1. Lisa Mead PSY 492 Advanced General Psychology August 20, 2011
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Editor's Notes
The purpose of a person’s mental state is one of the most difficult tasks that forensic psychologists deal with. While professionals counsel the court and the attorneys, making sure the defendant understands what being on trail means, and whether or not they are competent enough to stand trial, a psychologist has to figure out whether or not the defendant is malingering. That means is the person simulating a mental disorder in order to avoid a guilty verdict, prison sentence, or gain some sort of monetary value (Wrightsman, 2001). According to the American Psychiatric Association (DSM-IV-TR) intentionally fabricating of falsely embellishing psychological and or physical symptoms. These symptoms derive from motivation for external incentives such as avoiding work, getting out of military duty, getting financial compensation, acquiring pharmaceuticals, or evading criminal prosecution (2000).
Richard Rodgers and his associates (Rodgers, Sewell, & Goldstein, 1994) have characterized three types of malingerers. The first type is pathogenic. This is a person who is motivated by an underlying pathology. These people are authentically disturbed and Rodgers and his colleagues think that “the voluntary production of bogus symptoms will eventually erode and be replaced by a genuine disorder” (Rodgers, Sewell, & Goldstein, 1994, pp. 543-544). The second type of malingerer is criminological. These are people with oppositional and/or antisocial motivation. They fake mental disorders to get out of trouble and achieve outcomes that they do not deserve. The third type is the adaptational. This is a person who attempts “a constructive attempt, at least from the feigner’s perspective, to succeed in highly adversarial circumstances” (Rodgers, Sewell, & Goldstein, 1994, p. 544).
Kucharski, Falkenbach, Egan, and Duncan (2006), conducted a study with male criminal defendants. These defendants were assessed for malingering as part of their forensic evaluations. The subjects were broken up into three groups; those with antisocial personality disorder, those with a personality disorder other than antisocial personality disorder, and those without a personality disorder. These groups were tested and compared on validated measures of malingering. The tests being used were the Minnesota Multiphasic Personality Inventory – 2 (MMPI-2), the Personality Assessment Inventory (PAI) Negative Impression Scale, and the Structured Interview of Reported Symptoms (SIRS) scale. The findings were that less the 50% of the subjects in the antisocial personality disorder group attempted to malingerer, while potential malingering of moderate rates, between 20% and 30%, were found in the personality disorder other than antisocial personality disorder group attempted to malingerer (Kucharski, Falkenbach, Egan, & Duncan, 2006). These findings suggested that malingering may be more likely to occur with defendants with any personality disorder (Kucharski, Falkenbach, Egan, & Duncan, 2006).
Another study was done by using functional resonance imaging (fMRI) to collect data from mentally healthy participants during intent malingering and normal memory performances to distinguish feigned memory impairment (Browndyke, Paskavitz, Sweet, Cohen, Tucker, Welsh-Bohmer, Burke, & Schmechel, 2008). The participants were shown 50 images and were given instructions to remember all the images for later recognition. After that, participants were shown more images and asked to respond by pressing a button if the current stimuli being shown was one seen in the first set of images shown. The results found that inferior parietal and superior temporal activity were associated with malingered recognition memory errors, feigned recognition neglect showed up as dorsomedial frontal activity, and feigned foil false alarms activated the bilateral ventrolateral frontal regions.
An additional study was done with an fMRI and the Word Memory Test (WMT). The WMT, full-effort and simulated poor effect conditions, was given to ten subjects while they underwent fMRI. Larsen, Allen, Bigler, Goodrich-Hunsaker, and Hopkins (2010), performed this research design to examine the neural network involved during intentional malingering on the WMT. The results for the full-effort trial supported earlier findings that there were activation peaks in the dorsolateral prefrontal cortex, superior parietal lobe, anterior cingulate, bilateral lingual cortices and anterior insula/frontal operculum (Larsen, Allen, Bigler, Goodrich-Hunsaker, & Hopkins, 2010).
Jelicic, Merckelbach, Candel, and Geraerts (2007) did a study that compared the accuracy of the Structured Inventory of the Malingered Symptomatolgy (SIMS) with that of the Amsterdam Short Term Memory (ASTM) test is finding feigning of cognitive dysfunction in coached and naïve participants. Ninety undergraduate students were administered the two tests and were asked to respond honestly or instructed to malinger cognitive dysfunction based on head injury. The results were that both tests correctly classified the naïve malingerers 90% of the time, while the ATM detected 70% of the coached malingerers and the SIMS detected 90% of them (Jelicic, Merckelbach, Candel, & Geraerts, 2007).
A different research design was conducted to investigate the validity of the Coin in the Hand Test (CIH), Autobiographical Memory Index (AMI), Rey 15-Item Test (RIT), and the Wechsler Mental Control Test (MCT) for the detection of malingering. There were three groups of participants, patients with an acquired brain injury, and two groups of control one stimulating a head injury and one that was to do their best. The CIH and the MCT had good validity and showed high sensitivity and specificity when detecting malingering (Kelly, Baker, VanDen Broek, Jackson, & Humpheries, 2005). The RIT and the AMI did a poor job of distinguishing the control groups and the brain injury group.
There is still research that needs to be done on malingering and on the test that are used to detect it. A good question for further research would be what tests together have the best validity in detecting malingering. Another question would be whether or not suspected malingerers should go through an fMRI. These are important research questions because there are so many different tests out there that can aid in the detection of malingering and the use of multiple tests seem to work best for the detection. The current work that is being done tends to have more than one test administered as part of the procedure. With the use of an fMRI it was found that malingered recognition memory errors were associated with inferior parietal and superior temporal activity, feigned recognition misses showed up as dorsomedial frontal activity, and feigned foil false alarms activated the bilateral ventrolateral frontal regions (Browndyke, Paskavitz, Sweet, Cohen, Tucker, Welsh-Bohmer, Burke, & Schmechel, 2008). It is important to the research being done to see whether or not having a suspected malingerer go through an fMRI along with tests to detect malingering would make the diagnosis more solid.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: Author. Browndyke, J. N., Paskavitz, J., Sweet, L. H., Cohen, R. A., Tucker, K. A., Welsh-Bohmer, K. A., Burke, J. R., & Schmechel, D. E. (2008). Neuroanatomical correlates of malingered memory impairment: Event-related fMRI of deception on a recognition memory task. Brain Injury, 22 (6), 481-489. doi: 10.1080/02699050802084894 Hacker, V. & Jones, C. (2009). Detecting feigned impairment with the word list recognition of the Wechsler Memory Scale–3rd edition. Brain Injury, 23 (3), 243-249. doi: 10.1080/02699050902748315 Jelicic, M., Merckelbach, H., Candel, I., & Geraerts, E. (2007). Detection of feigned cognitive dysfunction using special malinger tests: A simulation study in naïve and coached malingerers. International Journal of Neuroscience, 117 , 1185-1192. doi: 10.1080/00207450600934697 Kelly, P. J., Baker, M. D., VanDen Broek, H., Jackson, H., & Humpheries, G. (2005). The detection of malingering in memory performance: The sensitivity and specificity of four measures in a UK population. British Journal of Clinical Psychology, 44 , 333–341. doi:10.1348/014466505X35687
Kucharski, T., Falkenbach, D., Egan, S., & Duncan, S. (2006). Antisocial personality disorder and the malingering of psychiatric disorder: A study of criminal defendants. International Journal of Forensic Mental Health, 5 (2), 195-204. Larsen, J. D., Allen, M. D., Bigler, E. D., Goodrich-Hunsaker, N. J., & Hopkins, R. O. (2010). Different patterns of cerebral activation in genuine and malingered cognitive effort during performance on the Word Memory Test. Brain Injury, 24 (2), 89-99. doi: 10.3109/02699050903508218 Rogers, R., Sewell, K. W., & Goldstein, A. M. (1994). Explanatory models of malingering: A prototypical analysis. Law and Human Behavior, 18 , 543-552. Rubenzer. S. (2006). Malingering of psychiatric problems, brain damage, chronic pain, and controversial syndromes in a personal injury context. FDCC Quarterly, 56 (4), 499- 523. Wrightsman, L. (2001). Forensic psychology. Belmont, CA: Wadsworth Thomson Learning.
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