Detecting Negative Response Bias Within the Trauma Symptom Inventory–2 (TSI-2): a Review of the Literature

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.

A-177 Classification Statistics of the Clinical Assessment of Attention Deficit – Adult (CAT-A) Negative Impression Scale for ADHD Evaluations in an Active Duty Sample

Objective To evaluate the classification statistics of the Clinical Assessment of Attention Deficit – Adult (CAT-A) Negative Impression (NI) scale, relative to the MMPI-2-RF in an active duty military sample. We hypothesized that MMPI-2-RF RBS would have the largest AUC. Method Retrospective review of 108 active duty service members consecutively referred to neuropsychology for clinical ADHD evaluations in a Midwest Army Health Center. Cases with missing data (10) and failures of MMPI-2-RF response consistency scales (3) were removed from analysis, resulting in final sample of 95. Average age was 32.62 (SD = 8.87) and average education was 14.66 (SD = 2.66). MMPI-2-RF symptom validity scales (F-r, Fp-r, Fs, FBS-r, and RBS) were employed as criterion measures at all standard cut-offs to evaluate the CAT-A NI scale. Results ROC analyses for the MMPI-2-RF over-reporting symptom validity scales ranged from 0.599 to 0.808, with the MMPI-2-RF RBS scale >79 demonstrating the lowest AUC (0.599; p 52. With specificity held at or above 0.90, sensitivities ranged from 22.86 to 60.00, with positive and negative predictive values ranging from 11.1 to 58.8 and 66.7 to 98.8, respectively. Conclusions The CAT-A NI scale demonstrated reasonable AUC values for nearly all MMPI-2-RF over-reporting scales. Psychologically-based over-reporting scales were superior to cognitively-based over-reporting scales in terms of classification statistics. The optimal cut in the current data (>52) is slightly higher (though roughly commensurate) to the cut score for atypical responses in the CAT-A manual (>45).

Malingering mental disorders: Clinical assessment

SummaryMalingering is the dishonest and intentional production of symptoms. It can cause considerable difficulty as assessment runs counter to normal practice, and it may expose clinicians to testing medicolegal situations. In this first part of a two-article review, we explore types of psychiatric malingering and their occurrence across a range of common and challenging scenarios, discussing presentations that may help delineate true from feigned illness. A framework is provided for undertaking an assessment where malingering is suspected, including recommendations on clinician approach, the use of collateral information, and self-evaluation of biases. The uses, and limitations, of psychometric tests are discussed, including ‘general’, malingering-specific and ‘symptom validity’ scales.Learning Objectives• Understand the challenges of determining ‘real’ from ‘malingered’ symptomatology across a range of psychiatric conditions• Have a rational strategy for approaching a clinical assessment where malingering is suspected• Appreciate the role and limitations of various psychometric tests that can be used in such assessments