been conducted to date on whether – and to what extend – empathy measures are susceptible to malingering. With this project, we aim to answer the question as to how vulnerable various empathy measures (i.e., self-report, experimental, psychophysiological, and implicit) are to faking good by using a randomized double-blind design. Furthermore, we will examine whether individuals who malinger can be accurately identified with both established social desirability scales and a newly developed empathy malingering scale. Our findings will help improve the accuracy of empathy assessments, particularly in situations where individuals have an incentive to exaggerate their level of empathy.

Individuals with BPD tend to endorse a wide range of symptoms, including dissociative symptoms. Consequently, some professionals may suspect that they engage in intentional symptom overreporting or malingering (Hong, Pirnie, Shobassy, 2019). In line with Hong et al. (2019), we propose another, more sensitive explanation: because individuals with BPD are prone to alexithymia (see a review by Derks et al., 2016), they may unintentionally engage in symptom overreporting. Briefly, alexithymia refers to difficulty in identifying or distinguishing feelings and bodily sensations. While alexithymic individuals experience heightened emotional arousal (Bagby, Parker, Taylor, 1994), their difficulty in translating internal experiences into words is thought to result in a tendency to respond overly affirmatively to symptom indices. This may explain why alexithymia has been found to be associated with a plethora of symptoms, including dissociative symptoms. In addition, alexithymia has recently been proposed to be a potential driver of unintentional symptom overreporting (Merckelbach et al., 2018). Thus, while it may seem that the relationship between BPD and (dissociative) symptom reporting can be explained by the notion that these patients intentionally overreport symptoms, it is possible that a far more important culprit is alexithymia. The purpose of this study is as follows. First, we will examine the relationship between borderline personality traits (BPD traits), alexithymia, dissociative symptoms, and symptom over-reporting in a non-clinical sample. Second, we will examine whether the relationship between borderline personality traits and both types of symptom reporting is moderated by alexithymia. Third, we will examine whether symptom overreporting predicts the reporting of dissociative symptoms and whether this association will hold once alexithymia is controlled for. Fourth, we will include exploratory analyses to see whether the relationship between alexithymia and symptom overreporting is mediated by coping styles (i.e., emotion-oriented coping) and impaired defense mechanisms (i.e., emotional hypochondriasis; see Zanarini et al, 1994). Finally, as BPD, alexithymia and symptom reporting may vary culturally (e.g., Choudhary, 2017), we will collect data from a European and Indian student sample to explore whether we can replicate these relationships cross culturally.

The Self-Report Symptom Inventory (SRSI; Merten et al., 2016) is a newly developed questionnaire that intends to detect over-reporting of symptoms in the context of e.g. litigation (e.g., subjects who seek compensation for traumatic brain injury, chronic fatigue, PTSD). A preliminary report concluded that the psychometric properties of the SRSI are promising, but much work needs to be done. This study wants to contribute to normative data about the SRSI. Basically, the SRSI consists of two types of items. One type is tapping into plausible complaints (e.g., I am rarely in a good mood; I am often exhausted) and the other is tapping into rare symptoms (e.g., Sometimes my left leg is really weak, sometimes the right one is; When I am in extreme pain I get double vision). The rationale is that patients will endorse more plausible than rare symptoms, while this differential pattern is absent in people who over-report/simulate their complaints. We want to test whether 1) differential responding is also present in a student comparison group (if students would endorse as much rare symptoms as real symptoms that would cast doubts on the quality of the SRSI) and 2) the SRSI can detect over-reporting when students are instructed to fake anxiety-symptoms, pain symptoms or fatigue.

The DSM-5 describes malingering as “the intentional production of false or grossly exaggerated physical symptoms motivated by external incentives” (APA, 2013) and thereby typologizes malingerers as antisocial individuals who intentionally produce symptoms for personal gain. This reliance on an antisocial typology of malingering does not rest on an empirical basis (e.g. Niesten et al., 2015). Hysteria is traditionally seen as an important differential diagnosis of malingering. A common characteristic between the two is a mismatch between objective and subjective markers of impairment. However, the symptom production in malingering is seen as intentional, whereas in hysteria it is considered unintentional (Turner, 1999). Thus, while malingerers are viewed as wolves in sheep’s clothing (Niesten, 2019) who consciously produce symptoms for personal gain, individuals fitting the hysterical typology are viewed as victims of their own unconscious symptom exaggeration. The aim of the proposed research is to investigate whether professionals will rate symptom validity differently depending on the personality typology of the patient (antisocial/hysteric/neutral), and whether they will adjust their diagnostic conclusions when presented with reliable indicators of symptom validity (i.e., Symptom Validity Test scores; e.g., Impelen et al., 2017). We expect that the information professionals receive first (i.e., patient’s personality typology) will affect their initial assessment and that this assessment will act as an anchor, so that subsequently added, relevant information (SVT scores) has less impact on the professionals’ final assessment. We expect this to be due to the anchoring effect: a cognitive bias originally found when people’s estimations of numbers stayed close to an initially presented number that acts as their “anchor” (Jacowitz & Kahneman, 1995).

INTRODUCTION: Research has shown non-trivial base rates of noncredible symptom report and performance in the clinical evaluation of attention-deficit/hyperactivity disorder (ADHD) in adulthood. The goal of this study is to estimate and replicate base rates of symptom and performance validity test failure in the clinical evaluation of adult ADHD and derive prediction models based on routine clinical measures.METHODS: This study reuses data of a previous publication of 196 adults seeking ADHD assessment and replicates the findings on an independent sample of 700 adults recruited in the same referral context. Measures of symptom and performance validity (one SVT, two PVTs) were applied to estimate base rates. Prediction models were developed using machine learning.RESULTS: Both samples showed substantial rates of noncredible symptom report (one SVT failure: 35.7% - 36.6%), noncredible test performance (one PVT failure: 32.1% - 49.3%; two PVT failures: 18.9% - 27.3%), or both (each one SVT and PVT failure: 13.3% - 22.4%; one SVT and two PVT failures: 9.7% - 13.7%). Machine learning algorithms resulted in generally moderate to weak prediction models, with advantages of the reused sample compared to the independent replication sample. Associations between measures of symptom and performance validity were negligible to small.CONCLUSIONS: This study highlights the necessity to include measures of symptom and performance validity in the clinical evaluation of adult ADHD. Further, this study demonstrates the difficulty to characterize the group failing symptom or performance validity assessment.

Background: The current study aimed to validate the utility of previously established validity indicators derived from MOXO-d-CPT’s continuous performance test. Method: Healthy simulators feigned impairment after searching online for relevant information, an ecologically valid coaching condition ( n = 39). They were compared to ADHD patients ( n = 36) and healthy controls ( n = 38). Results: Simulators performed significantly worse than ADHD patients in all MOXO-d-CPT indices, as well as a scale that integrates their contributions (feigned ADHD scale). Three indices (attention, hyperactivity, and impulsivity) and the latter scale exhibited adequate discriminative capacity. Higher education was associated with an exaggerated impairment among simulators, easing their detection. Conclusion: Similarity between the current study and a previous study which examned the utlity of the MOXO-d-CPT validity indicators, increases our confidence in the efficacy of the latters embedded validity indicators. Though the findings provide initial validation of these validity indicators, generalizing beyond highly functioning participants necessitates further research.

The purpose of this study was to evaluate relationships among the Word Memory Test (WMT), symptom validity test (SVT) indices of the Personality Assessment Inventory (PAI), history of mild traumatic brain injury (mTBI), and posttraumatic stress disorder (PTSD) symptom burden. Participants were postdeployment, predominantly male (88.5%) veterans (N = 417) who completed a neurocognition study that included the WMT and PAI. Correlations, chi-square analyses, and ANOVAs were used for analyses. Results of aim 1 examining relations among the two tests found that 20.4% produced invalid scores on the WMT (regardless of PAI scores), 13.8% produced an invalid PAI (regardless of WMT scores), and 4.6% were invalid on both tests. Of the 4 original PAI validity scales, only Negative Impression Management was related to WMT failure; the supplementary Malingering Index was also significant at a smaller effect size. The second aim evaluated mTBI and PTSD symptoms in relation to validity scores. History of mTBI was associated with invalid WMT scores but not PAI scores; follow-up analyses indicated that injuries sustained during deployment were significantly more likely to produce invalid WMT scores than non-deployment injuries. Contrary to hypotheses, PTSD symptom burden was related to WMT failure but not overreporting on the PAI. After dividing the sample into four groups based on valid versus invalid WMT and PAI scores, the invalid PVT valid SVT group had the highest proportion of mTBI, whereas PTSD symptom burden was highest in the groups that invalidated both measures or only the WMT. Service-connected disability status was unrelated to either type of validity. Given invalidating both types of validity measures is uncommon, the importance of sampling both types of validity is highlighted.

Background: The Miller Forensic Assessment of Symptoms Test (M-FAST) is used widely for the assessment of malingering of medical symptoms. Its validity has allegedly been supported by meta-analytic study of M-FAST in 2019 by Detullio et al. Credibility of Detullio’s results is damaged by an inclusion of data based on analog validation and also on dubious convergent validation procedures that falsify estimates of M-FAST’s validity. Method: In the present study, the meta-analysis was calculated on 3 types of M-FAST data: (1) 5 samples of scores of healthy persons instructed to respond honestly, (2) 5 samples of scores of medical patients, and (3) 10 samples of scores of healthy persons instructed to feign mental illness (so called “instructed malingerers”). Results: In an ANOVA (F(2,815)=398.50, p

The cry for help is a contentious attribution to give to the motivation for symptom exaggeration or negative response bias in results that do not reach the bar for malingering on symptom validity tests in psychological injury forensic and related disability assessments. Young (Psychological Injury and Law, 12(3–4), 225–237, 2019) had argued that the cry for help is a valid interpretive option in these circumstances, given that it refers to a call for attention for the most part. This paper advocates for replacing the term cry for help with a less contested one—a call for aid. This replacement term has multiple advantages relative to the term of a cry for help, which are elucidated. The evaluee might be experiencing litigation distress, for example, and feel that aid is required and behave in ways, either overtly or covertly, that call for the aid. The term cry for help is not actively researched, with only two relevant publications including the term since the 2019 article in question was published. Here, we examine those papers, and reflect on the implications for test/scale result interpretations involving psychological injury assessments. Also, through those articles, we propose mechanisms that might be at work in expressing the call for aid. Recommendations relate to undertaking a comprehensive research program on the call for aid in the types of assessments to which it might apply as a possible explanation of symptom validity test (SVT) and performance validity test (PVT) testing results. To facilitate research on the question, the article provides a table of 25 possible explanations for SVT/PVT results in forensic disability and related assessments that implicate exaggerated symptoms.

Introduction: Research to date has supported the use of multiple performance validity tests (PVTs) for determining validity status in clinical settings. However, the implications of including versu...

Objective This study examined the degree to which verbal and visuospatial memory abilities influence performance validity test (PVT) performance in a mixed clinical pediatric sample. Method Data from 252 consecutive clinical pediatric cases (Mage=11.23 years, SD=4.02; 61.9% male) seen for outpatient neuropsychological assessment were collected. Measures of learning and memory (e.g., The California Verbal Learning Test-Children’s Version; Child and Adolescent Memory Profile [ChAMP]), performance validity (Test of Memory Malingering Trial 1 [TOMM T1]; Wechsler Intelligence Scale for Children-Fifth Edition [WISC-V] or Wechsler Adult Intelligence Scale-Fourth Edition Digit Span indices; ChAMP Overall Validity Index), and intellectual abilities (e.g., WISC-V) were included. Results Learning/memory abilities were not significantly correlated with TOMM T1 and accounted for relatively little variance in overall TOMM T1 performance (i.e., ≤6%). Conversely, ChAMP Validity Index scores were significantly correlated with verbal and visual learning/memory abilities, and learning/memory accounted for significant variance in PVT performance (12%–26%). Verbal learning/memory performance accounted for 5%–16% of the variance across the Digit Span PVTs. No significant differences in TOMM T1 and Digit Span PVT scores emerged between verbal/visual learning/memory impairment groups. ChAMP validity scores were lower for the visual learning/memory impairment group relative to the nonimpaired group. Conclusions Findings highlight the utility of including PVTs as standard practice for pediatric populations, particularly when memory is a concern. Consistent with the adult literature, TOMM T1 outperformed other PVTs in its utility even among the diverse clinical sample with/without learning/memory impairment. In contrast, use of Digit Span indices appear to be best suited in the presence of visuospatial (but not verbal) learning/memory concerns. Finally, the ChAMP’s embedded validity measure was most strongly impacted by learning/memory performance.

Objective: The addition of Sequencing to WAIS-IV Digit Span (DS) brought about new Reliable Digit Span (RDS) indices and an Age-Corrected Scaled Score that includes Sequencing trials. Reports have indicated that these new performance validity tests (PVTs) are superior to the traditional RDS; however, comparisons in the context of known neurocognitive impairment are sparse. This study compared DS-derived PVT classification accuracies in a design that included adults with verified TBI. Methods: Participants included 64 adults with moderate-to-severe TBI (TBI), 51 healthy adults coached to simulate TBI (SIM), and 78 healthy comparisons (HC). Participants completed the WAIS-IV DS subtest in the context of a larger test battery. Results: Kruskal-Wallis tests indicated that all DS indices differed significantly across groups. Post hoc contrasts revealed that only RDS Forward and the traditional RDS differed significantly between SIM and TBI. ROC analyses indicated that RDS variables were comparable predictors of SIM vs. HC; however, the traditional RDS showed the highest sensitivity when approximating 90% specificity for SIM vs. TBI. A greater percentage of TBI scored RDS Sequencing < 1 compared to SIM and HC. Conclusion: In the context of moderate-to-severe TBI, the DS-derived PVTs showed comparable discriminability. However, the Greiffenstein et al. traditional RDS demonstrated the best classification accuracy with respect to specificity/sensitivity balance. This relative superiority may reflect that individuals with verified TBI are more likely to perseverate on prior instructions during DS Sequencing. Findings highlight the importance of including individuals with verified TBI when evaluating and developing PVTs.

People seeking higher privileges or disability benefits are prone to simulate cognitive difficulties (van Oorsouw, Merckelbach, 2010). The most common is the simulation of memory impairment, but there is no adapted test in Lithuania that could identify it. The purpose of this study is to determine Rey Fifteen-Item Test (FIT; Rey, 1964; Lezak, Howieson, Bigler, Tranel, 2012) sensitivity and specificity by comparing three groups of subjects: healthy responders, who perform tests, as usual, healthy responders, who were instructed to simulate memory impairments and patients with traumatic brain injuries. The study included 91 subjects aged 18 to 86 years (M=42.04 SD=13.5). The study used the “Short Term Memory Test” (STMT; Vasserman, Dorofeeva, Meyerson, 1997), the FIT, socio-demographic questions. The results of the study revealed that the malingerers and nonmalingerers did not differ in the STMA scores. Whereas in patients with traumatic brain injuries STMA scores were significantly lower. Nonmalingerers and patients with traumatic brain injuries performed better on FIT than malingerers. The probability that the malingerers score lower than people with memory difficulties is 62 up to 78 percent; FIT sensitivity ranges between 73 and 90 percent, specificity between 41 and 72 percent, depending on the RPOT cut-off score.

Lysosomal storage diseases (LSDs) are a heterogeneous group of conditions causing substrate accumulation leading to progressive organ damage. Newborn screening (NBS) for several LSDs has become available in recent years due to advances in technology and treatment availability. While early initiation of treatment is lifesaving for those with infantile presentations, controversy continues regarding diagnosis of milder, later-onset diseases in infancy, including creation of pre-symptomatic populations of 'patients-in-waiting', the potential for medicalization, stigmatization, and/or discrimination. In-depth interviews were conducted with 36 adults [11 with Fabry disease (FD), 8 with Gaucher disease (GD), and 17 with late-onset Pompe disease (LOPD)], to determine their perspectives on NBS for their respective conditions. Thirty-four of 36 participants were in favor of NBS; both participants not in favor had GD1. Emergent themes influencing participants favorably toward NBS included earlier age of onset, a long diagnostic odyssey, less efficacious treatment, and the desire to have made different life decisions (e.g., relationships, career, or lifestyle) with the knowledge of their diagnosis. Concerns about insurance discrimination and psychological or physical burdens were associated with less favorable opinions of NBS. The ability for parents to make future reproductive decisions based their child's NBS result was considered favorably by some participants and unfavorably by others. Participants' specific condition (GD1, FD, or LOPD) contributed to these experiences differently. Participants with LOPD and FD favored NBS to initiate earlier treatment and prevent irreversible organ damage, whereas fewer patients with GD1 mentioned this benefit. Participants with LOPD had the longest diagnostic odyssey, while those with FD were more likely to report feeling misunderstood and experiencing accusations of malingering, both contributing to favorable views of NBS. Results expand prior quantitative findings by illuminating how participants' lived experiences can shape opinions about NBS. By understanding how currently affected individuals perceive the lifelong impact of a NBS result, genetic counselors can provide better anticipatory guidance to the parents of individuals diagnosed with a later-onset LSD by NBS.

Objective: Two studies examined the psychometric properties of the Multidimensional ADHD Rating Scale (MARS), which assesses ADHD symptoms, related functional impairment, and symptom validity (SV). Method: Study 1 used MARS item responses from college students with and without ADHD (with some of the latter group assigned to feign ADHD) to create an SV-index, and to identify optimal cut scores for the clinical (symptom and impairment) indexes. Study 2 cross-validated the findings on a new sample. Results: In both studies, malingerers reported more symptoms and impairment than participants with ADHD, who reported more symptoms and impairment than controls. Receiver operating characteristic analyses found very good discrimination of genuine ADHD from control cases by the clinical MARS indexes, and very good discrimination of genuine ADHD from malingered ADHD by the SV-index. Conclusion: This research provides initial support for the effectiveness of the MARS to detect simulated cases of malingering, and to differentiate ADHD from non-ADHD cases in college students.

Intentional faking and/or exaggeration of disability increase unnecessary burden and costs for society, and they could be difficult to detect. This study aimed to explore which and how eye-based me...

Background: BERA is an objective study for assessing hearing loss on patients with inconsistent responses on pure tone audiogram. BERA is a non-invasive and the most cost-effective method for diagnosing retrocochlear lesion, not affected by sedation, anesthesia or age. Which helps to identify retrocochlear hearing loss. It is impossible to perform pure tone audiometry on infants and children. Methods and Aim: This is a cross sectional prospective cohortHospital based study, review of 50 patient subjected to BERA for SNHL in any age group referred to department of ENT Vijayanagara institute of medical sciences, Bellary. Our aim is to find out its applications on objective test in cases of inconsistent response to pure tone audiometry Result: Pure tone audiometry was done in all cooperative cases and found hearing loss of different severity, few with inconsistent responses, few retrocochlear pathology and also helps in identifying malingering as BERA as an objective test. Conclusion: BERA is useful in finding hearing thresholds in patients with inconsistent response to pure tone audiometry. Keywords: BERA, Pure tone audiometry, Absolute latency.

The Test of Memory Malingering (TOMM) Trial 1 (T1) and errors on the first 10 items of T1 (T1-e10) were developed as briefer versions of the TOMM to minimize evaluation time and burden, although th...