Malingered posttraumatic stress disorder (PTSD) poses a formidable clinical challenge in personal injury and disability cases because of the apparent ease in feigning PTSD and the supposed link (proximate cause) to the claimed damages. The effective assessment of feigned PTSD is particularly challenging because this diagnosis is both easier to fake than other Axis I disorders and more difficult to detect. As an additional confound, some patients with genuine PTSD produce highly variable, elevated profiles on multiscale inventories that are difficult to distinguish from feigned PTSD. The current study examined whether the Personality Assessment Inventory (PAI) can effectively differentiate between genuine and feigned PTSD in 109 inpatients from a trauma unit. The two most effective scales were the MAL and the NDS scales. As a primary focus, the current study was the first empirical investigation of Resnick's model of malingered PTSD that is comprised of three subtypes: pure malingering (pure-M), partial malingering (partial-M), and false imputation (false-I). The primary goal was to evaluate whether each feigning group was able to (a) effectively simulate PTSD symptoms and diagnoses and (b) avoid being classified as feigning. The partial-M group proved to be the best feigning group in achieving these two goals. Furthermore, the use of well-defined groups, including an indeterminate band (i.e., unclassified) around each cut score, was explored. Overall, the use of well-defined groups improved accuracy in classification and reduced the number of false-positives.

This study used subtests of the WAIS-IV to detect evidence of malingering. Developing reliable tests for malingering could significantly reduce costs paid to malingering individuals. A within-group known-group design was used. There were 3 known-group conditions. The first group (G1) was instructed to take the tests honestly. The second group (G2) was asked to fake a cognitive disability while taking the tests. The third group (G3) took the tests while undergoing the cold-pressor method (hand immersed in cold water) of inducing pain. Analysis of variance was performed. That analysis appeared to have significant differences; post hock Bonferroni testing was done. The G2 scores were significantly different from the G1 and G3 scores. Dependent variables were participants' group scores on Digit-Span and Block-Design subtests of the WAIS- IV. Independent variables were the testing conditions: honest, malingering or laboratory-induced pain. Outcome variables were the score differences within known-group conditions. The outcome variable score differences in this study supported Digit-Span and Block-Design as tests of mental malingering. Positive social change comes through adding an additional Test of Mental Malingering (TOMM) used to aid in detection of those trying to fake cognitive difficulties based on pain symptoms, reducing the associated costs to members of society paying higher costs for healthcare, and for government paying unnecessary compensation benefits to those who are malingering who do not deserve it.

Individuals undergoing forensic neuropsychological evaluation frequently stand to gain in some manner if neurocognitive dysfunction is diagnosed. As a result, neuropsychologists are customarily asked to test for neurocognitive feigning during the assessment. The current study employed an analogue design with a clinical comparison group to examine the utility of the TOCA (Rogers, 1996) as a measure of feigned neurocognitive impairment. Two groups of simulators (one cautioned about the presence of detection strategies and one not cautioned) were compared to clinical and normal control groups. Fourteen scales were developed based on five detection strategies: symptom validity testing, performance curve, magnitude of error, response time, and floor effect. Each was employed during both verbal and nonverbal tasks. Significant differences were revealed among groups when subjected to ANOVA. Classification rates from subsequent utility estimates and discriminant function analyses on the scales ranged from 58.8% to 100%. Combining strategies yielded a classification rate of 95.7%. The effect of cautioning simulators was modest; however, a trend was noted on some scales for cautioned simulators to appear less obviously impaired than noncautioned. Although the results require crossvalidation, preliminary data suggest that the TOCA is a sensitive and specific measure of feigned neurocognitive performance. Strengths and weaknesses of the study are discussed and directions for future research are proposed.

Empirically based methods of detecting retrospective malingering (i.e., the false assertion or exaggeration of physical or psychological symptoms reportedly experienced during a prior time period) are needed given that retrospective evaluations are commonplace in forensic assessments. This study's main objective was to develop and validate a focused, standardized measure of retrospective malingering. This objective was addressed by revising the Structured Interview of Reported Symptoms (SIRS), an established measure of current feigning. The SIRS' strategies were retained and its items modified to produce two new SIRS versions: The Retrospective Structured Interview of Reported Symptoms (R-SIRS) and The Concurrent-Time Structured Interview of Reported Symptoms (CT-SIRS). Forensic inpatients were used to test the R-SIRS (n = 25) and CT-SIRS (n = 26) which both showed good internal consistency and interrater reliability. The overall effectiveness of the R-SIRS and the CT-SIRS in the classification of malingerers and genuine patients was established in this initial validation study. Moreover, their classification rates were similar to those obtained by the SIRS. Pending additional validation, these measures are expected to increase the quality of forensic evaluations by providing the first standardized methods of assessing retrospective malingering.

The accurate determination of malingering relies on the use of validated and clinically relevant assessment measures. Simulation design is the most often-used research design to accomplish this. However, its external validity is sometimes questioned. The goal of the thesis was to systematically evaluate these major elements: situation, incentives, and coaching. The situation in simulation studies can vary from relevant (academic failure in a college population) to irrelevant (capital murder) for the samples being studied. Incentives refer to the external motivation given to improve simulators' performance and can be positive (extra credit and monetary reward) or negative (extra time and effort). Finally, coaching refers to whether the participant receives any information on detection strategies that are designed to identify feigners. Using a large undergraduate sample in a factorial design, results indicate that a scenario familiar to the participants generally improved the believability of their responses. Coaching also improved the ability to feign convincingly, while incentive type was not associated with any change in scores. The implications of these findings for future research designs and the connection to practice are discussed.

The 2002 Supreme Court decision (Atkins vs. Virginia, 536 U. S. 304), prohibiting the execution of mentally retarded persons, may potentially increase malingering of mental retardation (MR). There is limited research addressing the detection of feigned MR. The present study compared results from tests of intelligence, adaptive functioning, legal/courtroom knowledge, and psychiatric and neurocognitive feigning to determine how effectively these instruments discriminate between MR participants and community volunteers asked to either approach the test honestly (CVH group) or feign, or malinger, MR (CVM group). CVMs suppressed their IQ scores sufficiently to appear MR. CVMs overestimated deficits on individuals with genuine MR on tests of adaptive functioning and courtroom knowledge. Psychiatric feigning instruments did not discriminate between MR and CVM groups. Neurocognitive feigning instruments discriminated between groups, however specificity and Positive Predictive Power were unacceptably low. Revising cutting scores to hold specificity at .95 improved PPP significantly, suggesting the potential utility of these instruments to detect feigned mental retardation. Results from this study suggest that applying published decision rules to MR populations on tests commonly used in forensic neuropsychological evaluations will likely result in a high rate of false positive errors. Given the high stakes associated with classification errors in capital cases involving MR defendants, alternative cutting scores appropriate for this population should be determined.

This study examined the effectiveness of cautioning and education on simulating a mild traumatic brain injury on several neuropsychological measures. The measures used included the Word Memory Test (WMT), Wechsler Adult Intelligence Scales® - Third Edition (WAIS®-III), Wechsler Memory Scales®-3rd Edition instrument (WMS®-III), 16-item version of the Rey Memory Test, and a self-report symptom checklist. Five experimental groups were used including clinical and non-clinical controls, as well as three simulation groups. The design and implementation of this study also attempted to correct several methodological short comings of prior research by increasing the incentives for participants, expanding the generalizability of findings and examining research compliance and participant self-perception through debriefing. Discriminant analysis was utilized to determine if specific functions existed that would correctly classify and distinguish each experimental group. Several discriminant functions had at least moderate canonical correlations and good classification accuracy. Results also include utility estimates given projected varying base rates of malingering.

One obstacle to the accurate diagnosis of ADHD in college students is malingering, although many symptom self-report measures do not contain feigning validity scales. The Infrequency Index (CII) for the Conners’ Adult ADHD Rating Scale–Self-Report: Long Version (CAARS-S:L) was developed for this purpose, although further validation of the index is needed. Another topic of interest in ADHD malingering research is the increasing use of online assessments. Little is known about how ADHD is malingered in an online format, particularly on the CAARS-S:L. The current study aims to integrate these strands of research by examining the utility of the CII in detecting feigning and the effect of administration format on CAARS-S:L profiles. Data from 139 (27 diagnosed with ADHD, 46 without ADHD responding honestly, and 66 without ADHD instructed to feign) students were analyzed. Seventy-five completed the CAARS-S:L on paper, and 64 completed the assessment online. The clinical and feigning groups produced statistically similar elevations on seven of eight CAARS-S:L clinical scales. Administration format did not have a significant effect on the clinical scales or CII. The CII demonstrated 36% sensitivity and 85% specificity at the recommended cut score across administration formats. Specificity reached desirable levels at raised cut scores.

Thesis (Ph. D.)--University of Toronto, 2005. / Includes bibliographical references (leaves 86-96).

Thesis (Ph.D.)--University of Tulsa, 1994. / Includes bibliographical references (leaves 137-145).