Featured Article
Article Title
Invalid Response Set and Malingering‑Related Assessments in Psychological Injury: Definitions and a Hierarchy of Terms
Authors
Gerald Young - York University, Toronto, Canada
Luciano Giromini - University of Turin, Turin, Italy
Laszlo Erdodi - University of Windsor, Windsor, Canada; Star UBB Institute, Babeș-Bolyai University, M. Kogalniceanu St. 1, Cluj-Napoca-Napoca, Romania
Richard Rogers - University of North Texas, Denton, TX, USA
Abstract
Psychological injuries refer to diagnoses and conditions that are contentious in court and related venues, such as posttraumatic stress disorder (PTSD), chronic pain, and mild traumatic brain injury (MTBI). Forensic disability and related assessments (FDRA) must determine whether an examinee has engaged in malingering or related attributions, including feigning, or has demonstrated significant failures on validity testing. The assessor employs a comprehensive assessment approach, including the use of performance validity tests (PVTs) and symptom validity tests (SVTs) to determine the credibility or validity of the examinee’s presentation as part of the assessment undertaken. There are several issues concerning the definition of malingering in the context of psychological injury. The article reviews existing approaches to malingering and related definitions, highlighting their inconsistencies and proposing improvements. It also introduces a well-defined hierarchy of terms related to malingering, feigning, invalid response set, and minor symptom exaggeration, while indicating terms that should no longer be used. The article aims to assist forensic assessors in clarifying their understanding of malingering and related concepts, by offering a coherent framework for report writing and testimony. The limitations in the current terminology indicate a need for practice guidelines that include multiple examples.
Keywords
Psychological injury, Malingering, Feigning, Invalid response set, Symptom exaggeration, Malingering, Feigning, Forensics, Evaluation, Bias, Diagnosis, Psychology, Judgment, Training, Accuracy
Summary of Research
“Malingering is a cardinal topic in the area of psychological injury and law, and its assessment requires expertise in nomenclature, assessment, validity testing, test psychometrics, and test interpretation… The specifics of FDRA assessment are very different for the most contentious psychological injuries, such as posttraumatic stress disorder (PTSD), chronic pain, and mild traumatic brain injury (MTBI) that is uncomplicated by comorbidities such as PTSD and chronic pain. Different tests might be used in these varying assessments, including PVTs and symptom validity tests (SVTs). However, the goal of the assessment in all such cases is the same—to determine, using these validity tests, whether there is sufcient psychometric evidence to attribute invalid response set and, once analysis of the full profle is undertaken, to determine whether to include terms that involve intention for secondary (monetary) gain, like malingering” (p. 3- 4).
“Malingering is a critical term in FDRA for court and related purposes in the field of psychological injury and law, and beyond…To reduce disagreements in the contested adversarial divide, it is critical to establish clear definitions of the relevant terms. The purpose of this article is to clarify the terms related to malingering and associated behaviors by defining them more precisely and organizing them hierarchically…
The article presents a hierarchy of terms showing the similarities and differences among these and other terms used in the field, as well as those that should not be used” (p. 4- 6).
“Terms such as malingering, feigning, negative response bias, invalid response set, and PVT/SVT failure refer to presentations that are less than fully supported by the available data and not fully evident throughout a case in FDRA. Malingering cannot be attributed to a case at hand without incontrovertible evidence about the motivation underlying the non-credible test results. When assessors use terms like “malinger,” “malingered,” and “malingering,” they assume that the examinee is presenting with symptoms and impairments beyond what is expected based on their injury parameters and overall level of mental health status, while also finding compelling indicators of malingering.
To use these terms appropriately, there must be identifable external incentives that could account for the increased severity of symptoms and defcits observed by the assessor, along with clear evidence that the examinee is consciously exaggerating symptoms or minimizing functionality for monetary gain in the psychological injury and law (FDRA) context…
…The WHO definition of malingering has an advantage compared to the DSM approach. The WHO approach to malingering includes considering when the complainant refers falsely to an event at claim as being responsible for symptoms expressed, genuine or not, when that had not been the case…” (p. 9- 11).
“The definition provided is consistent with the DSM example of using a long description without separate sentences. Malingering can be defned as “the intentional or volitional misrepresentation or deceptive presentation or production of:
(a) false or grossly exaggerated physical or psychological problems or symptoms; which might be accompanied by
(b) false or grossly minimized physical or psychological problems or symptoms that had been present before an index event (i.e., the good old days bias); or
(c) false or grossly minimized functionality (capacities/capabilities); motivated by external incentives, such as for personal external incentives related to avoiding military duty/deployment or work [or any formal duty/role/responsibility at issue (e.g., avoiding probation, expulsion, termination, or suspension)], obtaining fnancial compensation, attempting to increase university accommodations, getting a sought for employment, or trying to obtain drugs beyond those medically justifed, as well as for avoiding other undesirable outcomes, such as avoiding an abusive relationship, evading criminal prosecution (avoiding being deemed competent to stand trial), or attempting to reduce sentencing conditions” (p. 11- 12).
“Specifically, in the hierarchy of terms, malingering resides at the first level, while minor symptom exaggeration—exaggeration of psychological problems that are genuinely experienced by the examinee—resides at the third level; other terms, such as feigning, reside between these levels” (p. 13).
“Malingering is a critical term in FDRA for court and related purposes in the field of psychological injury and law, and beyond…To reduce disagreements in the contested adversarial divide, it is critical to establish clear definitions of the relevant terms. The purpose of this article is to clarify the terms related to malingering and associated behaviors by defining them more precisely and organizing them hierarchically…
The article presents a hierarchy of terms showing the similarities and differences among these and other terms used in the field, as well as those that should not be used” (p. 4- 6).
“Terms such as malingering, feigning, negative response bias, invalid response set, and PVT/SVT failure refer to presentations that are less than fully supported by the available data and not fully evident throughout a case in FDRA. Malingering cannot be attributed to a case at hand without incontrovertible evidence about the motivation underlying the non-credible test results. When assessors use terms like “malinger,” “malingered,” and “malingering,” they assume that the examinee is presenting with symptoms and impairments beyond what is expected based on their injury parameters and overall level of mental health status, while also finding compelling indicators of malingering.
To use these terms appropriately, there must be identifable external incentives that could account for the increased severity of symptoms and defcits observed by the assessor, along with clear evidence that the examinee is consciously exaggerating symptoms or minimizing functionality for monetary gain in the psychological injury and law (FDRA) context…
…The WHO definition of malingering has an advantage compared to the DSM approach. The WHO approach to malingering includes considering when the complainant refers falsely to an event at claim as being responsible for symptoms expressed, genuine or not, when that had not been the case…” (p. 9- 11).
“The definition provided is consistent with the DSM example of using a long description without separate sentences. Malingering can be defned as “the intentional or volitional misrepresentation or deceptive presentation or production of:
(a) false or grossly exaggerated physical or psychological problems or symptoms; which might be accompanied by
(b) false or grossly minimized physical or psychological problems or symptoms that had been present before an index event (i.e., the good old days bias); or
(c) false or grossly minimized functionality (capacities/capabilities); motivated by external incentives, such as for personal external incentives related to avoiding military duty/deployment or work [or any formal duty/role/responsibility at issue (e.g., avoiding probation, expulsion, termination, or suspension)], obtaining fnancial compensation, attempting to increase university accommodations, getting a sought for employment, or trying to obtain drugs beyond those medically justifed, as well as for avoiding other undesirable outcomes, such as avoiding an abusive relationship, evading criminal prosecution (avoiding being deemed competent to stand trial), or attempting to reduce sentencing conditions” (p. 11- 12).
“Specifically, in the hierarchy of terms, malingering resides at the first level, while minor symptom exaggeration—exaggeration of psychological problems that are genuinely experienced by the examinee—resides at the third level; other terms, such as feigning, reside between these levels” (p. 13).
Translating Research into Practice
“...The article proposes a simple formula that captures the range of terms used in the feld for presentations that do not reach thresholds for malingering:
(1) These terms include the following adjectives: negative/problematic/noncredible/invalid;
(2) Also, for the nouns, they include bias/ overreporting/impression management. Qualifers include performance, presentation, production, data, and results.
(3) Also, beyond that, the assessor should specify adjectives such as gross/compelling, and the like to indicate the degree or extent of the non-credible presentation…
Future research can determine whether there are valid conceptual, empirical, and taxonomic reasons to separate the categories of definite, probable, and possible malingering. That said, it is not common, as far as we know, that FDRA assessors will use adjectives like mild, moderate, and severe in these regards, but we recommend that this should become standard practice” (p. 6- 7).
“FDRA assessors can proceed in their assessments using established protocols, but they should proceed cautiously, and by adhering to all applicable ethical codes and assessment guidelines, adopting a comprehensive, impartial, scientific approach. The present hierarchy of terms on malingering and related attributions in FDRA, along with the cautions provided, should be part of this reasoned and reasonable approach”(p. 16).
(1) These terms include the following adjectives: negative/problematic/noncredible/invalid;
(2) Also, for the nouns, they include bias/ overreporting/impression management. Qualifers include performance, presentation, production, data, and results.
(3) Also, beyond that, the assessor should specify adjectives such as gross/compelling, and the like to indicate the degree or extent of the non-credible presentation…
Future research can determine whether there are valid conceptual, empirical, and taxonomic reasons to separate the categories of definite, probable, and possible malingering. That said, it is not common, as far as we know, that FDRA assessors will use adjectives like mild, moderate, and severe in these regards, but we recommend that this should become standard practice” (p. 6- 7).
“FDRA assessors can proceed in their assessments using established protocols, but they should proceed cautiously, and by adhering to all applicable ethical codes and assessment guidelines, adopting a comprehensive, impartial, scientific approach. The present hierarchy of terms on malingering and related attributions in FDRA, along with the cautions provided, should be part of this reasoned and reasonable approach”(p. 16).
Other Interesting Tidbits for Researchers and Clinicians
“Malingering is one possible interpretation in a particular FDRA file when:
(a) the overall examinee presentation is deemed not credible, for example, on the basis of multiple PVT failures;
(b) the examinee presents with evidence of intentional exaggeration of symptoms and impairments for secondary gain (e.g., monetary compensation); and
(c) other potential interpretations of the examinee’s full clinical profile can be ruled out. The attribution of malingering, following a comprehensive, scientifically informed, reliable, and valid assessment, requires a thorough justification based on the full information set of the examinee” (p. 5).
“...The definition of malingering should be extended to indicate the intentional presentation of falsely reduced or grossly minimized functionality” (p. 11).
(a) the overall examinee presentation is deemed not credible, for example, on the basis of multiple PVT failures;
(b) the examinee presents with evidence of intentional exaggeration of symptoms and impairments for secondary gain (e.g., monetary compensation); and
(c) other potential interpretations of the examinee’s full clinical profile can be ruled out. The attribution of malingering, following a comprehensive, scientifically informed, reliable, and valid assessment, requires a thorough justification based on the full information set of the examinee” (p. 5).
“...The definition of malingering should be extended to indicate the intentional presentation of falsely reduced or grossly minimized functionality” (p. 11).
Additional Resources/Programs
As always, please join the discussion below if you have thoughts or comments to add!
- Distinguished Contributions Award Winner Dr. Frederick on Multiple Measures of Malingering (Video)
- High Base Rate of Feigning Detected Among Defendants Committed for Competency Restoration
- Capacity to classify feigned symptoms of mental illness and/or cognitive impairment using the Structured Inventory of Malingered Symptomatology
- Multiple Feigning Strategies Used in Competence (CST) Evaluations - CONCEPT Professional Training
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