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Diagnostic System for Malingered PTSD Disability/Dysfunction and Related Negative Response Biases: User Version and Worksheet

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Malingering, Feigning, and Response Bias in Psychiatric/ Psychological Injury

Part of the book series: International Library of Ethics, Law, and the New Medicine ((LIME,volume 56))

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Abstract

This chapter and the next two present the three malingering diagnostic systems that have been created in the present book (see Chap. 5). As a whole, the system is referred to as the Psychological Injury Disability/Dysfunction – Feigning/Malingering/Response Bias System: (PID-FMR-S).

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Author information

Authors and Affiliations

  1. Glendon College, York University, Toronto, ON, Canada

    Gerald Young

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  1. Gerald Young
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Worksheet

Worksheet

1.1 Worksheet for Non-Credible System Feigned Posttraumatic Stress Disorder and Related Disability/Dysfunction

Instructions

This worksheet will make it easier to use the systems in practice. Moreover, it will help in teaching and continuing education. After becoming sufficiently familiar with the PID-FMR-S system, the evaluator should be using the appropriate psychological tests, measures, and scales as indicated in the system and then score them appropriately according to the rules of the system. Then, for the particular assessment being undertaken, the evaluator should seek the inconsistencies/discrepancies described in the system. The results of the tests and the inconsistencies/discrepancies found should be transferred to the appropriate locations in the worksheet to facilitate using the system in order to arrive at ratings of malingering and related biases in presentation and performance by the evaluee. The worksheet offers sufficient space to fill in the required details obtained in the evaluation and, if needed, supplementary pages can be added. These should be kept on file for report writing, testimony, and other assessment and court needs. The worksheet will facilitate arriving at appropriate conclusions and meeting all professional and legal requirements in using the system. As needed, use blank pages to elaborate comments in the notes section.

Worksheet Items

I. The System(s)

1.

System Used (check one)

F-PTSDR-D   F-NCR -D   F-PR-D

2.

Tests Used to Rate System

(a) Forced-choice measures

____________________________________________________________

(b) Structured inventory measures

____________________________________________________________

(c) Personality measures

____________________________________________________________

(d) Dedicated PTSD measures

____________________________________________________________

(e) Dedicated pain measures

____________________________________________________________

(f) Cognitive/Neuropsychological measures

____________________________________________________________

Other measures

____________________________________________________________

3.

The pathways followed (please check one(s) used):

Regular   Cognitive/neuropsychological

4.

The 10–15 primary measures used for Regular pathway:

___________________________________________________________________________

___________________________________________________________________________

5.

The 10–15 primary measures used for cognitive/neuropsychological pathway:

______________________________________________________________________________________________________________________________________________________

6.

The 5–8 critical measures used for Regular pathway:

___________________________________________________________________________

7.

The 5–8 critical measures used for cognitive/neuropsychological pathway:

___________________________________________________________________________

___________________________________________________________________________

II. The Criteria/Rules

Criterion A: Evidence of significant external incentive.  check √ or X

Criterion B: Evidence from psychological testing.    check √ or X

A. Different Degrees of Certainty of Response Bias, According to Psychological Testing

(A1)

Definite Malingering.

  (i) Below chance performance (p < .05) on two or more forced-choice, tests, etc.

(ii) Performance on five or more well-validated tests.

(A2)

Definite negative response bias.

(i) Below chance performance (p < .05) on one forced-choice measure.

(ii) Performance on four well-validated tests.

(A3)

Probable negative response bias.

(i) Performance on three well-validated tests.

(A3-4)

Intermediate (Probable to possible, gray zone) negative response bias.

(i) Supplementary data available, results for extra tests, meeting criteria for A4, and performance on two well-validated supplementary and not primary tests.

(ii) Performance on three or more well-validated supplementary and not primary tests.

(A4)

Possible negative response bias.

(i) Performance on two well-validated tests.

(ii) Criteria for Definite or Probable Response Bias are met except for Criterion D.

(A5)

Minimal negative response bias.

(i) Performance on one well-validated test.

(ii) Just below cut-off performance on two well-validated tests.

(A6)

No evident response bias.

(i) Performance on not even one well-validated test.

(ii) There might be just below cut-off performance on one well-validated test.

Weighting Rules for Test Batteries

Indicate

√ Accounted For

X Not Applicable

Rule 1: Two pathways.

Rule 2: Forced-choice.

Rule 3: Tests.

Rule 4: MMPI family.

Rule 5: Others needed.

Rule 6: Improbable symptoms.

Rule 7: PTSD.

Rule 8: Pain.

Rule 9: Cognitive (embedded).

Rule 10: 10–15 Primary.

Rule 11: 5–8 Critical.

Rule 12: Not at cut-off.

Rule 13: Neuropsychology.

Rule 14: Supplementary tests.

Rule 15: Secondary information.

Rule 16: Pattern analysis.

Rule 17: Limited cognitive testing.

Rule 18: Neuropsychological path.

Rule 19: Test independence.

Rule 20: Prioritizing.

Rule 21: Exception 1.

Rule 22: Exception 2.

Rule 23: Exception 3.

Rule 24: Exception 4.

Rule 25: Maximum use 1.

Rule 26: Omnibus tests.

Rule 27: Dedicated tests.

Rule 28: Nondedicated tests.

Rule 29: Maximum use 2.

Rule 30: Adjusted rating, lowering it.

Rule 31: Adjusted rating, raising it

Rule 32: Patterns.

Rule 33: Preselection.

Rule 34: Fishing expeditions.

Rule 35: No exceptions.

Rule 36: Ecological validity.

Rule 37: Warnings.

Rule 38: Qualifications.

Rule 39: State-of-the-art.

Rule 40: No harm.

Rule 41: Cognitive/Neuropsychological testing.

Rule 42: Rating cognitive/neuropsychological tests.

Rule 43: Cognitive/Neuropsychological and Regular rating.

Rule 44: Positive results for only one of the two paths.

Rule 45: Cognitive/Neuropsychological path alone.

Rule 46: Test selection.

Rule 47: Minimal testing.

Rule 48: Less than minimal testing.

Rule 49: Less testing yet doing enough.

Rule 50: Justify less testing.

Rule 51: Larrabee (2012a).

Rule 52: Supplementary evaluators.

Rule 53: Seconding team work.

Rule 54: Leading team work.

Rule 55: Interdisciplinary assessments.

Rule 56: Specific dedicated tests.

Rule 57: Altering rules on testing and test battery.

Rule 58: Special populations.

Rule 59: Consider whole file.

Rule 60: Combining test data with consistencies/discrepancies.

Criterion C: Evidence from Inconsistencies/Discrepancies. check √ or X

(a)

Inconsistencies/Discrepancies in Conjunction with Testing.

(a1) Inconsistency/Discrepancy between cognitive/neurocognitive test data and known patterns of brain functioning. (Inconsistency #1)

(a2) Inconsistency/Discrepancy between test data of PTSD-related symptoms after event at claim and known patterns of physiological reactivity. (Inconsistency #2)

(a3) Inconsistency/Discrepancy between test data self-report. (Inconsistency #3)

(a4) Inconsistency/Discrepancy between test data of PTSD-related symptoms after event at claim and verbal and/or nonverbal observed behavior/symptoms/complaints/limitations/functions. (Inconsistency #4)

(a5) Inconsistency/Discrepancy between test data and information reported by reliable informants/collaterals. (Inconsistency #5)

(a6) Inconsistency/Discrepancy between test data and information reported in reliable documents. (Inconsistency #6)

(b)

Inconsistencies in Conjunction with Self-Report.

(b1) Known patterns of brain function. (Inconsistency #7)

(b2) Known patterns of physiological function. (Inconsistency #8)

(b3) Observed behavior/symptoms/complaints/limitations/functions. (Inconsistency #9)

(b4) Information reported by reliable informants/collaterals. (Inconsistency #10)

(b5) Information reported in reliable documents. (Inconsistency #11)

(c)

Inconsistencies/Discrepancies in Conjunction with Observations (other than with testing and with self-report).

(c1) Known patterns of brain function. (Inconsistency #12)

(c2) Known patterns of physiological function. (Inconsistency #13)

(c3) Information reported by reliable informants/collaterals. (Inconsistency #14)

(c4) Information reported in reliable documents. (Inconsistency #15)

(d)

Inconsistencies/Discrepancies in Conjunction with Collateral Information (other than with testing, self-report, and observations).

(d1) Known patterns of brain function. (Inconsistency #16)

(d2) Known patterns of physiological function. (Inconsistency #17)

(d3) Information reported in reliable documents. (Inconsistency #18)

(e)

Inconsistencies/Discrepancies in Conjunction with Documentation (other than with testing, self-report, observations, and collateral information).

(e1) Known patterns of brain function. (Inconsistency #19)

(e2) Known patterns of physiological function. (Inconsistency #20)

(f)

Inconsistencies/Discrepancies Within Major Data Sources (not between them which are scored above)

(f1) Known patterns of brain function. (Inconsistency #21)

(f2) Known patterns of physiological function. (Inconsistency #22)

(f3) Self-report. (Inconsistency #23)

(f4) Observed behavior/symptoms/complaints/limitations/functions. (Inconsistency #24)

(f5) Information reported by reliable informants/collaterals. (Inconsistency #25)

(f6) Information reported in reliable documents. (Inconsistency #26)

(g)

Other, Miscellaneous Inconsistencies/Discrepancies

(g1) No causality attributable to the event at claim. (Inconsistency #27)

(g2) Only minimal causality attributable. (Inconsistency #28)

(g3) Material-level causality attributable to the event at claim, but not to the degree insisted by the evaluee. (Inconsistency #29)

(g4) Other. (Inconsistency #30)

B. Different Degrees of Certainty of Response Bias According to Inconsistencies/Discrepancies

(B1)

Definite Malingering.

(i) One extremely compelling inconsistency/discrepancy.

(ii) The evidence is incontrovertible.

(iii) (a) One marked, substantial inconsistency/discrepancy from items a–g.

(iii) (b) Performance on four (not five) well-validated tests.

(iv) (a) Two marked/substantial inconsistencies/discrepancies.

(iv) (b) Performance on three (not five) well-validated tests.

(B2)

Definite negative response bias.

(i) Two marked, substantial inconsistencies/discrepancies from items a–g.

(ii) (a) One marked, substantial inconsistency/discrepancy from items a–g.

(ii) (b) Performance on three (not four) well-validated tests.

(B3)

Probable negative response bias.

(i) One marked, substantial inconsistency/discrepancy from items a–g.

(ii) (a) Five moderate/nontrivial inconsistencies/discrepancies from items a–g.

(ii) (b) Performance on two (not three) well-validated tests.

(B3-4)

Intermediate (Probable to possible, gray zone) negative response bias the data meet the requirements for classification of possible negative response bias; supplementary data available about the evaluee that raises the rating.

(i) Inconsistencies/discrepancies are reliably found in other assessments.

(ii) There is clear evidence of or other confounding factors the evaluee would have to show five or more of the following 15 factors when one to four of these criteria are evident instead of five or more and so they cannot be used as part of the data for rating Probable Response Bias, as per the above, the evaluator should use these as part of the ratings for Possible Negative Response bias, as per below.

 (a) Personality disorder.

 (b) Blaming.

 (c) Not trying.

 (d) Sick Role.

 (e) Somatization.

 (f) Failure to treat substance abuse.

 (g) Failure to take recommended medications.

 (h) Refusing a work-hardening trial, modified duties, and training.

 (i) Catastrophizing/crying out for help.

 (j) Any other from the pre-event background.

 (k) Psychiatric.

 (l) Criminal.

 (m) Work or other role.

 (n) Family, partners, friends, and social life.

 (o) Financial stresses.

(B4)

Possible negative response bias.

(i) Four moderate, non-trivial inconsistencies/discrepancies.

(ii) (a) Three moderate, nontrivial inconsistencies/discrepancies from items a–g.

(ii) (b) Performance on one (not two) well-validated tests.

(B5)

Minimal negative response bias.

(i) Two moderate, nontrivial inconsistencies/discrepancies.

(ii) (a) One moderate, nontrivial inconsistency/discrepancy from items a–g.

(ii) (b) Just below cut-off performance on one (not two or more) well-validated tests.

(B6)

No evidence response bias.

Criterion D: Behaviors meeting necessary criteria from groups B and C are not fully accounted for by psychiatric, neurologic, developmental, or other factors.

Notes for Comments

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Young, G. (2014). Diagnostic System for Malingered PTSD Disability/Dysfunction and Related Negative Response Biases: User Version and Worksheet. In: Malingering, Feigning, and Response Bias in Psychiatric/ Psychological Injury. International Library of Ethics, Law, and the New Medicine, vol 56. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7899-3_27

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