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Some self-report symptom validity tests, such as the Self-Report Symptom Inventory (SRSI), rely on a detection strategy that uses bizarre, extreme, or very rare symptoms. Thus, items are constructed to invite respondents with an invalid response style to affirm pseudosymptoms that are usually not experienced by genuine patients. However, these pseudosymptoms should not be easily recognizable, because otherwise sophisticated over-reporters could strategically avoid them and go undetected. Therefore, we tested how well future psychology professionals were able to differentiate between genuine complaints and pseudosymptoms in terms of their plausibility and prevalence.Psychology students (N = 87) received the items of the SRSI online and were given the task to rate each item as to its plausibility and prevalence in the community.Students evaluated genuine symptoms as significantly more plausible and more prevalent than pseudosymptoms. However, 56% of students rated pseudosymptoms as moderately plausible, whereas 17% rated them as moderately prevalent in the general public.Overall, it appears that psychology students are successful in distinguishing bizarre, unusual, or rare symptoms from genuine complaints. Yet, the majority of students still attributed relatively high prima facie plausibility to pseudosymptoms. We contend that if such a trusting attitude is true for psychology students, it may also be the case for young psychology practitioners, which, consequently, may diminish the probability of employing self-report validity measures in psychological assessments.

Strategies of malingering detection have brought about a wealth of neuropsychological studies in the last decades. However, the investigation of physiological measures to reliably differentiate between authentic and manipulated symptom presentations is still in its infancy. The present study examined event-related potentials (ERP) to identify feigned memory impairment. We tested instructed malingerers (n = 25) and control participants (n = 22) with a recognition task similar to the Test of Memory Malingering. No differences between groups were found for P1 (70–110 ms) but for N1 (120–170 ms) and P300 components, with lower amplitudes for instructed malingerers. Behavioral data showed a typical pattern of unrealistically high errors in a forced-choice recognition task and less overall recalled stimuli in instructed malingerers. We also found study-phase repetition and old/new effects in the P300, but no interactions with groups (control vs. malingering). Post-hoc analyses revealed that the P300 effect is greater when participants reported an attention-based faking strategy, as opposed to response-based malingerers and controls. The employment of physiological measures can yield additional information on the validity of test data without the need to perform additional tests.

In 2013, a special issue of the Spanish journal Clinica y Salud published a review on symptom and performance validity assessment in European countries (Merten et al. in Clinica y Salud, 24(3), 129-138, 2013). At that time, developments were judged to be in their infancy in many countries, with major publication activities stemming from only four countries: Spain, The Netherlands, Great Britain, and Germany. As an introduction to a special issue of Psychological Injury and Law, this is an updated report of developments during the last 10 years. In that period of time, research activities have reached a level where it is difficult to follow all developments; some validity measures were newly developed, others were adapted for European languages, and validity assessment has found a much stronger place in real-world evaluation contexts. Next to an update from the four nations mentioned above, reports are now given from Austria, Italy, and Switzerland, too.

Factitious disorder and malingering are two forms of abnormal illness behaviour in which mental or somatic symptoms are deliberately fabricated or grossly exaggerated or otherwise grossly misrepresented. They are forms of other-deceit, with the person in question assumed to be fully aware of this deceit. The central distinguishing feature of both is that factitious disorder is commonly thought to be motivated by internal incentives (primary gain: medical treatment, assuming the sick role), while malingering is directed towards an external goal (secondary gain, for example monetary compensation, sick leave). The utility of distinguishing between the two forms of feigning has long been questioned. Similarly, it must be questioned why factitious disorder is apprehended as a mental disorder in its own right. Neither the Diagnostic and Statistical Manual of Mental Disorders (DSM) nor the International Classification of Diseases (ICD) contains useful diagnostic guidelines for reliably diagnosing feigned illness presentations; in particular, several decades of malingering research and conceptual developments have found no repercussion there.

In medicolegal contexts, the expert is confronted with a number of apparent or seemingly paradox constellations that are mostly not even explicit to the assessor involved, yet when they occur, they may have a profound effect on the shaping of the expert’s opinion and, subsequently, on the outcome of litigation. Because the paradoxes in this forensic work have not been made explicit for the most part in the field, it can be assumed that forensic experts themselves are often unaware of paradoxical situations and logical incoherence to be found in many cases. Difficulties to positively diagnose somatoform and dissociative disorders in disability claimants and compensation-seeking litigants are among the most prominent of these paradoxes. For example, in these diagnoses, presumably unconscious core motives and an involuntarily, unconsciously distorted symptom presentation (both being central for the diagnosis) might contrast with conscious symptom magnification and pursuit of monetary interests on the part of the complainant (external incentives in the form of disability or compensation seeking). Other paradoxes discussed in more detail are linked with symptom validity assessment in forensic psychology. Logical dilemmas and paradoxes, if not placed at the forefront in forensic psychological evaluations, potentially undermine the quality of forensic determinations.

In forensic contexts, an increased prevalence of feigned symptom presentations should be expected, although it will probably vary by the context and specific forensic issue. Forensic experts should examine this possibility proactively while maintaining a balanced perspective that actively considers clinical data for both feigning and genuine responding. Psychological measures and standardized methods developed for feigning and other response styles can facilitate these often complex determinations. The current article provides an international perspective on the issue of feigned mental disabilities. In particular, important conceptual issues are discussed, such as the categorical versus dimensional approaches to feigning, and the advisability of well-defined rather than single-point cut scores for accuracy in clinical decision-making. Salient problems of differential diagnosis include a spectrum from malingering and factitious disorders to somatoform and conversion disorders. In rendering these important diagnostic distinctions, the questions of motivations and intentions remain key. However, the establishment of motivation cannot be facilely assumed from the context. Instead, forensic psychologists and psychiatrists bear the professional burden of carefully evaluating motivation and recognizing the clinical reality that sometimes the motivation in especially challenging cases may not be fully determined. Copyright © 2017 John Wiley & Sons, Ltd.

Some researchers argue that the Modified Stroop Task (MST) can be employed to rule out feigning. According to these authors, Modified Stroop interference effects are beyond conscious control and therefore indicative of genuine psychopathology. We examined this assumption using a within-subjects design. In the first session, students (N = 22) responded honestly, while in the second session they were asked to read a vignette about test anxiety and then fake this condition. During both sessions, we administered an MST consisting of neutral, anxiety-related, and test anxiety-related words. Participants also completed the Self-Report Symptom Inventory (SRSI; Merten et al., 2016) that focuses on over-reporting of pseudosymptoms. Our feigning instructions were successful in that students succeeded in generating the typical MST effect by providing longer response latencies on anxiety related (r = 0.43) and test anxiety – related (r = 0.31) words, compared with neutral words. Furthermore, students endorsed significantly more pseudosymptoms on the SRSI (r = 0.62) in the feigning session than in the honest control condition. We conclude that the MST effect is not immune to feigning tendencies, while the SRSI provides promising results that require future research. Keywords Feigning; Over-reporting; Feigning; Test anxiety; SRSI; Modified Stroop task

We meta-analytically reviewed studies that used the Structured Inventory of Malingered Symptomatology (SIMS) to detect feigned psychopathology. We present weighted mean diagnostic accuracy and predictive power indices in various populations, based on 31 studies, including 61 subsamples and 4009 SIMS protocols. In addition, we provide normative data of patients, claimants, defendants, nonclinical adults, and various experimental feigners, based on 41 studies, including 125 subsamples and 4810 SIMS protocols. We conclude that the SIMS (1) is able to differentiate well between instructed feigners and honest responders; (2) generates heightened scores in groups that are known to have a raised prevalence of feigning (e.g., offenders who claim crime-related amnesia); (3) may overestimate feigning in patients who suffer from schizophrenia, intellectual disability, or psychogenic non-epileptic seizures; and (4) is fairly robust against coaching. The diagnostic power of the traditional cut scores of the SIMS (i.e., > 14 and > 16) is not so much limited by their sensitivity-which is satisfactory-but rather by their substandard specificity. This, however, can be worked around by combining the SIMS with other symptom validity measures and by raising the cut score, although the latter solution sacrifices sensitivity for specificity.

During the last decades, symptom validity has become an important topic in the neuropsychological and psychiatric literature with respect to how it relates to malingering, factitious disorder, and somatoform complaints. We conducted a survey among neuropsychologists (N = 515) from six European countries (Germany, Italy, Denmark, Finland, Norway, and the Netherlands). We queried the respondents about the tools they used to evaluate symptom credibility in clinical and forensic assessments and other issues related to symptom validity testing (SVT). Although the majority of the respondents demonstrated technical knowledge about symptom validity, a sizeable minority of the respondents relied on outdated notions (e.g., the idea that clinicians can determine symptom credibility based on intuitive judgment). There is little consensus among neuropsychologists on how to instruct patients when they are administered SVTs and how to handle test failure. Our findings indicate that the issues regarding how to administer and communicate the SVT results to patients warrant systematic research.

When patients present with unusual, atypical, and difficult-to-understand complaints known as dissociative and somatoform disorders or medically unexplained symptoms, clinicians may administer symptom validity tests (SVTs) to determine whether or not the patient exhibits negative response bias. Such tests are especially informative in a context where incentives play a substantial role (e.g., the legal arena). If patients fail SVTs and exhibit negative response bias, how should that bias be interpreted? Some authors have argued that psychological problems (e.g., unconscious conflicts and depression) and circumstances (e.g., a cry for help) may explain such bias. In the current article, we critically review this “psychopathology = superordinate” position. We argue that (1) there is no empirical evidence to suggest that psychological problems may foster SVT failure per se and (2) that the “psychopathology = superordinate” position invites circular argumentation: to clarify the nature of the atypical symptoms, SVTs are administered and a negative response bias is found, which is explained away by the atypical symptoms. Negative response bias allows for only one conclusion: the patient’s self-report of symptoms and life history can no longer be taken at face value.

Hasta no hace mucho tiempo la evaluación de la validez de los síntomas en Europa, tanto en su vertiente científico-académica como en la práctica profesional, estaba muy por detrás de los avances que se producían en Norteamérica y particularmente la simulación se consideraba un tema tabú entre los profesionales de la Psicología y la Medicina. En la última década las cosas parecen haber cambiado, observándose un incremento en el interés por la evaluación del sesgo de respuesta negativo. Las tasas base de prevalencia obtenidas utilizando pruebas de rendimiento subóptimo en contextos civiles y forenses son similares a las obtenidas en Norteamérica. Los fenómenos de exageración de síntomas en autoinformes y rendimiento insuficiente en pruebas neuropsicológicas parecen ocurrir en semejante proporción de pacientes. Aunque se han producido avances notables en el establecimiento de la evaluación de la validez de los síntomas como una parte integral e indispensable de la evaluación psicológica y neuropsicológica en algunos países europeos, en otros sin embargo la situación es mucho más incipiente. De hecho, en algunos países sigue existiendo una gran resistencia a la evaluación de la validez de los síntomas proveniente de algunos profesionales de la psiquiatría y la neuropsicología.

Self-report instruments to detect distorted symptom reporting play a crucial role in clinical and forensic psychology. Most of the instruments currently available for this purpose only list implausible symptoms, which makes them easily identifiable as symptom validity tests. We developed the Self-Report Symptom Inventory (SRSI), combining five self-report scales of genuine symptoms with five pseudosymptom scales to screen for distorted symptom reporting in various domains (e.g., depression, post-traumatic stress). With a preliminary questionnaire version, we collected data in a heterogeneous sample (N = 239) and performed an item selection, resulting in the final 107-item version. This version was evaluated in civil forensic patients, inmates of a prison, and a population-based sample; N = 387). Data show that (a) SRSI pseudosymptom scores correlate highly (=. 80) with other instruments tapping distorted symptom endorsement, notably the Structured Inventory of Malingered Symptomatology; (b) High SRSI pseudosymptom scores tend to correlate with underperformance; and (c) The psychometric features of the SRSI are satisfactory, with internal consistency for the total scales >.90 and retest reliability >.85. The instrument appears to be a promising tool for examining symptom exaggeration, but further work is required, in particular cross-validation with other samples and different methods.

Symptom validity testing has become a prolific research field in neuropsychology. Its original and most powerful version is the forced-choice procedure that continues to play an important role because it allows for an experimental approach to test the hypothesis of intentional symptom distortion. When conducting forced-choice tests, below-chance response patterns are considered to be indicative of this type of distortion. In this article, we discuss the rationale behind the forced-choice technique and its historical development. We also present three case vignettes that illustrate the experimental background of forced-choice testing and how it may help to clarify diagnostic issues. The diagnostic considerations in these cases concerned (1) complete memory loss, (2) Ganser syndrome, and (3) dementia. Employing forced-choice methodology, intentional false symptom production could be demonstrated in all three patients. Thus, the cases demonstrate how, in the context of substantial external benefits, forced-choice testing may help to determine whether healthy individuals try to appear psychologically impaired.

This paper proposes that malingered symptoms may become internalized due to the self-deceptive power of cognitive dissonance. Studies demonstrating how other-deception may turn into self-deception are briefly discussed, as are clinical notions about the overlap between malingering and medically unexplained symptoms. In our view this literature showcases the relevance of cognitive dissonance for research on malingering. A cognitive dissonance perspective may help to clarify how ambiguous sensations may escalate into subjectively compelling symptoms. This perspective suggests that malingered symptom reports are more than just a complication during psychological evaluation. It may generate new research avenues and may clarify practically relevant issues.

In the context of criminal forensic evaluations, experts are often confronted with the problem of offenders' claims of crime-related amnesia. Because of the far-reaching legal consequences of the expert opinion, the nature of the suspected memory disorder has to be investigated with special care and due consideration of differential diagnoses. While the diagnosis of organic amnesia is comparatively easy to make, the same is not true for dissociative amnesia. Despite existing theoretical explanations such as stress, peritraumatic dissociation or repression, to date there is no sound, scientifically based and empirically supported explanation for the occurrence of genuine, non-organic crime-related amnesia. In the criminal context of claimed amnesia, secondary gain is usually obvious; thus, possible malingering of memory loss has to be carefully investigated by the forensic expert. To test this hypothesis, the expert has to resort to methods based on a high methodological level. The diagnosis of dissociative amnesia cannot be made by mere exclusion of evidence for organic amnesia; instead, malingering has to be ruled out on an explicit basis.

Claims of crime-related amnesia appear to be common. Using a mock crime approach, the diagnostic power of seven symptom validity instruments was investigated. Sixty participants were assigned to three conditions: responding honestly; feigning crime-related amnesia; feigning amnesia with a warning not to exaggerate. High sensitivity and specificity were obtained for the Structured Inventory of Malingered Symptomatology, the Amsterdam Short-Term Memory Test, and the Morel Emotional Numbing Test. Only three warned malingerers went undetected. The results demonstrate that validated instruments exist to support forensic decision making about crime-related amnesia. Yet, warning may undermine their effectiveness, even when using a multi-method approach.

The study aimed to provide independent data on the specificity of the Nonverbal Medical Symptom Validity Test (NV-MSVT; Green, 2008 ), a new test that combines conventional decision making based on cutoffs with profile analyses in order to identify invalid test performance and to reduce false positive classifications. The results of 65 bona fide neurological patients (with 21 of them meeting Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, DSM-IV, core criteria for dementia) were compared to 50 healthy volunteers. One patient was wrongly classified as malingering, resulting in a specificity of 98.5% for neurological patients and 100% for controls. A total of 13 patients with dementia (62%), 6 patients without dementia (14%), and 1 healthy participant exhibited a dementia profile in the NV-MSVT. While these results confirm the high specificity of the NV-MSVT for the classification insufficient effort, its sensitivity has to be verified by independent research data.

In independent medical examinations, unjustified claims of posttraumatic stress disorder (PTSD) are to be expected at an increased rate. In a prospective study, consecutive cases of patients claiming PTSD who underwent independent neuropsychiatric evaluation were analyzed. For 61 adult patients, results of three symptom validity tests (Morel Emotional Numbing Test, Structured Inventory of Malingered Symptomatology, and Word Memory Test) were available. Seventy percent of all claimants showed probable negative response bias in at least one of the three tests, 25% in all three tests. High probability of negative response bias was associated with symptom overreporting and demonstration of cognitive deficits in performance tests. The results indicate that high rates of uncooperativeness must be expected in civil forensic patients with claimed PTSD. A multi-method approach to the assessment of response distortion in PTSD claimants is indicated.

Symptom validity testing is a major topic in the field of neuropsychological research, but until now, few studies focus on effort testing in children. Three symptom validity tests (SVTs), the Medical Symptom Validity Test, the Test of Memory Malingering, and the Fifteen Item Test plus several standard neuropsychological tests were administered to 73 German-language school children from 6 to 11 years. Participants were either instructed to give full effort or to follow a malingering scenario. It could be demonstrated that, except for one child, all participants with a basic reading level of grade 2 were able to pass all administered SVTs according to established cutoffs for poor effort (i.e., earned a score higher than the cutoff). For the experimental malingerers, however, it was fairly difficult to act according to the scenario throughout the session. While they scored worse in the neuropsychological tests, all but one of them failed at least one SVT. The results support the use of SVTs in childhood age. More elaborate experimental designs and studies with bona-fide patients and suspected malingerers are needed in order to evaluate both the appropriateness of available effort tests and the capabilities of children to fake poor performance.

Objective: This study used the Medical Symptom Validity Test (MSVT) to examine exaggeration of memory impairment in disability claimants. Methods: The MSVT was administered to patients with soft tissue injuries undergoing an independent medical examination (IME). Their results were compared with those from groups of volunteers who were either trying their best on the test or simulating memory impairment. Results: Non-French-speaking volunteers, who were tested in French, showed near perfect performance on the effort subtests, but 42% of IME patients failed the effort tests in English. Their overall results were very similar to those of simulators. Conclusion: This study suggests that exaggeration of cognitive symptoms is widespread in disability-related evaluations. It would be unwise to accept self-reported memory complaints at face value. Criteria-normed symptom validity testing should be done to rule out symptom exaggeration.

Coaching is a topic of utmost importance for forensic neuropsychological assessment, and symptom validity tests (SVTs) should be resistant against it. Four groups of experimental malingerers (n = 15, each) were given scenarios to feign cognitive symptoms after traumatic brain injury. Group A obtained a basic scenario. For Group B, symptom information was added. Group C received an explicit warning against exaggerating symptom presentation. Group D obtained a specific coaching which contained an introduction into principles of effort measurement. All groups were given a short neuropsychological battery including three SVTs: the Amsterdam Short-Term Memory Test (ASTM), the Medical Symptom Validity Test (MSVT), and the Word Completion Memory Test (WCMT). While a general trend for gradually better results in SVTs from Group A to Group D was observed, only in Group D were pass rates elevated for the MSVT and the WCMT. Not a single participant passed the ASTM test. Coaching appears to be more effective...

In a reanalysis of data previously published (Merten, 1992, 1993b), the relations between a variety of indicators of word-association tests (WATs) and personality variables, verbal intelligence, age, and self-reflected thought and speech disorders were studied. Multiple regression analyses performed with a group of 46 healthy individuals showed pyschoticism to be a strong predictor for response creativity. On the basis of the data, more stringent methodological approaches to the WAT (common and individual response condition) are suggested for personality and creativity research. A cluster analysis of WAT data from 43 schizophrenics, 15 affective psychotics, and 46 control revealed different response patterns to be related to a number of variables, such as psychopathology, verbal intelligence, and personality. Although there seemed to exist a clear relation between the dimension of conformity/nonconformity and WAT responses, this relation is far more complex than correlational analyses or group comparisons...

Effort has repeatedly been shown to have a pervasive effect on performance in psychological tests. The current study evaluates to what degree performance on various psychological tests is affected by lack of effort as compared with brain injury. Psychological and medical data from a sample of 233 patients referred from Workers' Compensation Boards or from claimants in personal injury litigation were retrospectively analyzed. Each patient underwent a battery of psychological tests and a medical examination. Measures of effort were derived from the Word Memory Test (WMT) and the Medical Symptom Validity Test (MSVT). Insufficient effort was shown by 44.6% of the patients. The frequency of patients failing the effort tests was independent of age, sex, referral source, and leading complaint. Effort accounted for up to 35% of the variance of performance in the domains of cognitive speed, memory and intelligence. After controlling for effort, there was no significant effect that could be attributed to substantial brain injury. The findings confirm that there is a general and strong effect of effort on psychological test results, which dwarfs the impact of substantial brain injury. Effort testing should become a standard procedure in psychological testing.

Although symptom validity testing is an integral part of the repertory of neuropsychologists in a number of countries, this is not yet true for Germany. The German adaptations of two effort tests, the Medical Symptom Validity Test (MSVT) by Green and the Amsterdam Short-Term Memory Test (ASTM) by Schmand et al., were investigated with a German-language sample. An analog study was performed with 18 healthy experimental malingerers and 18 controls with a mean age of 25.4 years. The scenario contained detailed information about mild post-traumatic cognitive impairment, as well as an explicit warning against symptom exaggeration. In addition to MSVT and ASTM, the Trail Making Test (TMT), the Complex Figure Test (CFT), and Digit Span were performed. Half of the sample were also given Rey's 15-Item-Test (FIT). Both groups were significantly different in all effort and performance measures, with the exception of the ratio TMT-B:TMT-A. With MSVT and ASTM, correct classification of group membership was between 97 and 100%. For the ratio TMT-B:TMT-A, there was a considerable overlap in the test scores for the two groups and the sensitivity of the FIT was too low. Although the ASTM and the MSVT were identified by a number of subjects as possible effort measures, both tests obtained very good results within this analog design.