Assessment of Malingering

The Assessment of Malingering inPsychodiagnostic Evaluations:

Research-Based Concepts and Methods for ConsultantsRobert G. MeyerSarah M. Deitsch

University of LouisvilleUniversity of Kentucky

This article first discusses overall perspectives re-lated to malingering, with an emphasis on appli-cations most relevant to the consultant-expertwitness. This is followed by a brief presentationof those overall patterns characteristic of malin-gering. Then, in order, there are discussions ofindexes of malingering developed through re-search on the Minnesota Multiphasic PersonalityInventory-2 (MMPI-2; Butcher, Dahlstrom, Gra-ham, Tellegen, & Kaemmer, 1989), the MMPIAdolescent (MMPI-A; Archer, 1992), the fifth edi-tion of the Sixteen Personality Factor Question-naire(16PF; Conn&Rieke, 1994), theRorschach(Rorschach, 1921/1942), and other standard testssuch as theMillon Clinical Multiaxial Inventory/// (MCMI-III; Meyer & Deitsch, in press). Fol-lowing this are those tests specifically designedto detect malingering. The last two sections focuson physiological indicators and overt behavioralcues, ending with a commentary.

Consultants in most settings, for example,the school and workplace, especially thosecalled upon to be expert witnesses, are of-ten confronted with the issue of malinger-ing (in truth an act, not primarily a mentaldisorder) and distorted response sets. It isoften appropriate to broaden the concept ofmalingering to any type of response that dis-torts the production of an accurate record;this is the context in which the followingdiscussion is placed.

The focus of the Diagnostic and Statisti-cal Manual of Mental DisordersFourthEdition (DSM-IV; American Psychiatric As-sociation, 1994) criteria for malingering isthe voluntary presentation of false or grosslyexaggerated physical or psychologicalsymptoms. DSM-IV notes that malingeringshould be suspected when there is (a) a

medicolegal context, (b) discrepancy be-tween objective findings and reported symp-toms, (c) compliance problems, and (d) pres-ence of an antisocial personality disorder.Good advice, except that the fourth pointshould be considerably broadened; indeed,malingering can occur with virtually everyDSM-IV diagnosis, or when no diagnosis iswarranted. Malingering is often more un-derstandable by the evident incentives andcircumstances of the situation, rather thanby the person's individual psychology.

Overall IndicatorsSeveral overall patterns have been found

to be characteristic of interview and test datafrom malingerers (Berry, Wetter, & Baer,1995; Ekman, 1985; Fox, Gerson, & Lees-Haley, 1995; Meyer & Deitsch, in press;Pope, Butcher, & Seelen, 1993; Rogers,1988). These characteristic patterns dependto some degree on the specific distorted re-sponse pattern that is being observed, thatis, whether it is the result of malingering,defensiveness, disinterest, or something else.

Robert G. Meyer, PhD, specializes in clinicaland forensic psychology and in hypnosis and isa professor in the Department of Psychology atthe University of Louisville.

Sarah M. Deitsch, MA, has carried out re-search on the MMPI-2 and is involved in re-search on the NEO-PI-R at the University ofKentucky.

Correspondence concerning this article shouldbe addressed to Robert G. Meyer, Departmentof Psychology, c/o 317 Life Sciences Building,University of Louisville, Louisville, Kentucky40292.

234 Copyright 1995 by the Educational Publishing Foundation and the Division of Consulting Psychology, 1061-J087/95/S3.00Consulting Psychology Journal: Practice and Research, Vol. 47, No.4, 234-245

First, any symptom reports shouldbe rigorously questioned, at least at first us-ing open-ended questions such as, "What arethose voices telling you?" rather than "Dothose voices tell you to do anything?" It isalso important, to the degree possible, toobtain verifying collateral information.

In general, malingerers more often reportrelatively rare symptoms, as well as a highertotal number of symptoms, than do honestrespondents. Also, look for malingerers topresent very obvious and prosaic symptomsor improbable or absurd symptoms or symp-tom combinations, or symptoms of unprob-able severity, for example, being extremelyhigh on 6, 8, and F on the MinnesotaMultiphasic Personality Inventory2(MMPI-2; Butcher, Dahlstrom, Graham,Tellegen, & Kaemmer, 1989). Malingerersare also more likely to be willing to discusstheir disorder, especially how the negativeeffects of their disorder affect rather narrowareas of functioning. They are more likelyto report a sudden onset of the disorder; toreport a more sudden cessation of symptomsif that has some functional value; to dem-onstrate more exaggerated behavior, moresuicidal ideation, more visual hallucinations,more symptoms that do not cluster; and toendorse the more evident, flamboyant, anddisabling symptoms. They are more likelyto give vague or approximate responseswhen confronted, to make inconsistentsymptom reports, to take a longer time tocomplete a test or an interview response, torepeat questions, to use qualifiers and vagueresponses, to miss easy items and then scoreaccurately on harder or more complex items,and to endorse the obvious rather than thesubtle symptoms usually associated with adisorder (hence, obvious-subtle item dis-criminations on the MMPI-2 may be help-ful here). Malingerers tend to report the fol-lowing less often than true psychotics: dis-turbed affect, incoherent speech, poor per-sonal hygiene patterns, concrete thinking orformal thought disorder, incoherent speech,or grandiose delusions or ideas of reference.

MMPI-2

The assessment of malingering onthe MMPI-2 naturally centers on the valid-ity scales as predictors of distorted responsesets (Berry et al., 1995; Woychyshyn,McElheran, & Romney, 1992). Neverthe-less, a number of other measures may alsobe useful here. For example, as suggestedearlier, one face-valid method is to comparedifferences on those items originally desig-nated by Weiner and Harmon (1946) as ob-vious and subtle, although some experts(Graham, 1993) do not see much value inthese items. Jackson (1971) argued that thesubtle items may have appeared in the origi-nal MMPI scales (Hathaway & McKinley,1943) because of sampling errors in the ini-tial item selection procedures. Hovanitz andJordan-Brown (1986) found that when di-agnostic or drug-outcome criteria were used,the exclusion of the subtle MMPI-2 itemsresulted in a statistically significant loss ofpredictive ability. The obvious items, how-ever, were found to be related to many diag-nostic constructs within the scales. Woy-chyshyn et al. (1992) found the subtle-ob-vious scales to be more effective in detect-ing faking good than faking bad.

The standard validity scales (L, F, K, andFb) do, however, provide much valuable in-formation in this regard, and there is sup-port for the use of the three validity scalesexcerpted from the test as a whole (Cassini& Workman, 1992). Of the standard valid-ity scales, the consensus is the F is the bestindicator of malingering (Bagby, Buis, &Nicholson, 1995; Berry etal., 1995; Iverson,Franzen, & Hammond, 1995). Bagby et al.(1995) compared college students asked tofake bad to general psychiatric and forensicgroups, and found that (a) the F scale pro-vided the strongest prediction value, (b) theF scale provided incremental value over theObvious-Subtle (O-S) index, and (c) the O-S index should not typically be used insteadof the traditional validity scales to identifyfaked profiles. Iverson et al. (1995) com-

Cmsulting Psychology Journal: Practice and ResearchFall 1995

235

pared inmates instructed to malinger to psy-chiatric inpatients and inmates answeringunder standard instructions. The F scale, F -K index, and Fb offered the most valuablepredictions, in that order. Using a cuttingscore of 17, the F scale correctly classified89% of malingering inmates, 100% of stan-dard instruction inmates, and 98% of psy-chiatric inpatients, thus producing a 96%overall rate.

Understand that a high F or Fb scorewarns the examiner of statistically deviantresponses, but cannot by itself definitivelyidentify the source of the deviance. Clarifi-cation may be found by looking at otherscores, for example, the Variable ResponseInconsistency (VRIN) scale. A high F witha high VRIN suggests random responding,but a high F with a low VRIN suggests ma-lingering. Or, possibly, actual F-K ratio is+9 (or some other number, depending onwho is responding); such people are tryingto fake bad, that is, to present a distortedpicture of themselves that emphasizes pa-thology. If the score is 0 or lower, the em-phasis is on trying to look good and denypathology. However, it is generally agreedthat these axioms only hold if F and K arerelatively low, and even then, there are a highnumber of false-positives and false-nega-tives. For example, psychotic and other se-verely distressed individualsthat is, thosewith a high level of anxietyare likely toscore in a T range of 65-80 on the F scaleand so at first may appear to be malinger-ing. It is also noteworthy that when there isevidence of a defensive profilethat is, ahigh Kelevations in the T range above 65are usually of high clinical significance.Rothke at al. (1994) and Fox et al. (1995)offered varying suggested FK cutoff scoresfor several different client populations.

Graham, Watts, and Timbrook (1991)provided more recent and comprehensivedata on faking bad and faking good on theMMPI-2 that allow the following guide-lines. Remember, this is to gain maximum

discrimination power in a statistical analy-sis; lower scores than those suggested maystill suggest malingering, especially whencombined with other MMPI-2 data or datafrom other sources.

A. For discriminating those consciouslyfaking bad within an essentially normalpopulation (using raw scores):

1. Use a cutoff score of 18 on F, withthose faking bad being higher;

2. Use an F-K score of 17 for men and12 for women, with higher scores indicat-ing faking bad;

3. Use a raw score Fb (back side of F) of19 for men and 22 for women, again, higherscores indicating faking bad.

B. For discriminating those consciouslyfaking bad within a psychiatric population(again, using raw scores and assessinghigher scores on all of these as suggestingfaking bad):

1. Use a cutoff of 27 for men and 29 forwomen;

2. Use an F-K of 27 for men and 25 forwomen;

3. Use an Fb of 23 for men and 24 forwomen.

Using any of these scales to assess fak-ing good has always been a somewhat diffi-cult discrimination, and Graham et al.'s(1991) data echo that admonition. Also,those solid findings that were obtained areconfounded by the issue of whether one istrying to identify faked profiles or honestones. L proved to be the most effective scalefor males, with an i score of 8 correctly clas-sifying 93% of honest profiles but only 67%of the fake goods. To correctly classify 96%of the males faking good, a cutoff of 4 on Lwas necessary. Scores of 8 and 5 producedsimilar respective discriminations in fe-males. An L-K index of 23 was quite effec-tive, in both directions, for females, but didnot work as effectively as L alone for males.

When the MMPI was restandardized as

236 Consulting Psychology Journal: Practice and ResearchFall 1995

MMPI-2, some of the malingering scaleswere not retained, most notably Gough'sDissimulation Scale and its later revision,Ds-r, and this is to some very unfortunate(Fox et al., 1995). Fox et al. argued this isespecially so, as the Ds-r targets the feign-ing of more subtle "neurotic" symptoms.These are more often a problem in the schoolor workplace than are flamboyant psychoticsymptoms. Fox et al. (1995) argued that, asonly 6 of the 40 Ds-r items were eliminatedin MMPI-2, proration is feasible, and theyoffered some data in this regard.

Lees-Haley, English, and Glenn (1991)devised a Fake Bad Scale for persons whoare making a personal injury claim and whoare possibly feigning or exaggerating emo-tional distress. Fox et al. (1995) providedfurther data for the interpretation of thisscale.

Borum and Stock (1993) suggested theuse of a more recently developed index, Es-K, using T scores. Using this index was ef-fective in discriminating law enforcementapplicants identified as being deceptive froma comparison group for whom no deceptionwas indicated, and this index was superiorto all the standard indexes. The deceptivegroup showed a mean Es-K index of-7.00(SD = 4.31); the comparison group had a+2.22 (SD = 5.59), with a low false-positiverate.

Profiles with F scores that are in the Trange above 90 are commonly associatedwith extremely disturbed individuals whomanifest hallucinations, delusion, and gen-eral confusion. This is particularly so whenone is dealing with an inpatient population.But, such a T score finding in an outpatientor forensic client should suggest a possibil-ity of malingering (Ganellan, Wasliw,Haywood, & Grossman, 1993). Also, indi-viduals who have a T score of greater than95 on the F scale have probably either re-sponded to the MMPI-2 in a random fash-ion or have answered virtually all the items"true." If all or the great majority of items

are answered "false," the T scores are typi-cally in the 75-99 range. Graham et al.(1991) noted that, in addition to the high F,the highest scales, in order, are typically 8,6, with lesser but substantial elevations (i.e.,aT score of 80-90) on 7,1,4, and 9 (slightlyless on 9 for females, but in this range on2), with elevations above 70 on 3, 2, and 0.A fake-good profile tends to have all scoreswell within the normal range, most near 50,with mild elevations on 5 and 9 in femalesand on 9 and 0 for men and occasionally on2 in traditional females.

Malingering or other response distortion(or low comprehension or reading ability)may be reflected in an irrelevant (if not ir-reverent) and/or random response pattern.Because the Cannot Say scale is highly re-lated to clinical profile stability and to itemchange measures, there is good reason forattempting to strongly limit the number ofallowable missed responses.

In general, when F and K are both quitehigh or when F is high and K is low, lookfor deliberate faking. But, if I is high andFand AT are well within acceptable limits, firstconsider faking good, but also consider thatthe individual is either naive or unsophisti-cated (or both) and at the same time is try-ing to look good. If K is high and L and Fare within the normal range, a more sophis-ticated defensive system is probable and theprofile can be considered as an indicationof subclinical trends.

TRIN and VRIN

Two response inconsistency scales weredeveloped for MMPI-2, True Response In-consistency (TRIN) and Variable ResponseInconsistency (VRIN), and there is good evi-dence that they are by far the best measuresof random or inconsistent responding (Berryet al., 1995; Sabine & Meyer, 1994; Wetter,Baer, Berry, Smith, & Larson, 1992; Wetter& Deitsch, in press).

TRIN is based on 20 item pairs for which

Consulting Psychology Journal: Practice and ResearchFall 1995

237

a combination of two true or two false re-sponses is semantically inconsistent, for ex-ample, the pair "I am happy most of thetime" and "Most of the time I feel blue." Ahigh score (Graham suggests 13 or higher)indicates indiscriminate "true" responding;a low score (less than 6) points to indiscrimi-nate "false" responding.

VRIN is composed of 49 item pairs thatproduce one or two, out of four, possibleconfigurations (true-true, true-false, false-true, false-false), again, where responseswould be semantically inconsistent. Scoresoccur in a range of 0 to 49, with high scorespointing to random responding and/or con-fusion. The MMPI-2 research group at theUniversity of Kentucky has accumulatedevidence showing that, although both ran-dom and malingered responding producedsignificant elevations on F and Fb, only ran-dom responding generated significant eleva-tions on VRIN (Wetter et al., 1992).

MMPI-A

The development of the MMPI-Adoles-cent (MMPI-A; Archer, 1992), with its fournew validity scales (Fl, F2, VRIN, andTRIN) and adolescent-based norms, has al-lowed greater precision in the assessment ofmalingering in adolescents. These four va-lidity scales are included at the beginningof the MMPI-A basic scale profile andshould be interpreted in conjunction with Land K. The validity scales were additionallyreordered for the MMPI-A from L, F K toFL.K.

The following overall guidelines are forscreening for faking good on the MMPI-A:(a) Elevations are found on validity scales Iand K and (b) all clinical scales' T-scorevalues are 60 or less, but produced by ado-lescents with strongly suspected or estab-lished psychotherapy. Screening criteria forfaking bad on the MMPI-A are (a) the Fscale is elevated to aT score of 90 or greaterand (b) a floating profile evident, charac-terized by clinical scale elevations within the

clinical ranges, with the exception ofMf andSi scale values (Archer, 1992).

16 PFThe older versions of the Sixteen Person-

ality Factor Questionnaire (16 PF) are be-ing rapidly supplanted by the fifth editionof the 16 PF, first available in 1994. It con-tains an effective Impression Managementscale, as well as an Acquiescence Scale(Conn & Rieke, 1994). For those who usethe older versions, which are obviously stillvalid and likely to remain in use for sometime, the following data on the Faking Goodand Faking Bad scales are useful. The bestdata are on Form A of the 16 PF.

Winder, O'Dell, and Karson (1975) pro-vided the original data. However, Krug(1978) obtained data on a much broader andmore representative sample, and he offeredimproved cutoff scores. Krug's data suggestthat the cutoff score of 6 for the faking-goodscales, as suggested by Winder et al., is muchtoo liberal, as, in using this cutoff score, al-most 55% of those people who are routinelyscreened would be labeled as faking good,instead of the approximately 7% that Winderet al. reported. Krug's data would suggestthat a raw score of 10 on the faking-goodscale would be a much more appropriatecutoff point. Only about 15% of people tak-ing the test would attain a score this high.

Winder et al.'s suggestion of a cutoff scoreof 6 for the faking-bad scale is supportedby Krug. Both report that fewer than 10%of those taking the test will score above 6on this scale.

Rorschach TestDifficulties with the use of the Rorschach

(Rorschach, 1921/1942; as well as other pro-jective techniques) in the detection of de-ceptionthe apparent susceptibility to fakepsychosis on the testwere evident in anearly study by Albert, Fox, and Kahn (1980).Though using a small sample, results sug-gested that these experts were unable to dis-


criminate the fakers (uninformed and in-formed college students) from the actualpsychotic individuals, although they did dis-criminate all groups (fakers and truepsychotics) from the normal group. Thegroup most often seen by these experts aspsychotic was the Informed Fakers group.

With this in mind, the general clinical lit-erature (Exner, 1993; Gacono & Meloy,1994; Lerner, 1995; Meloy & Gacono, 1995;Meyer & Deitsch, in press) offers some con-sensus that malingering clients (especiallyif unsophisticated) will respond to theRorschach with a reduced number of re-sponses, and this is the most well-replicatedfinding. It is also often asserted that theywill show slow reaction times, even whenthey do not produce particularly well-inte-grated or complex responses. They take acautious attitude and thereby produce fewresponses, primarily determined by color.There are often high percentages of pure Fand Popular responses. They allegedly mayfeel distressed by the ambiguity of thestimuli and will subtly try to obtain feed-back from the examiner as to the accuracyof their performances. Also, Seamons,Howell, Carlisle, and Roe (1981) noted thatif the F%, L, and X+% variables are in thenormal range and there are a high numberof texture, shading, blood, dramatic, nonhu-man-movement, vista, or inappropriate-combination responses, malingering tocause a false appearance of a mentally dis-ordered state should be considered. Ganellanet al. (1993) found malingerers attemptingto portray themselves as psychotic to pro-vide more unusual percepts (Xu%) and moreDramatic Content responses, especiallyMorbid Content.

Other Standard TestsThe MCMIIII (Meyer & Deitsch, in

press) contains four modifier indexes, threeof which are designed to assess variousforms of malingering. These are the Disclo-sure Scale (DIS), the Desirability Gauge

Scale (DES), and the Debasement Measure(DEB). The fourth modifier, the Validity In-dex (VI), consists of four items with an en-dorsement frequency of less than .01. TheDIS was designed to detect the degree towhich respondents are inclined to be self-revealing and frank and is thought to be neu-tral to psychopathology. The DES is thoughtto essentially measure "faking good"; theDEB is thought to measure "faking bad."However, Bagby, Gillis, Toner, andGoldberg's (1991) data suggest that all threescales are bidirectional indicators of dis-simulations, that is, they tap both faking-badand faking-good components; hence, theymust be used with caution. When an indi-vidual is "faking bad," the Thought Disor-der scale is easily elevated, as it is quite sus-ceptible to faking (Jackson, Greenblatt,Davis, Murphy, & Trimakas, 1991). TheDisclosure and Debasement scales are posi-tively correlated with the Faking Bad scaleand negatively correlated with the FakingGood scale on the original 16 PF test(Grossman & Craig, 1995).

Several other standard though lesser-usedpersonality instruments, the Basic Person-ality Inventory (BPI) and the California Psy-chological Inventory (CPI), offer validityscales that allow inferences about malinger-ing (Berry et al., 1995).

On intelligence and other performancetests, there is an overall consensus that ma-lingerers perform too poorly and inconsis-tently in relation to observed behavior orabilities as assessed by indirect methods.They are more likely to produce abnormalscatter; give illogical, inconsistent, or "ap-proximate" answers; produce odd or surpris-ing "near misses"; miss easy items whilethey pass hard ones; and also sometimes givebizarre responses where intellectually slowindividuals might give concrete responses.

Specific Tests for MalingeringConsultants are advised to look more to

specific tests if there is any question of dis-


239

honesty. For example, the Personality Inven-tory for ChildrenRevised, Shortened For-mat, has been found to be effective in as-sessing deception in children (Daldin, 1985).Also, scales that tap a social desirability re-sponse set, such as the Marlowe-CrowneSocial Desirability Scale (Crowne & Mar-lowe, 1964), give an idea of the direction ofa client's response set, and this test hasshown good reliability and validity (Robin-ette, 1991). A validated short version of theMarlowe-Crowne also exists (Zook &Sipps, 1985).

The Schedule forAffective Disorders andSchizophrenia (Spitzer & Endicott, 1978),a semistructured interview technique, is alsoof potential help here. A drawback of its usewith malingerers is that it takes up to 4 hoursto complete, although its length makes iteasier to trip up a malingering client on in-consistent responses. Malingering is sug-gested if (a) 16 or more of the "severe"symptoms are subscribed to, (b) 40 or moresymptoms are scored in the "clinical"rangea score of 3 or greateror (c) 4 ormore "rare" symptoms are subscribed to.These rare symptoms are each only foundin 5% of a sample of 105 forensic patients,and only about 1% of this population showed5 or more of these symptoms: (a) markedlyelevated mood, (b) much less sleep in theprevious week, (c) significantly increasedactivity level in the previous week, (d)thought withdrawalsomething or someoneis "pulling" thought from them, (e) delusionsof guilt, (f) marked somatic delusions, (7)evident and recent loosening of associations,(g) poverty of speech, or (h) neologisms.These rare symptoms could probably be ef-fectively included in a short screening pro-cedure.

The Structured Interview of ReportedSymptoms (SIRS; Rogers, 1988) provides12 strategies for the detection of malingeredmental illness. In its current form, the SIRSis alleged to require 3040 min for admin-istration. In practice, the SIRS is of ques-tionable usefulness as most find it actually

takes an hour or more to administer it, cli-ents find a number of the items to be odd oroffensive, it is less effective with the moresubtle malingering patterns, and the authorof the test has been consistently disinclinedto provide any clear cutoff points or deci-sion rules.

The M Test (Beaber, Marston, Michelli,& Mills, 1985) is a brief screening measuredesigned to identify the malingering ofschizophrenic symptoms across a variety ofsettings. It is composed of 33 true-falsestatements measuring (a) bizarre attitudes,(b) false symptoms of mental disorder, and(c) true symptoms of schizophrenia. Princi-pal-components analysis of M Test itemsproduced a three-factor solution that closelycorresponded to the three scales of the test.Excellent internal consistency reliabilities(KR-20) were obtained in a diverse sample(n =318) of community subjects, under-graduates, correctional inmates, and psychi-atric patients (.87 for C, .87 for S, and .93for M). Although Connell and Meyer (1992)found support for the use of the M Test andthe SIRS in this respect, Gillis, Rogers, andBagby's (1991) data did not support the useof the M Test. Rogers, Bagby, and Gillis(1992) asserted an improvement of the use-fulness of the M test with a two-step deci-sion process that is helpful for anyone whoconsistently uses this test. However, Smith,Borum, and Schinka (1993) suggested theimprovement is not as great as Rogers et al.(1992) suggested. Using the M Test, Kurtzand Meyer (1994) reported classificationrates of simulated malingerers in correc-tional samples of 73% and 75%, respec-tively, although there was a problematic levelof false positives. Various authors have of-fered alternative scoring procedures for theM Test to increase validity.

Rey, in 1964, introduced a simple 15-item(3 columns by 5 rows) visual memory test.Test-taking set is important, as the test is pre-sented as quite difficult, to enhance themalingerer's proneness to exaggeratesymptomatology. It has since been adopted


by others as a specific test for malingering.For example, Lee, Loring, and Martin (1992)administered the test to 56 outpatients withneurological disorders and 100 temporallobe epilepsy inpatients. An error score of 7was found to occur at or below the fifth per-centile for both groups, suggesting 7 as acutoff score to alert one to possible malin-gering of memory disorder. Although cor-related with intelligence, a consensus of theresearch is that, in the absence of signifi-cant psychiatric disorder, cognitive impair-ment, or neurological disorder, persons withat least borderline intelligence should notrecall fewer than 8-9 items or three com-plete rows.

The Balanced Inventory of Desirable Re-sponding (BIDR-6; Paulhus, 1991) is a 40Likert-item self-report measure of the ten-dency to give socially desirable responses.It has yet to have a minimal clinical appli-cation, but it offers potential as a dissimula-tion measure. Factor analytic investigationsof socially desirable responding have yieldedtwo, relatively uncorrelated, factors repre-sented by the BIDR subscales, Self-Decep-tive Enhancement (SDE) and ImpressionManagement (IM). The reliability of bothscales is favorable, with internal consistencyvalues ranging from .70 to .82 for SDE, and.80 to .86 for IM, across four samples (hon-est responders, fake good, religious adults,and inmate psychopaths). Test-retest coef-ficients obtained in an undergraduate re-search sample (n = 83) over a 5-week inter-val were .69 and .65 for SDE and IM, re-spectively. Initial evidence for the constructvalidity of the BIDR scales has been gener-ally positive.

David Schretlen and his colleagues(Schretlen, Wilkins, Van Gorp, & Bobholz,1992) have provided interesting data to sup-port the use of a recently developed Malin-gering Test (MgS), the Bender-Gestalt, andthe MMPI in the detection of faked insan-ity. The MgS is a 90-item, paper-and-penciltest, composed of simple questions in bothone-ended and forced-choice formats, that

takes about 25 min to complete. On the ba-sis of earlier research, the following scor-ing criteria (Schretlen et al., 1992) for theBender-Gestalt were found to be effectivein detecting faked psychosis:

(a) inhibited figure size, each figure thatcould be completely covered by a 3.2 cmsquare was scored +1; (b) changed position,each easily recognized figure whose positionwas rotated greater than 45 degrees wasscored +1; (c) distorted relationship, eacheasily recognized figure with correctly drawnparts that were misplaced in relationship toone another was scored +1; (d) complex ad-ditions, each easily recognized figure thatcontained additional complex or bizarre de-tails was scored +1; (e) gross simplification,each figure that showed a developmental levelof 6 years or less was scored +1; and (f) in-consistent form quality, each protocol thatcontained at least one drawing with a devel-opmental level of 6 years or less and at leastone drawing with a developmental level of 9years or more was scored +1. Scores for thefirst five of these features were then summedas a composite index of faking, (p. 78)

The technique of explicit alternative test-ing (EAT) is effective for the detection ofmalingered memory deficits and has beenused in a number of studies (Bickart, Meyer,& Connell, 1991; Hall, Shooter, Craine, &Paulsen, 1991). The technique, also knownas forced-choice, two-alternative, SymptomValidity Testing, involves the assessment ofreported deficit (usually reports of sensoryor cognitive loss) by presenting a visual orauditory stimulus randomly over a numberof trials with instruction for the patient toguess whether or not the stimulus is actu-ally presented in a given time interval. Vari-ous specific tests such as the Portland DigitRecognition Test or the Test of NonverbalIntelligence are available. Chance respond-ing (generally set at *- 1.96 standard errorsof 50% correct) is the expected performanceof a genuinely sensorially impaired person.Performance below chance implies that thesubject is aware of the stimulus but selec-

Consulting Psychobgy Journal: Practice and ResearchFall 1995

241

tively denies its presence. Using an inter-ference procedure, for example, having theclient sort cards between requests for stimuliidentification, increases effectiveness. Themost common methods usedchoosing theopposite color, deliberate attempts to forgetthe present color, patterned responsesarerarely if ever sufficient for subjects to foolthe statistical model.

Hall et al. (1991) presented the follow-ing common faking strategies in SymptomValidity Testing: (a) While clients attemptto present realistic symptoms, their percep-tion of what is realistic may be quite off; (b)fakers tend to distribute elaborate errorsthroughout test rather than miss only diffi-cult items. They unusually do not guess ran-domly on items which they know but, rather,try to control the percentage of errors; (3)fakers tend to perform at a crudely estimatedfraction of their actual ability; and (4) fak-ers frequently protest that tasks are too dif-ficult or feign confusion and frustration.

Other MethodsOne option not often mentioned in dis-

cussions of malingering assessment is to fo-cus on personality rather than technique.That is, assess for degree of psychopathy,making two assumptions: first, psychopathyexists as a continuum rather than as an ei-ther-or phenomenon in the population; andsecond, if the situation makes malingeringa reasonable expectancy, and a significantdegree of psychopathy is found, malinger-ing becomes quite probable. A number ofmeasures for assessing psychopathy areavailable (Meloy & Gacono 1995), but mostexperts agree that the premier instrument isHare's Psychopathy ChecklistRevised(PCL-R; Meloy & Gacono, 1995; Meyer &Deitsch, in press; Widiger & Sanderson,1995). An added advantage of the PCL-Ris that it discriminates two factors; Factor 1,which is considered a measure of truepsychopathy, and Factor 2, which is more ameasure of social deviance.

It is ironic that, on a relative basis, men-

tal health professionals have not becomesophisticated in methods other than psycho-logical test measures of deception. Only re-cently have clinicians shown any significantinterest in adding physiological methods ofdeception assessment to their armamen-tarium. At the same time, most states arepassing laws that considerably restrict theuse of the title "polygrapher," often to thosewho have specific rather than adequate train-ing. Also, unfortunately, some of the less ef-ficient assessment modalities are often theones used in the standard examination for-mat and may even be mandated by state law.

One promising development is the use ofevent-related potentials (ERPs), that is,changes in brain wave activity, upon the pre-sentation of various stimuli that minimizethe effects of conscious reflection. ERPs, forexample, as measured by an EEG, can beeither exogenous, dependent on and vary-ing with external stimulation, or endog-enous, manifest when the subject must makea decision about the stimuli and occurringwithin the first 100-150 ms after the pre-sentation. Both are potentially useful.

Several consistent behavioral cues havebeen noted in individuals who present a dis-honest portrayal of themselves (Bull &Rumsey, 1988; Ekman, 1985; Ekman &O'Sullivan, 1991). For example, on the av-erage, such individuals nod, grimace, andgesture more than honest interviewees do,tend to tighten the eyebrow or lower eyelid,and have less frequent foot an leg move-ments. They also talk less and pause moreoften and speak more slowly, although theymake more speech errors and smile moreoften. In addition, the dishonest intervieweestend to take positions that are physically far-ther from the interviewer. High voice pitchand many face and hand movements, in re-lation to the individual's standard behavior,are also indicative of deception. Deceivers(a) manifest more nonwords, such as, "ah"or "uh"; (2) show more repetitions such as"I mean...I mean I really"; and (3) use morepartial words such as "I cer-certainly did like


it." Changes in pitch are the most accuratevoice indicator of deception. Facial signs arenot always reliable. And there is no real sup-port for the idea that people who are deceiv-ing will necessarily avoid eye contact. How-ever, the practical usefulness of behavioraland facial cues is somewhat limited, in partbecause those cues that are the most imper-vious to conscious faking are the most dif-ficult to measure.

Comment

It would be useful if graduate trainingprograms in the mental health professionsemphasized more the use of physiologicalmeasures in detecting deception. For ex-ample, the psychologist's extensive back-ground in the study of human behavior andexpertise in interviewing and psychologicaltesting could easily be supplemented by thisspecific training. Not only would this facili-tate the accuracy of general psychologicaltesting, it would also provide consulting cli-ents with a much more expert opinion re-garding the detection of deception than isavailable from the usually minimally trainedpolygrapher.

References

Albert, S., Fox, H., & Kahn, M. (1980). Fakingpsychosis on the Rorschach: Can expertjudges detect malingering? Journal of Person-ality Assessment, 44, 115-119.

American Psychiatric Association. (1994). Di-agnostic and statistical manual of mental dis-orders (4th ed.). Washington, DC: Author.

Archer, R. (1992). MMPI-A: Assessing ado-lescent psychopathology. Hillsdale, NJ:Erlbaum.

Bagby, R., Buis,T., & Nicholson, R. (1995). Rela-tive effectiveness of the Standard ValidityScales in detecting fake-bad and fake-goodresponding: Replication and extension. Psy-chological Assessment, 7, 84-92.

Bagby, R., Gillis, J., Toner, B., & Goldberg, J.(1991). Detecting fake-good and fake-bad re-sponding on the Millon Clinical MultiaxialInventory-II. Psychological Assessment, 3,496-498.

Beaber, R., Marston, A., Michelli, I , & Mills,

M. (1985). A brief test for measuring malinger-ing in schizophrenic individuals. The AmericanJournal of Psychiatry, 142, 1478-1481.

Berry, D., Wetter, M., & Baer, R. (1995). Assess-ment of malingering. In J. Butcher (Ed.),Clinical personality assessment. New York:Oxford.

Bickart, W, Meyer, R., & Connell, D. (1991). TheSymptom Validity Technique as a measure offeigned short-term memory deficit. AmericanJournal of Forensic Psychology, 2, 3-11.

Borum, R., & Stock, H. (1993). Detection of de-tection in law enforcement applicants. Lawand Human Behavior, 17, 157-166.

Bull, R., & Rumsey, N. (1988). The social psy-chology of facial appearance. New York:Springer-Verlag.

Butcher, J. N., Dahlstrom, W. G., Graham, J. R.,Tellegen, A., & Kaemmer, B. (1989). Minne-sota Multiphasic Personality Inventory2.Manual for administration and scoring. Min-neapolis: University of Minnesota Press.

Cassini, J., & Workman, D. (1992). The detec-tion of malingering and deception with aShort Form of the MMPI-2 based on L, F,and K Scales. Journal of Clinical Psychol-ogy, 48, 54-63.

Conn, S., & Rieke, M. (Eds.). (1994). The 16 PFfifth edition technical manual. Champaign,IL: IPAT.

Connell, D., & Meyer, R. (1992). Differentialvalidity of the SIRS and M test. Unpublishedmanuscript.

Crowne, D. P., & Marlowe, D. (1964). The ap-proval motive: Studies in evaluative depen-dence. New York: Wiley.

Daldin, H. (1985). Faking good and faking badon the Personality Inventory for ChildrenRevised, Shortened Format. Journal of Con-sulting and Clinical Psychology, 53, 561-563.

Ekman, P. (1985). Tellinglies. New York: Norton.Ekman, P., & O'Sullivan, M. (1991). Who can

catch a Mail American Psychologist, 46, 913-920.

Exner, J. (1993). The Rorschach: A comprehen-sive system (Vol. 2,3rd ed.). New York: Wiley.

Fox, D., Gerson, A., & Lees-Haley, P. (1995). In-terrelationship of MMPI-2 Validity Scales inpersonal injury claims. Journal of ClinicalPsychology, 51, A2-A1.

Gacono, C , & Meloy, J. R. (1994). The Rorschachassessment of aggressive and psychopathicpersonalities. Hillsdale, NJ: Erlbaum.

Ganellan, R., Wasliw, G., Haywood, T., &Grossman, L. (1993, August). Can psychosisbe malingered on the Rorschach? Paperpresented at the 101st Annual Convention


243

of the American Psychological Association,Toronto, Ontario, Canada.

Gillis, J., Rogers, R., & Bagby, R. (1991). Valid-ity of the M Test. Journal of Personality As-sessment, 57, 130-140.

Graham, J. (1993). MPPI-2: Assessing person-ality and psychopathology (2nd ed.). NewYork: Oxford.

Graham, I , Watts, D., & Timbrook, R. (1991).Detecting fake-good and fake-bad MMPI-2profiles. Journal of Personality Assessment,57, 264-277.

Grossman, L., & Craig, R. (1995). Comparisonof MCMI-II and 16 PFValidity Scales.Jour-nal of Personality Assessment, 64, 384-389.

Hall, H., Shooter, E., Craine, J., & Paulsen, S.(1991). Explicit alternative testing: A trilogyof studies on faked memory deficits. Foren-sic Reports, 4, 259-279.

Hathaway, S. R., & McKinley, J. C. (1943). TheMinnesota Multiphasic Personality Inventory.Minneapolis: University of Minnesota Press.

Hovanitz, C , & Jordan-Brown, D. (1986). Thevalidity of MMPI Subtle and Obvious itemsin psychiatric patients. Journal of ClinicalPsychology, 42, 100-108.

Iverson, G., Franzen, I , & Hammond, J. (1995).Examination of inmates' ability to malingeron the MMPI-2. Psychological Assessment,7, 118-121.

Jackson, D. (1971). The dynamics of structuredpersonality tests. Psychological Review, 78,224-248.

Jackson, J., Greenblatt, R., Davis, W., Murphy,T, & Trimakas, K. (1991). Assessment ofschizophrenic inpatients with the MCMI.Journal of Clinical Psychology, 44, 72-75.

Krug, S. (1978). Further evidence on the 16 PFDistortion Scales. Journal of Personality As-sessment, 42, 513-518.

Kurtz, R., & Meyer, R. (1994). The M Test,MMPI, and SIRS in assessments ofmaling.Albuquerque, NM: American Psychology/Law Society.

Lee, G., Loring, D., & Martin, R. (1992). Rey's15-Item Visual Memory Test for the detec-tion of malingering: Normative observationson patients with neurological disorders. Psy-chological Assessment, 4, 43^16.

Lees-Haley, P., English, L., & Glenn, W. (1991).A fake bad scale on the MMPI-2 for personalinjury claimants. Psychological Reports, 68,203-210.

Lerner, P. (1995). Assessing adaptive capacitiesby means of the Rorschach. In J. Butcher(Ed.), Clinical personality assessment. NewYork: Oxford.

Meloy, J. R., & Gacono, C. (1995). Assessing thepsychopathic personality. In J. Butcher (Ed.),Clinical personality assessment. New York:Oxford.

Meyer, R., & Deitsch, S. (in press). The clini-cians'handbook: Integrated diagnostics, as-sessment and intervention in adult and ado-lescent psychopathology (4th ed.). Boston:Allyn & Bacon.

Paulhus, D. L. (1991). Manual for the BalancedInventory of Desirable Responding. Unpub-lished manuscript, University of British Co-lumbia, Vancouver, British Columbia,Canada.

Pope, K., Butcher, J., & Seelen, J. (1993). MMPI,MMPI-2 and MMPI-A in court: A practicalguide for expert witnesses and attorneys.Washington, DC: American PsychologicalAssociation.

Rey, A. (1964). L'examen clinique enpsychologie[The clinical examination in psychology].Paris: Presses Universitaires de France.

Robinette, R. (1991). The relationship betweenthe Marlowe-Crowne Form C and the Valid-ity Scales of the MMPI. Journal of ClinicalPsychology, 47, 396^400.

Rogers, R. (Ed.). (1988). Clinical assessment ofmalingering and deception. New York:Guilford Press.

Rogers, R., Bagby, M., & Gillis, R. (1992). Im-provements in the MTest as a screening mea-sure for malingering. Bulletin of the Ameri-cas Academy of Psychiatry and the Law, 20,101-104.

Rorschach, H. (1942). Psychodiagnostics. NewYork: Grune & Stratton. (Original published1921)

Rothke, S., Friedman, A., Dahlstrom,W, Green,R. et al. (1994). MMPI-2 normative data forthe F-K Index: Implications for clinical,neuropsychological and forensic practice. As-sessment, I, 1-15.

Sabine, D., & Meyer, R. (1994). MMPI-2 re-sponses in a low-SES population. Unpub-lished manuscript.

Schretlen, D., Wilkins, S., Van Gorp, W, &Bobholz, J. (1992). Cross-validation of a psy-chological test battery to detect faked insan-ity. Psychological Assessment, 4, 77-83.

Seamons, D., Howell, R., Carlisle, A., & Roe, A.(1981). Rorschach simulation of mental ill-ness and normality by psychotic and nonpsy-chotic legal offenders. Journal of Personal-ity Assessment, 45, 130-135.

Smith, G., Borum, R., & Schinka, J. (1993). Rule-out and rule-in scales for the M test for ma-lingering: A cross-validation. Bulletin of the


American Academy of Psychiatry and theLaw, 21, 107-110.

Spitzer, R., & Endicott, J. (1978). Schedule ofaffective disorders and schizophrenia. NewYork: Biometrics Research.

Weiner, D., & Harmon, L. (1946). Subtle andObvious keys for the MMPI. (AdvisementBulletin 16). Minneapolis, MN: Regional Vet-erans Administration Office.

Wetter, M., Baer, R., Berry, D., Smith, G., &Larson, L. (1992). Sensitivity of MMPI-2Validity Scales to random responding andmalingering. Psychological Assessment, 4,369-374.

Wetter, M, & Deitsch, S. (in press). Faking specificdisorders and temporal response consistency on the

MMPI-2. Psychological Assessment.Widiger, T., & Sanderson, C. (1995). Assessing

personality disorders. In J. Butcher (Ed.),Clinical personality assessment. New York:Oxford.

Winder, P., O'Dell, J., & Karson, S. (1975). NewMotivational Distortion Scales for the 16 PRJournal of Personality Assessment, 39, 532-537.

Woychyshyn, C , McElheran, W, & Romney, D.(1992). MMPI Validity Measures. Journal ofPersonality Assessment, 58, 138-148.

Zook, A., & Sipps, G. (1985). Cross-validationof a short form of the Marlowe-Crowne So-cial Desirability Scale. Journal of ClinicalPsychology, 41, 236-238.

ml Circulation

Vonl'uiTini PayelwloiT Jeuriwli

"CIST!,-I . I 'M


245

Assessment of Malingering

Documents

Transcript of Assessment of Malingering