This document discusses strategies for identifying faked or exaggerated symptoms of emotional distress in personal injury suits. It notes that while malingering is difficult to detect with certainty, several approaches can be used, including behavioral observations, interviews, reviewing records, and psychological testing - particularly using multiple validity scales on the MMPI-2 test. Though no single method is perfect, combining data from these different sources provides the best current approach for forensic psychologists to identify potential malingering when evaluating plaintiffs for personal injury claims.

1. IDENTIFYING FAKED OR EXAGGERATED SYMPTOMS
OF EMOTIONAL DISTRESS IN PERSONAL INJURY SUITS
May 29, 1999
Stuart J. Clayman, Ph.D.
Licensed Psychologist
75 Potter Pond
Lexington, MA 02421
Tel.: (781) 862-4292
Fax: (781) 861-1993
jay@braindoctor.org
Psychologists have long been interested in the effect that rewards and punishments have on
human behavior. Because huge rewards are potentially available in personal injury suits, the
forensic psychologist understands that a personal injury litigant might try to engage in
"impression management" during the psychological exam and carefully assesses the likelihood
this has occurred. A personal injury litigant may, for example, exaggerate or minimize symptoms
and impairments in order to obtain certain goals. This article discusses some aspects of symptom
exaggeration and how it can be measured. Symptom minimization or denial of psychological
symptoms can also be seen in certain types of personal injuries and will be the subject of another
article.
“Malingering” is the term psychologists and other mental health professionals use to describe
“the intentional production of false or grossly exaggerated physical or psychological symptoms,
motivated by external incentives such as avoiding military duty, avoiding work, obtaining
financial compensation, evading criminal prosecution or obtaining drugs” 1
. The individual
engaging in malingering is thought to be consciously aware that he or she does not have the
physical or mental illness that is being presented.
There should be a strong suspicion of malingering if any two or more of the following are
identified: 2
1. Medicologal context of presentation (e.g. the person is referred by an attorney to the
clinician for examination)
2. Marked discrepancy between the person’s claimed stress or disability and the
objective findings
3. Lack of cooperation during the diagnostic evaluation and in complying with the
prescribed treatment regimen
4. The presence of Antisocial Personality Disorder
Antisocial Personality Disorder (in the past referred to as “psychopathy” or “sociopathy”) can
raise concern about the possibility of malingering since deceitfulness is identified in the DSM-IV
as a cardinal feature of this disorder.

2. Identifying Faked or Exaggerated Symptoms of Emotional Distress in Personal Injury Suits Page 2
There is another class of disorders that can be confused with malingering: Factitious Disorders.
A Factitious Disorder is also characterized by “the intentional production of physical or
psychological signs or symptoms”3
, but differs from malingering in that the motivation for the
symptom production in Factitious Disorder is to assume the sick role rather than to obtain the
external incentives which are the hallmark of malingering. A factitious disorder may involve a
self-induced injury and tends to imply more genuine psychopathology than malingering since the
“secondary gain” (external incentive) is absent or much less noticeable. Overholser4
traces the
historical development of factitious disorder and suggests some ways of differentiating
malingering and factitious disorders. He reports, for example, that most malingerers are seen on
an outpatient basis while factitious disorder is often seen on an inpatient service, that malingerers
seem “agreeable” while those with factitious illness are “belligerent” and that the primary source
of motivation is “external” in malingerers and “internal” in those with factitious disorder.
Overholser notes that another writer, Asher, first suggested this syndrome and named it in honor
of Baron Hieronymus Karl Friederich von Munchausen, an 18th
century nobleman noted for his
ability to tell exaggerated stories. In 1968, Spiro5
defined a broader category of problems as
“factitious illness”, which includes Munchausen’s Syndrome.
How often do plaintiffs fake or exaggerate emotional distress in personal injury suits. This figure
is not known with certainty. Mental health professionals who study faking offer widely varying
estimates of how often malingering occurs. In an article appearing in the journal
OCCUPATIONAL HEALTH AND SAFETY, W. Donald Ross cites a Washington state survey
which revealed that only one of one million claims were actually self-inflicted injuries being
masqueraded as work injuries6
. He concluded that “True malingering is rare”. G. G. Hay, in his
review of the simulation of mental illness7
, estimated that five out of about 12,000 admissions to
a South Manchester hospital were believed to be faking a psychosis, a rate of less than 1/20th of
a percent. In a more recent study, Paul Lees-Haley found that only one of 64 personal injury
claimants scored in the significant range on two different measures of malingering and he
remarked upon “the large number of forensic patients who scored lower than one might imagine
(on indices of faking) from a population that often is characterized as disturbed, making a cry for
help, or exaggerating emotional distress" 8
. Simon, in his 1995 book Posttraumatic Stress
Disorder in Litigation, states that “The incidence of malingered psychiatric symptoms after
injury is unknown”.9
He cites estimates of occurrence of malingering by other experts that range
from 1% to over 50%. Simon goes on to differentiate “pure malingering-the feigning of disease
when it does not exist at all” from “partial malingering-the conscious exaggeration of existing
symptoms or the fraudulent allegation that prior genuine symptoms are still present”.
Various strategies have been suggested as aids in the detection of malingering. Huddleston10
, for
example, recommended a technique to use with military men which involved depriving the
soldier of books, tobacco and friends since this would often result in an improvement of faked
symptoms. Other authors have suggested studying the eyes for signs of shiftiness or
“wavering”11
In more recent times, drugs have been utilized to attempt to identify the faker. But,
studies have shown that subjects can continue to deceive during amobarbital interviews12
. And,
according to Hall and Pritchard13
, a hypnotic state does not guarantee against faking either.
Modern psychology offers some behavioral cues which might be useful in detecting malingering.
Freud suggested that liars make more “slips of the tongue” than those telling the truth. Others

3. Identifying Faked or Exaggerated Symptoms of Emotional Distress in Personal Injury Suits Page 3
have suggested that liars blink their eyes more often than truth tellers14
, that liars’ pupils are
more dilated15
and DePaulo has said that nervous people and introverts are less successful as
liars 16
. But DePaulo goes on to say that many of these behaviors, which appear to be associated
with level of anxiety, are not consistently associated with faking.
Several clinical strategies have been employed in an attempt to differentiate between the
individual with a genuine psychological disorder and one who is faking or malingering. Among
these are observation or videotaping of the suspected malingerer, a technique apparently
employed by insurance companies, interviews without using psychological tests, a method
sometimes used by psychiatrists, and formal psychological testing. Schretlen, in his excellent
review of the use of psychological tests to identify malingering of psychological disorders,
concludes that research supports psychological testing as a method of differentiating between
genuine and feigned mental problems but research demonstrating that the psychiatric interview
by itself can be used in this way is lacking.17
Many psychological tests have been examined with respect to their ability to help identify
malingering. Schretlen, in the same review article, mentions a few including the MMPI-2, the
Rorschach test and the Bender Gestalt test. But there is controversy about the reliability and
validity of the Rorschach and Bender Gestalt and some investigators feel this severely limits
their usefulness in forensic settings.
The Minnesota Multiphasic Personality Inventory (MMPI-2) is “the most widely used and
researched objective personality inventory”.18
It may also be the psychological test most often
used in the assessment of malingering of mental disorders. The MMPI, originally developed in
the early 1940s by Hathaway and McKinley, was re-standardized in 1989, re-named the MMPI-
2. The MMPI-2 consists of 567 true-false items which are grouped into Validity scales, which
measure "test-taking attitudes", and Clinical scales which measure various aspects of personality
and psychological symptoms. It has been referred to as the “gold standard” in the psychometric
assessment of malingering
The MMPI/MMPI-2 has been used in several different ways to detect malingering. Early on,
Gough looked at ways the validity scales of the MMPI could be utilized to identify
malingering.19 20
He reported in his 1950 study that the raw score on Validity Scale F minus the
raw score on Validity Scale K (F-K) was quite useful in detecting “overreporting” profiles, those
MMPI profiles in which examinees exaggerated their mental problems. Many studies of the
usefulness of F minus K as a means of detecting malingering have subsequently been done and
the consensus seems to be that this formula is accurate in distinguishing faked from normal
profiles but is less accurate in distinguishing faked profiles from profiles of examinees with
actual mental illness (Schretlen, 1988). Research continues into the best way to use the F minus
K formula to measure faking.
Validity Scale F by itself has also been used to detect malingering. Berry and Baer21
looked at
the combined data from more than 25 studies which examined how well MMPI validity scales
could detect overreporting of psychological symptoms. The best indicator of faking was the F
scale; F minus K was somewhat less effective. But investigators learned that random reporting
(in addition to faking and real mental problems), also had the effect of elevating the F scale. A

4. Identifying Faked or Exaggerated Symptoms of Emotional Distress in Personal Injury Suits Page 4
method was needed for differentiating between random responding and exaggeration of
symptoms. With the re-standardization of the MMPI known as the “MMPI-2”, VRIN (variable
response inconsistency) and TRIN (true response inconsistency)22 23
were introduced. VRIN
consists of special MMPI-2 items which can be used to rule out random responding. TRIN can
be used to identify a different type of inconsistent responding.
As promising as some of these MMPI-2 Validity Scales are in the detection of malingered
symptoms of mental disorders, efforts continue to improve their predictive power. For example,
since much of the research database supporting the use of the MMPI-2 in personal injury work
comes from scientific studies in medical and mental health outpatient settings, and from actual
forensic assessments, more MMPI-2 data is needed from scientific studies of actual personal
injury litigants.24
Research also continues into techniques that can improve the forensic
psychologist’s ability to understand personal injury litigants. For example, Paul Lees-Haley,
who often publishes research studies of malingering, described a “credibility scale” for assessing
personal injury claimants25
. Lees-Haley also combined existing MMPI-2 test items into a new
“fake bad” scale for use, specifically, with personal injury claimants.
CONCLUSIONS: It is safe to say there is no method of detecting malingering of emotional
distress symptoms that is 100% accurate in all settings. Many forensic psychologists believe, and
I agree, that the best procedure currently available for identifying faked symptoms of emotional
distress in legal settings is to use multiple sources of information. Good psychological practice
requires that these would include behavioral observations, psychodiagnostic interviews, review
of medical and psychological records, performance data (such as school grades and work
performance reviews) and psychological test procedures specifically designed to measure faking.
Gathering the data needed for this kind of evaluation will ordinarily require several meetings
between the forensic psychologist and the lawyer’s client. The Validity scales of the MMPI-2
can be very powerful tools for assessing the likelihood of faking in personal injury settings. But
MMPI-2 test results must be interpreted in combination with various other forms of data when
making such important judgments.
Endnotes
1
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), American Psychiatric
Association, 1994, pp. 683
2
DSM-IV, pp 471
3
DSM-IV, pp 727
4
Overholser, J.C., Differential Diagnosis of Malingering and Factitious Disorder with Physical Symptoms,
Behavioral Sciences and the Law, 1990, 8, 55-65
5
Spiro, H. Chronic factitious illness: Munchausen’s syndrome. Archives of General Psychiatry, 1968, 18, 569-579
6
Ross, W. Donald, How to Get a Neurotic Worker Back on the Job Successfully. Occupational Health and Safety,
1977, January/February, 20-23
7
Hay, G.G. Feigned Psychosis-A Review of the simulation of mental illness. British Journal of Psychiatry, 1983,
143, 8-10.
8
Lees-Haley, P., Efficacy of MMPI-2 Validity Scales and MCMI-II Modifier Scales for Detecting Spurious PTSD
Claims: F, F-K, Fake Bad Scale, Ego Strength, Subtle-Obvious Subscales, DIS, and DEB. Journal of Clinical
Psychology, 1992, 48, 681-689.
9
Simon, R.I. (Ed.), Postraumatic Stress Disorder in Litigation, Guidelines for Forensic Assessment. American
Psychiatric Press, 1995.
10
Huddleston, J.H., Accidents, Neuroses and Compensation. Williams and Wilkins, Baltimore, 1932.

5. Identifying Faked or Exaggerated Symptoms of Emotional Distress in Personal Injury Suits Page 5
11
Basset Jones, A. and Llewellyn, L.J., Malingering or the Simulation of Disease. William Heinemann, London,
1917.
12
Adatto, CP., Observations on criminal patients during narcoanalysis. Archives of Neurology and Psychiatry, 1949,
69, 82-92.
13
Hall, HV. And Pritchard, D.A., Detecting Malingering and Deception: A Forensic Distortion Analysis. St. Lucie
Press, Delray Beach, Florida, 1996.
14
Nunnally, J.D., Knott, P.D., Duchnowski, A. and Parker, R., Pupillary Response as a General Measure of
Activation. Perception and Psychophysics, 1967, 2, 149-155.
15
Simpson, HM and Hale, SM., Pupillary Changes During a Decision-Making Task. Perceptual and Motor Skills,
1969, 29, 495-498.
16
DePaulo, BM, Stone, JI and Lassiter, DG., Deceiving and detecting deceit, in The Self and Social Life, Barry
Schlenker (Ed.), McGraw Hill, New York, 1985.
17
Schretlen, D.J. The Use of Psychological Tests to Identify Malingered Symptoms of Mental Disorder. Clinical
Psychology Review, 1988, 8, 451-476.
18
Greene, R.L. The MMPI-2/MMPI: An Interpretive Manual. Allyn and Bacon, 1991.
19
Gough, H.G. Simulated patterns on the Minnesota Multiphasic Personality Inventory. Journal of Abnormal and
Social Psychology, 1947, 42, 215-255.
20
Gough, H.G. The F minus K dissimulation index for the Minnesota Multiphasic Personality Inventory, 1950, 14,
154-156.
21
Berry, D., Baer, R.A., & Harris, M.J. Detection of Malingering on the MMPI: A meta-analysis. Clinical
Psychology Review, 1991, 11,585-598.
22
Greene, RL., The MMPI-2/MMPI: An Interpretive Manual. Allyn and Bacon, 1991.
23
Pope, K.S., Butcher, J.N. and Seelen, J., The MMPI, MMPI-2 and MMPI-A in Court. American Psychological
Association, Washington, D.C., 1996.
24
Butcher, James. Personality Patterns of Personal Injury Litigants. In Forensic Applications of the MMPI-2, Ben-
Porath, Y., Graham, J., Hall, G., Hirschman, R., and Zaragoza, M. (Eds.), Sage Publications, 1995.
25
Lees-Haley, P. Provisional Normative Data for a Credibility Scale for Assessing Personal Injury Claimants.
Psychological Reports, 1990, 66, 1355-1360.