Test #3 Flashcards
Malingering
intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives (work, criminal, money)
How is malingering distinct from somatoform disorder?
the physical symptoms are not intentionally feigned or produced and the incentive is not psychological
How is malingering distinct from factitious disorder?
the symptoms are not performed to assume the sick role, though behaviors are intentional
Definitional difficulties for malingering
- Somatoform/Factitious definitions do not target cognitive symptoms
- Definition requires judgment about internal states
- Determining relative weight of external incentive and sick role (external incentives must be absent)
Criteria for definite malingering
- presence of substantial external incentive
- evidence of negative response bias
- behaviors are not due to psychiatric, neurological, or developmental factors
Criteria for probable malingering
- presence of substantial external incentive
- two or more types of evidence from testing (excluding negative response bias)–or one from testing and one from self-report
- behaviors are not due to psychiatric, neurological or developmental factors
Cogniform Disorder
- cognitive complaints/ test performance is rare for the level of brain injury
- delayed onset of excessive cognitive complaints
- inconsistencies across scores/ repeated evaluations
- evidence of suboptimal effort
- condition: inconsistencies between performance in evaluation and other areas of life
Risk factors for extended recovery times following mild TBI
- premorbid psychiatric history
- severity of self-reported symptoms
- involvement in compensation seeking
- physical comorbidities
- concurrent PTSD/pain
- lower education
- income/ level of employment
incidence estimates of cogniform disorder/ extended recovery times for mTBI
1-50%
Malingering Designs: Simulation
- analogue design in which subjects are given instructions to feign, then are compared to normal and brain injured groups
- generalizability concerns.
- motivation/preparation of participants
- simulation malingering paradox
Simulation malingering paradox
ask people to comply with instructions to study people who don’t comply with instructions
Malingering Designs: Differential prevalence designs
- high & low base rate groups
- allow determination of average responses
- maybe good malingerers are still getting by
Malingering Designs: known group designs
- used when you have an identified group of malingerers
- how are they identified?
- maybe good malingerers are still getting by
Malingering Detection Strategies
Symptom validity testing
- Word Choice Effort Form (Wechsler)
- forced choice paradigm (ex. left vs right hand)
- TOMM
TOMM scores
45 questionable, 42-43 basically never seen, expect near 50
Gold standard for Malingering Detection Strategies
below chance
Rey 15-item test
- used to detect malingering
- is a poor measure
- 1,2,3, I, II,III,A,B, C,a,b,c, triangle, circle, square
Problems with Malingering Detection Strategies
- floor effect
- poor sensitivity (not catching fakers)
- poor specificity (identifying people who aren’t faking as fakers)
- ethics
Floor effects & the Rey 15-item test
- cut off is 7-9 items
- pattern of response failure
Floor effects and Malingering Detection Strategies
even people with known, moderate to severe injuries obtain correct scores
key component of a malingering measure
they should look more difficult than they are
Malingering: Embedded measures
- WAIS-IV
- CVLT-II
- Rarely Missed Index
WAIS-IV & Malingering
-low digit span (age corrected score
CVLT-II and Malingering
- low recognition
- low delayed forced choice
- sensitivity questionable for other CVLT scores