Comparing the Ability of MMPI-2 and MMPI-2-RF Validity Scales to Detect Feigning: A Meta-Analysis

Several meta-analyses of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) have examined these instruments’ ability to detect symptom exaggeration or feigning. However, limited research has directly compared whether the scales across these two instruments are equally effective. This study used a moderated meta-analysis to compare 109 MMPI-2 and 41 MMPI-2-RF feigning studies, 83 (56.46%) of which were not included in previous meta-analyses. Although there were differences between the two test versions, with most MMPI-2 validity scales generating larger effect sizes than the corresponding MMPI-2-RF scales, these differences were not significant after controlling for study design and type of symptoms being feigned. Additional analyses showed that the F and Fp-r scales generated the largest effect sizes in identifying feigned psychiatric symptoms, while the FBS and RBS were better at detecting exaggerated medical symptoms. The findings indicate that the MMPI-2 validity scales and their MMPI-2-RF counterparts were similarly effective in differentiating genuine responders from those exaggerating or feigning psychiatric and medical symptoms. These results provide reassurance for the use of both the MMPI-2 and MMPI-2-RF in settings where symptom exaggeration or feigning is likely. Findings are discussed in the context of the recently released MMPI-3.

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.

Psychological profiles of irritable bowel syndrome patients with different phenotypes

Background/Aims: Abnormal psychological profiles are frequently found in patients with functional gastrointestinal disorders (FGIDs). The present study aimed to evaluate the psychological profiles of FGID patients with irritable bowel syndrome (IBS), and IBS phenotypes.Methods: In 608 FGID patients, including 235 with IBS, have filled a Rome III questionnaire and the French version of the Minnesota Multiphasic Personality Inventory 2. Data analysis was performed using univariate analysis and multivariate logistic regression.Results: This study shows that IBS patients have abnormal psychological profiles with more significant symptom exaggeration and decreased test defensiveness than non-IBS patients. They have a significantly higher score for all clinical scales. Logistic regression analysis showed in IBS patients a decrease of body mass index (<i>P</i>= 0.002), and test defensiveness score K (<i>P</i>= 0.001) and an increase of Hypochondriasis (<i>P</i>< 0.001) and Masculinity-Femininity scale (<i>P</i>= 0.018). By comparison with non-IBS patients, IBS-constipation, IBS-diarrhea, and mixed IBS patients have increased Hypochondriasis value and Depression score, mixed IBS patients have higher Psychasthenia score and higher Hypomania score. No item was significantly different in the IBS-unspecified group.Conclusions: This study shows that IBS patients have different psychological profiles than other FGID patients and that psychological characteristics are associated with IBS phenotypes except for patients with unsubtyped IBS.

Does Validity Measure Response Affect CPT Group Outcomes in Veterans with PTSD?

Introduction There is a dearth of research on the impact of pre-treatment assessment effort and symptom exaggeration on the treatment outcomes of Veterans engaging in trauma-focused therapy, handicapping therapists providing these treatments. Research suggests a multi-method approach for assessing symptom exaggeration in Veterans with posttraumatic stress disorder (PTSD), which includes effort and symptom validity tests, is preferable. Symptom exaggeration has also been considered a “cry for help,” associated with increased PTSD and depressive symptoms. Recently, research has identified resilience as a moderator of PTSD and depressive symptom severity and an important predictor of treatment response among individuals with PTSD. Thus, it is important to examine the intersection of symptom exaggeration, resilience, and treatment outcome to determine whether assessment effort and symptom exaggeration compromise treatment response. Materials and Methods We recruited Veterans, aged 18–50 who served during the Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) era, from mental health clinics and fliers posted in a large Veterans Affairs Medical Center. Veterans met inclusion criteria if they were diagnosed with PTSD via a clinician-administered assessment. Sixty-one Veterans consented to participate and self-selected into a cognitive processing therapy (CPT) group or treatment-as-usual. We offered self-selection because low recruitment rates delayed treatment start dates and were consistent with a Veteran-centered care philosophy. Veterans were assessed before and after treatment to determine the impact of assessment effort and symptom exaggeration scores on measures of PTSD and depressive symptoms and resilience. This study examined whether assessment effort failure and symptom exaggeration were associated with compromised psychotherapy outcomes in Veterans with PTSD undergoing CPT group. We hypothesized that a pattern of responding consistent with both effort and symptom exaggeration would result in higher (ie, more severe) pre- and post-treatment scores on PTSD and depressive symptom outcome measures and lower resiliency when compared to Veterans providing good effort and genuine responding. Hypotheses were evaluated using bivariate correlation analyses, analysis of variance, and chi-square analyses. Results Pre-treatment scores on measures of PTSD and depressive symptoms were higher among Veterans whose pattern of responding was consistent with poor assessment effort and symptom exaggeration; these Veterans also scored lower on a measure of resiliency. At post-treatment, there were no differences between Veterans displaying good and failed effort testing on measures of PTSD and depressive symptoms or in whether they completed treatment. Post-treatment resiliency scores remained significantly lower in those with failed effort testing. Conclusion These results suggest that Veterans with PTSD whose validity testing scores are indicative of poor effort and symptom exaggeration may be less resilient but may still complete a CPT group treatment and benefit from treatment at a rate comparable to Veterans who evidence good assessment effort and genuine symptom reporting pre-treatment. These findings also challenge the assumption that pre-treatment assessment effort failure and symptom exaggeration accurately predict poor effort in trauma-focused psychotherapy.

A-74 Patients with Psychogenic Non-Epileptic Events Differentially Report Emotional Distress and Activities of Daily Living Completion When Controlling for Performance Validity

Objective While the use of validity testing in neuropsychological assessments to assist in differentiation between epileptic seizures (ES) and psychogenic non-epileptic events (PNEE) is becoming common, validity considerations regarding symptom self-reporting is seldom examined. This study seeks to add clarity by examining performance validity tests (PVT), and self-report measures of emotional symptoms and daily functioning, in a sample of those with either ES or PNEE. Methods Patients: Consecutive Veteran patients referred to an epilepsy monitoring unit for evaluation of intractable seizures, and subsequently diagnosed with ES (32) or PNEE (75). A fixed battery of psychological (Beck Depression Inventory-II, Patient Competency Rating Scale, Quality of Life in Epilepsy) and PVT (Test of Memory Malinger, Word Memory Test) measures were administered as part of a broader neuropsychological assessment. Patients were classified by both their diagnostic, and PVT pass/fail, statuses (PNEEpass, PNEEfail, & ESpass – ESfail was too small to analyze). Results PNEE reported more severe symptoms/impairments than ES (each p < .01) when ignoring PVT results. Importantly, when PVTs were considered, PNEEfail reported worse symptoms/impairments than PNEEpass (each p < .01), and PNEEpass and ESpass did not differ on emotional distress (p = .07). Conclusions Those with PNEE who fail PVTs report worse psychological distress and functional abilities than both those who pass and those with ES. This is likely due to symptom exaggeration. Validity testing should thus be considered a crucial component of assessment of these individuals: if invalid self-reporting is not accounted for, clinicians put themselves at risk for coming to faulty conclusions while more parsimonious explanations are available.

Malingering and factitious disorder

Although exaggeration or amplification of symptoms is common in all illness, deliberate deception is rare. In settings associated with litigation/disability evaluation, the rate of malingering may be as high as 30%, but its frequency in clinical practice is not known. We describe the main characteristics of deliberate deception (factitious disorders and malingering) and ways that neurologists might detect symptom exaggeration. The key to establishing that the extent or severity of reported symptoms does not truly represent their severity is to elicit inconsistencies in different domains, but it is not possible to determine whether the reports are intentionally inaccurate. Neurological disorders where difficulty in determining the degree of willed exaggeration is most likely include functional weakness and movement disorders, post-concussional syndrome (or mild traumatic brain injury), psychogenic non-epileptic attacks and complex regional pain syndrome type 1 (especially when there is an associated functional movement disorder). Symptom amplification or even fabrication are more likely if the patient might gain benefit of some sort, not necessarily financial. Techniques to detect deception in medicolegal settings include covert surveillance and review of social media accounts. We also briefly describe specialised psychological tests designed to elicit effort from the patient.

A Lab Model for Symptom Exaggeration: What do we Need?

This article reflects on the current state of the art in research on individuals who exaggerate their symptoms (i.e., feigning). We argue that the most commonly used approach in this field, namely simply providing research participants with instructions to overreport symptoms, is valuable for validating measures that tap into symptom exaggeration, but is less suitable for addressing the theoretical foundations of feigning. That is, feigning serves to actively mislead others and is done deliberately. These characteristics produce experiences (e.g., feelings of guilt) in individuals who feign that lab research in its current form is unable to accommodate for. Paradigms that take these factors into account may not only yield more ecologically valid data, but may also stimulate a shift from the study of how to detect feigning to more fundamental issues. One such issue is the cognitive dissonance (e.g., feelings of guilt) that – in some cases – accompanies feigning and that may foster internalized fabrications. We present three studies (N's = 78, 60, and 54) in which we tried to abate current issues and discuss their merits for future research.