Malingering and Other Validity Considerations: With an Emphasis on Document Review
Chris Stewart Patterson
Search for other papers by Chris Stewart Patterson in
Current site
Google Scholar
PubMed
Close
,
Robert J. Barth
Search for other papers by Robert J. Barth in
Current site
Google Scholar
PubMed
Close
,
Christopher R. Brigham
Search for other papers by Christopher R. Brigham in
Current site
Google Scholar
PubMed
Close
,
James B. Talmage
Search for other papers by James B. Talmage in
Current site
Google Scholar
PubMed
Close
,
Steven Leclair
Search for other papers by Steven Leclair in
Current site
Google Scholar
PubMed
Close
, and
Michael Coupland
Search for other papers by Michael Coupland in
Current site
Google Scholar
PubMed
Close
Restricted access

Abstract

Many of the methods used to assess impairment rely on the completeness, accuracy, and reliability of patients’ self-presentations, and evaluators should be able to identify behavioral factors such as illness behavior and malingering; the latter is not ratable, but its presence complicates appropriate case management. This article focuses on the clinical data and the analysis that can be helpful in identifying malingering, as well as validity problems during document and medical file reviews. According to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, examiners always should be aware of the possibility of malingering during impairment evaluations, and the possibility of avoiding responsibility and/or obtaining monetary awards increases the likelihood of exaggeration and/or malingering. Current methods for assessing malingering in general assess the probability of malingering based on comparisons to research statistics and free the evaluator from any reliance on expert opinion. Correlating multiple clinical sources is useful in assessing the validity of a clinical presentation and includes the individual's pre-existing status; information about the injury; the history of the presenting illness, past medical and social histories, physical examination, questionnaires and scales, functional capacity evaluations, and video surveillance. Coherence analysis is a method of clinical data review that uses multiple themes to determine if data provide an integrated presentation. Evaluators should highlight issues of discontinuity, inconsistencies, incongruencies, noncompliance, or poor effort.

  • 1.

    Ensalada LH. Behavioral Factors Impact Impairment and Disability Evaluation. AMA Guides Newsletter. July/August 2011.

  • 2.

    Aylward M. Origins, practice and limitations of disability assessment medicine. In: Halligan P, Bass C, Oakley D, Eds. Malingering and Illness Deception. Oxford, England: Oxford University Press; 2003: Ch 22 pp 287300.

    • Search Google Scholar
    • Export Citation
  • 3.

    Aronoff G. Evaluating Malingering in Contested Injury or Illness, Pain Practice. 2007;7(2):178204.

  • 4.

    Strauss A. Malingery: Stealing the Truth; 2008.

  • 5.

    Reid, WH. Malingering, Journal of Psychiatric Practice. 2000; 226228.

  • 6.

    Samuel RZ, Mittenberg W. Determination of malingering in disability evaluations. Primary Psychiatry. 2005;12(12):6068.

  • 7.

    U.S. Social Security Administration. SSR 96-7p: Policy Interpretation Ruling Titles II and XVI. Evaluation of symptoms in disability claims: Assessing the credibility of an individual's statements. 2-1-/Retrieved June 20, 2010 from www.ssa.gov/OP_Home/rulings/di/01/SSR96-07-di-01.html

    • Search Google Scholar
    • Export Citation
  • 8.

    Halligan PW, Bass C, Oakley DA (Eds.). Malingering and illness deception. Oxford, UK: Oxford University Press, 2003.

  • 9.

    Faust D. Detection of deception. Neurol Clin 1995;13(2):255265.

  • 10.

    Barth R. Examinee-Reported History is Not a Credible Basis for Clinical or Administrative Decision. AMA Guides Newsletter. September/October 2009.

    • Search Google Scholar
    • Export Citation
  • 11.

    Barth RJ, Brigham CR. Who is in the better position to evaluate, the treating physician or an independent examiner? AMA Guides Newsletter. September/October 2005.

    • Search Google Scholar
    • Export Citation
  • 12.

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: American Psychiatric Association Press; 2000.

    • Search Google Scholar
    • Export Citation
  • 13.

    Slick DJ, Sherman EM, Iverson GL. Diagnostic criteria for malingered neuro-cognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist. 1999;13(4):545561.

    • Search Google Scholar
    • Export Citation
  • 14.

    Simon, RI (editor). Posttraumatic Stress Disorder in Litigation. Guidelines for Forensic Assessment. Second Edition. American Psychiatric Publishing, Inc., 2003.

    • Search Google Scholar
    • Export Citation
  • 15.

    Larrabee, GL (editor). Assessment of Malingered Neuropsychological Deficits. Oxford University Press, 2007.

  • 16.

    Simon GE, VonKorff M, Piccinelli M, Fullerton C, Ormel J. An international study of the relation between somatic symptoms and depression. New England Journal of Medicine. 1999;341(18):13291335.

    • Search Google Scholar
    • Export Citation
  • 17.

    Nelson, NW et al. Updated Meta-Analysis of the MMPI-Two Symptom Validity Scale (FBS): Verified Utility in Forensic Practice. The Clinical Neuropsychologist, 24: 701724, 2010.

    • Search Google Scholar
    • Export Citation
  • 18.

    Suls, J, Rothman A. Evolution of the biopsychosocial model: prospects and challenges for health psychology. Health Psychol. 2004| 23(2) 11925

    • Search Google Scholar
    • Export Citation
  • 19.

    Warren, P. Behavioral health concerns as a causation issue in workers' compensation and disability claims. The International Journal of Industrial Accident Boards and Commissions; Fall 2009: 1755.

    • Search Google Scholar
    • Export Citation
  • 20.

    Coupland, M., Margison, D. Early Intervention in Psychosocial Risk Factors for Chronic Pain, Musculoskeletal Disorders and Chronic Pain Conference, Los Angeles, CA Feb 2011.

    • Search Google Scholar
    • Export Citation
  • 21.

    Gatchel RJ. Comorbidity of chronic pain and mental health disorders: the biopsychosocial perspective. Am Psychol 2004;59(8):795805

  • 22.

    Keefe FJ, Rumble ME, Scipio CD, Giordano LA, Perri LCM. Psychological aspects of persistent pain: current state of the science. Journal of Pain. 2004: 195211

    • Search Google Scholar
    • Export Citation
  • 23.

    Coupland, M. Psychosocial Interventions for Chronic Pain Management. The International Journal of Industrial Accident Boards and Commissions. Fall 2009: 7792

    • Search Google Scholar
    • Export Citation
  • 24.

    Jones AB, Llewellyn LJ. Malingering or the simulation of disease. London, UK: William Heinemann. 1917.

  • 25.

    Melhorn JM, Ackerman WE (Eds.). Guides to the evaluation of disease and injury causation. Chicago, IL: American Medical Association. 2008.

    • Search Google Scholar
    • Export Citation
  • 26.

    Genovese E, Galper J S. (Eds.). Guide to the evaluation of functional ability. Chicago, IL: American Medical Association. 2009.

  • 27.

    Mittenberg W, Patton C, Canyock EM, Condit DC. Base rates of malingering and symptom exaggeration. Journal of Clinical and Experimental Neuropsychology. 2002;2 4(8):10941102.

    • Search Google Scholar
    • Export Citation
  • 28.

    Slick DJ, Tan JE, Strauss EH, Hultsch DF. Detecting malingering: A survey of experts' practices. Archives of Clinical Neuropsychology. 2004;19(4):465473.

    • Search Google Scholar
    • Export Citation
  • 29.

    Bianchini K, Love JM, Greve KW, Adams D. Detection and diagnosis of malingering in electrical injury. Archives of Clinical Neuropsychology. 2005; 20(3):365373.

    • Search Google Scholar
    • Export Citation
  • 30.

    Schutz JS, Mavrakanas NA. The value of the ophthalmological independent medical examination: Analysis of 344 cases. British Journal of Ophthalmology. 2009;93:13711375.

    • Search Google Scholar
    • Export Citation
  • 31.

    Greve KW, Bianchini KJ, Black FW, Heinly MT, Love JM, Swift DA, Ciota M. The prevalence of cognitive malingering in persons reporting exposure to occupational and environmental substances. NeuroToxicology. 2006;27(6), 940950.

    • Search Google Scholar
    • Export Citation
  • 32.

    Greve KW, Ord JS, Bianchini KJ, Curtis KL. Prevalence of malingering in patients with chronic pain referred for psychologic evaluation in a medico-legal context. Archives of Physical Medicine and Rehabilitation. 2009;90(7):11171126.

    • Search Google Scholar
    • Export Citation
  • 33.

    Fishbain, DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain disability exaggeration/malingering and submaximal effort research [review]. The Clinical Journal of Pain. 1999;15(4):244274.

    • Search Google Scholar
    • Export Citation
  • 34.

    Lees-Haley PR, Dunn JT. The ability of naive subjects to report symptoms of mild brain injury, post-traumatic stress disorder, major depression, and generalized anxiety disorder. Journal of Clinical Psychology. 1994; 50(2):252256.

    • Search Google Scholar
    • Export Citation
  • 35.

    Demeter SL, Andersson GBJ. (Eds.). Disability evaluation (2nd ed.). St. Louis, MO: American Medical Association. 2003.

  • 36.

    Gold LH, Anfang SA, Drukteinis AM, Metzner JL, Price M, Wall BW, Wylonis L, Zonana HV. AAPL practice guideline for the forensic evaluation of psychiatric disability. The Journal of the American Academy of Psychiatry and the Law. 2008;36(Suppl 4):S3S50.

    • Search Google Scholar
    • Export Citation
  • 37.

    Trimble M. Somatoform disorders: A medicolegal guide. Cambridge, UK: Cambridge University Press. 2004.

  • 38.

    Knoll J, Resnick PJ. The detection of malingered post-traumatic stress disorder. Psychiatric Clinics of North America. 2006;29(3):629647.

    • Search Google Scholar
    • Export Citation
  • 39.

    Lees-Haley PR, Williams CW, English LT. Response bias in self-reported history of plaintiffs compared with non-litigating patients. Psychol Rep 1996;79(3 pt 1):811818.

    • Search Google Scholar
    • Export Citation
  • 40.

    Lees-Haley PR, Williams CW, Zasler ND, Marguilies S, English LT, Stevens KB. Response bias in plaintiffs' histories. Brain Injury 1997;11(11):791799.

    • Search Google Scholar
    • Export Citation
  • 41.

    Carragee EJ. Validity of self-reported history in patients with acute back or neck pain after motor vehicle accidents. Spine J 2008;8(2):311319.

    • Search Google Scholar
    • Export Citation
  • 42.

    Don AS, Carragee EJ. Is the self-reported history accurate in patients with persistent axial pain after a motor vehicle accident? Spine J. 2009;9(1):412.

    • Search Google Scholar
    • Export Citation
  • 43.

    Blais MA, Smallwood P, Groves JE, Rivas-Vazquez RA. Personality and personality disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 3.

    • Search Google Scholar
    • Export Citation
  • 44.

    Brigham CR, Ensalada LH. Nonorganic findings. Guides Newsletter. July/August 2000.

  • 45.

    DeMyer. WE. Technique of the neurologic examination (5th ed.) New York, NY: McGraw-Hill Professional. 2003.

  • 46.

    Rom WN, Markowitz S. Environmental and occupational medicine (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. 2007.

  • 47.

    Collie J. Malingering and Feigned Sickness. London: Edward Arnold Ltd; 1913.

  • 48.

    Hoover CF. A new sign for the detection of malingering and functional paresis of the lower extremities. JAMA. 1908;51:746747.

  • 49.

    Waddell G, McCulloch JA, Kummel E, Venner R. Nonorganic physical signs in low-back pain. Spine. 1980;5:117125.

  • 50.

    Sobel JB, Sollenberger PT, Robinson R, Polatin PB, Gatchel RJ. Cervical nonorganic signs: a new clinical tool to assess abnormal illness behavior in neck pain patients: a pilot study. Arch Phys Med Rehabil. 2000;81:170175.

    • Search Google Scholar
    • Export Citation
  • 51.

    Rush AJ, First MB, Blacker D. Handbook of psychiatric measures (2nd ed.). Washington, DC: American Psychiatric Publishing, Inc. 2008.

  • 52.

    Richman J, Green P, Gervais R, Flaro L, Merten T, Brockhaus R, Ranks D. Objective tests of symptom exaggeration in independent medical examinations. Journal of Occupational and Environmental Medicine 2006;48(3):303311.

    • Search Google Scholar
    • Export Citation
  • 53.

    Le Page JA, Iverson, GL, Collins P. The impact of judges' perceptions of credibility in fibromyalgia claims. International Journal of Law and Psychiatry. 2008;31(1): 3040.

    • Search Google Scholar
    • Export Citation
  • 54.

    Kay NR, Morris-Jones H. Injury 1998; 29(4):3058.

  • 55.

    Young G, Kane AW, Nicholson K. (Eds.) Psychological knowledge in court: PTSD, Pain, and TBI. New York, NY: Springer Science+Business Media 2006.

    • Search Google Scholar
    • Export Citation
  • 56.

    U.S. Social Security Administration. Consultative examinations: A guide for health professionals, Part II — Evidence requirements, Medical evidence. 2009. Retrieved December 31, 2009, from www.socialsecurity.gov/disability/professionals/greenbook/ce-evidence.htm.

    • Search Google Scholar
    • Export Citation
  • 57.

    Lempert T, Brandt T, Dieterich M, Huppert D. How to identify psycho-genic disorders of stance and gait: A video study in 37 patients. Journal of Neurology. 1991:238(3):140146.

    • Search Google Scholar
    • Export Citation
  • 58.

    Oyebode AT, Cantley L, Schroeder M. Impairment and disability evaluation: The role of the family physician. American Family Physician. 2008;77(12):16891694.

    • Search Google Scholar
    • Export Citation
  • 59.

    Panton LB, Kingsley JD, Toole T, Cress ME, Abboud G, Sirithienthad P, Mathis R, McMillan V. A comparison of physical functional performance and strength in women with fibromyalgia, age- and weight-matched controls, and older women who are healthy. Physical Therapy 2006;86(11):14791488.

    • Search Google Scholar
    • Export Citation
  • 60.

    Talmage, JB, Melhorn JM. (Eds.). A physician's guide to return to work. Chicago, IL: American Medical Association Press. 2005.

  • 61.

    Turk DC. Assess the person, not just the pain. Pain Clinical Updates. 1993:1(3).

  • 62.

    Von Korff M, Crane P, Lane M, Miglioretti DL, Simon G, Saunders K, Kessler R. Chronic spinal pain and physical-mental comorbidity in the United States: Results from the national comorbidity survey replication. Pain. 2005;113(3):331339.

    • Search Google Scholar
    • Export Citation
  • 63.

    Enns MW, Swenson JR, McIntyre RS, Swinson RP, Kennedy SH.. Clinical guidelines for the treatment of depressive disorders. Canadian Journal of Psychiatry. 2001;46(Suppl 1):S77S90.

    • Search Google Scholar
    • Export Citation
  • 64.

    Fanuele JC, Abdu WA, Hanscom B, Weinstein JN. Association between obesity and functional status in patients with spine disease. Spine. 2002;27(3): 306312.

    • Search Google Scholar
    • Export Citation
  • 65.

    Levy HI, Hanscom B, Boden SD. Three-question depression screener used for lumbar disc herniations and spinal stenosis. Spine. 2002;27(11):12321237.

    • Search Google Scholar
    • Export Citation
  • 66.

    Raspe H, Matthis C, Croft P, O'Neill T. Variation in back pain between countries: The example of Britain and Germany. Spine. 2004;29(9):10171021.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 170 170 79
Full Text Views 30 30 0
PDF Downloads 0 0 0
Save