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Industry: Email Alert RSS FeedTraumatic brain injury when symptoms don't add up: conversion and malingering in the rehabilitation setting - Traumatic Brain Injury
Journal of Rehabilitation, April-June, 2002 by Patricia Rogers Babin, Patricia Gross
Psychology Tests Used to Detect Malingering
The MMPI and its successor, the MMPI-2, are the most common tests administered to detect malingering. The Psychopathic Deviate Scale (Scale 4), a measure of antisocial traits, may be elevated in some malingering individuals. However, it frequently is not. The Infrequency scale (F), Back Infrequency scale (Fb), Infrequency-Psychopathology scale, and the Dissimulation scale-2 (D-sub(s2)), are scales that are typically analyzed in persons presenting with exaggerated complaints. Although these scales can differentiate between personal injury litigants and controls, the scales were not able to differentiate litigants and clinical, nonlitigants. The Fake Bad Scale (FBS) was able to differentiate between litigants and clinical, non-litigants (Tsushima & Tsushima, 2001). Regarding MMPI/MMPI-2 clinical scales, Boone and Lu (1999) found that the 1-3/3-1 (Hypochondriasis and Depression) code types showed evidence of non-credible cognitive performance on malingering and neuropsychological tests. Some sophisticated feigners of malingering produce valid MMPI-2 profiles, while the most unsophisticated feigners produce suspicious profiles (Slick, et al., 1996). One neuropsychological test expert, Lezak (1995) contends that no "Malingering Profile" exists on the MMPI or MMPI-2.
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The Structured Interview of Reported Symptoms (SIRS; Rogers, 1986, 1992) was developed for psychiatric patients. Its primary scales include compendiums of rare, improbable and absurd symptoms, as well as blatant versus subtle symptoms. The supplementary scales include a direct appraisal of honesty as well as subscales for defensive symptoms, overly specified symptoms, and symptom inconsistency, which can be helpful in interviewing a suspected malingerer.
Case Study: Suspected Malingering with Ultimate Conversion Diagnosis
History of injury: The first case study involves a 39-year-old man (H.B.) who sustained a moderate TBI in a motor vehicle accident. H.B. was a passenger traveling to his job, when the car he was in was hit head-on. H.B. lost consciousness at the scene. CT scan on admission and on follow-up three days post injury revealed a large amount of intraventricular hemorrhage. Upon admission to acute rehabilitation almost two weeks after his accident, he was confused, restless, distractible, and logorrheic. He was also mildly anomic, but speech was generally fluent. At discharge from inpatient treatment two weeks later, he was oriented in all spheres and had mild to moderate deficits in memory. His thoughts were generally organized and he could independently complete all simple activities of daily living. He was discharged to his home with his girlfriend and began treatment in an outpatient brain injury program.
Social and Mental Health History: H.B.'s medical history was unremarkable. With regard to mental health history, he reported a depressive episode after the death of his mother. He self-medicated with alcohol, but never received treatment for depression or alcohol abuse. Prior to the accident, he was a moderate social drinker. H.B.'s work and relationship history was somewhat complex. He had numerous careers and jobs throughout his adulthood. At one point he studied ballet, but most of his jobs were unskilled or semi-skilled. He attended college, but did not complete any course of study. He had a history of close, and sometimes chaotic social relationships. Most recently, he lived with his girlfriend of eight months. Apparently, they became seriously involved after two weeks of dating. During his outpatient treatment, the girlfriend revealed she was dissatisfied in the relationship prior to the accident. He had a relatively unremarkable legal history, but admitted to nonpayment of taxes for five years. This was a source of conflict in his relationship with the girlfriend. H.B. also noted that he was intent on suing the driver of the car that caused the accident.
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