Damages and rewards: assessment of malingered disorders in compensation cases

1. Multi-Method Approach

• No single test or method is sufficient.

• Recommended: combine clinical interview, record review, psychometric testing, and collateral information.

• Inconsistencies across data sources raise suspicion.

2. Use of Validity Tests

• Employ Symptom Validity Tests (SVTs) and Performance Validity Tests (PVTs):

  • TOMM (Test of Memory Malingering)

  • Word Memory Test (WMT)

  • MMPI-2 F, Fp, Fb, F-K indices

  • PAI Negative Impression Management (NIM), Malingering Index (MAL)

• Validity indicators are seen as probabilistic—elevation does not equal malingering, but clusters of elevations strengthen suspicion.

3. Criteria for Malingering

They adopted and refined Slick et al.’s (1999) criteria for malingered neurocognitive dysfunction and extended them to psychiatric presentations:

• Definite malingering: strong evidence of feigned or exaggerated symptoms with external incentive.

• Probable malingering: substantial evidence but missing a clear-cut marker.

• Possible malingering: some inconsistencies, but not enough to conclude.

4. Symptom Profile Analysis

• Look for improbable or extreme symptoms inconsistent with genuine psychiatric syndromes:

  • Endorsing all possible symptoms.

  • Contradictory complaints (e.g., severe memory loss yet detailed recall of accident events).

  • Rare or atypical symptom combinations (e.g., reporting hallucinations with features not found in psychosis).

• Compare claimant’s symptom pattern against base rates of true clinical populations.

5. Behavioral Observation

• Monitor during testing and interviews:

  • Variability in performance effort.

  • Symptom exaggeration when being observed vs. not observed.

  • Overly dramatic or “Hollywood” presentation of psychiatric symptoms.

6. Collateral & Contextual Data

• Review of employment records, medical files, accident reports, and surveillance.

• Evaluate timing (e.g., sudden onset after legal/financial incentive).

• Inconsistencies between reported limitations and observed activities.

7. Caution Against Overpathologizing

• Rogers & Payne stressed the importance of avoiding false positives:

  • High-stakes settings can encourage over-interpretation.

  • Must carefully distinguish malingering from:

    • Somatization

    • Conversion disorder

    • Factitious disorder

    • Genuine psychiatric illness with poor coping.

📊 Practical Application in Psychiatry

• Best practice: Incorporate multiple validity measures within the evaluation battery.

• Red flags: Inconsistencies, atypical symptom profiles, effort test failures, external gain.

• Defensibility: Document all data sources and show convergence of evidence before concluding malingering.

• https://onlinelibrary.wiley.com/doi/epdf/10.1002/bsl.687