A large sample of chronic postconcussive patients with and without overt malingering signs was compared with objectively brain-injured patients on common episodic memory and malingered amnesia measures. Probable malingerers and traumatically brain-injured subjects were not differentiated on popular episodic recall tests. In contrast, probable malingerers performed poorly on the Rey 15-Item, Rey Word Recognition List, Reliable Digit Span, Portland Digit Recognition Test, and Rey Auditory Verbal Learning Test recognition trial. These findings validated both commonly cited malingering measures and newly introduced methods of classifying malingering in real-world clinical samples. The base rate for malingering in chronically complaining mild head injury patients may be much larger than previously assumed.

A known group methodology was used to compare the predictive accuracies of MMPI-2 validity scales and malingered amnesia measures in the detection of real versus feigned traumatic brain-injury. The domain specific compliance measures were consistently more accurate in the separation of factitious brain-injury patients (JT = 68) from severe brain-injury patients ( N = 56). Among MMPI-2 measures, only scale SL. improved on base-rate predictions of probable malingering. Anti-social traits, as measured by Pd, had no relationship to malingered amnesia. Factor analysis suggested independent psychiatric and neurological malingering factors. The implications for DSM-IV malingering criteria and models of feigned illness are discussed.

A comparison of premorbid and postinjury MMPI-2 profiles was performed in 23 patients with mild cranial/cervical injuries. All claimants attributed major personality change to their injuries during the course of compensation-related neuropsychological examinations. Their premorbid MMPI-2 profiles were all abnormal and the modal code-type indicated somatoform psychopathology. The post-accident MMPI profiles showed continuous somatization trends, but they unexpectedly showed (a) increased defensiveness and (b) a general decrease in global psychopathology. The findings did not support an 'eggshell plaintiff' theory of chronic postconcussive complaints. The view that chronic postconcussive complaints require a wider focus on non-neuropsychological factors is enhanced.

We tested the validity of the Lees-Haley Fake Bad Scale (FBS) and the family of MMPI-2 F scales (F-family; F, F(p), and F-K scales) in predicting improbable psychological trauma claims in an applied setting. Litigants reporting implausible symptoms long after minor scares and nonlitigants clinically referred following severe stressors completed the MMPI-2. Both groups were naturally matched on social class. The FBS demonstrated sensitivity, specificity, and positive predictive power in the detection of atypical problems but the F-family showed poor utility. FBS cutting scores derived from logistic regression were applied to a third group made up of litigants with histories of undeniably severe traumas. A substantial number of this third group scored above cutoffs for exaggeration, but this finding is ambiguous. Reasons for the F-family's insensitivity to real-world exaggeration may include using student simulators for validation and content reflective of psychotic simulation. The superiority of the FBS in applied forensic settings could derive from its development in actual litigants and content reflective of nonpsychotic exaggerations. The FBS appears acceptable for use in applied forensic settings where persons seek compensation for nonpsychotic syndromes.

The correlational and diagnostic properties of Lees-Haley's MMPI-2 Fake Bad Scale (FBS) were examined in litigating atypical minor, litigating moderate-severe, and non-litigating moderate-severe head injury samples. Overall, the FBS was sensitive to both litigation status and nonconforming versus conforming symptom courses. The FBS appeared superior to the MMPI-2 F and F-K scales in differentiating atypical from real brain-injury outcomes. High FBS scorers also had higher scores on somatic complaining (Hs, Hy) and to a lesser degree with psychotic complaints (F, Pa, Sc). FBS showed significant associations with various neuropsychological symptom validity measures. FBS appears to capture a hybrid of infrequent symptom reporting styles with an emphasis on unauthentic physical complaints. However, FBS also correlated with documented abnormal neurological signs within a litigating moderate-severe brain-injury group. Its use as a symptom infrequency measure may have to be modified in more severe injury litigants, as some FBS items may reflect true long-term outcome in severe cerebral dysfunction.