Beyond Rare-Symptoms Endorsement: a Clinical Comparison Simulation Study Using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) with the Inventory of Problems-29 (IOP-29) Abstract To date, the MMPI-based, rare-symptom detection strategy is considered one of the most effective ones in symptom validity assessment. Because many of the items of the Inventory of Problems-29 (IOP-29) were designed specifically to provide incremental validity over the MMPI F scales, this study tested whether using the IOP-29 in combination with the MMPI-2 would provide higher classification accuracy compared to using either instrument alone. A total of 155 Italian adult individuals contributed to this study. About half (n = 93) were experimental malingerers (expMAL) instructed to simulate depression without being detected as feigners. The others were either (a) depressed patients in treatment (n = 36) or (b) individuals evaluated for possible malingering associated with work-related stress and considered to be genuinely affected by depression (n = 26). All were administered the Italian versions of both the MMPI-2 and the IOP-29. As expected, both instruments were highly effective in discriminating feigned from bona fide depression, with AUC values ranging from .77 to .90. More importantly, when entering the IOP-29 after each of the MMPI-2 scales under consideration (i.e., F, Fb, and Fp), the logistic regression models predicting group membership (0 = patient; 1 = expMAL) improved significantly. Likewise, each of the three MMPI-2 scales under consideration also significantly improved the prediction of group membership, when entered after the IOP-29. These findings thus indicate that using the MMPI-2 together with the IOP-29 could provide incremental validity over using either instrument alone, when testing depression-related complaints.

Translated Measures in Forensic Evaluations with Specific Applications to Feigned Mental Disorders Abstract Forensic assessments continue to grow exponentially from international and transcultural perspectives. As a result, psychological measures are increasingly translated and adapted from their original (source) language to targeted languages. This article begins with broad conceptual issues before proceeding to specific applications. It examines the pitfalls inherent in imposed etic and Western, educated, industrialized, rich, and democratic (WEIRD)-centric adaptation practices. Recommended guidelines for translating and validating tests are discussed, including those promulgated by the International Test Commission (ITC) and the World Health Organization (WHO). The article then focuses on feigning measures—critically important to forensic evaluations—for differentiating between malingered and genuine mental disorders. Finally, feigning research on translated measures of the MMPI-2 and MMPI-2-RF are featured selectively because of their breadth and depth both in general adaptations and their specific attention to feigned mental disorders.

Expert Witnesses, Dissociative Amnesia, and Extraordinary Remembering: Response to Brand et al.

The Impact of Substance Arrests on the Efficacy of Mental Health Court Abstract There is ample evidence that Mental Health Courts (MHCs) are effective in reducing recidivism for participants who are mentally ill. This study will examine if MHCs are effective for the large number of clients with mental illness who abuse substances. Participants in Brevard County Florida’s Mental Health Court (N = 118) were examined for a history of substance arrests. Those with a substance history (n = 63) were compared to those without a substance history and examined for the outcome variables of days free before rearrest, severity of rearrest, and offense type (e.g., substance related, etc.). A history of substance arrests resulted in more rearrests for any offense at 1 year and more rearrests for a substance offense 3 years post-MHC, compared to participants without prior substance arrests. A survival analysis demonstrated that more MHC graduates without substance arrest history were able to remain arrest free in the community than those with substance arrest history. For those participants with a substance arrest history, graduating MHC was associated with less rearrests in general, less substance rearrests, and less severe rearrests than their non-graduating comparison group. Within the first 6 months of leaving MHC, the amount of substance arrests before they enter the program predicts the amount of substance offenses committed after they leave the program, and the association is much stronger in those who do not graduate MHC. Findings suggest that MHC has a significant impact even on those with co-occurring disorders. However, they are at greatest vulnerability to relapse with substances within the first 6 months after leaving MHC, suggesting greater substance-specific supports in the community for dually diagnosed participants may be beneficial.

The Cry for Help in Psychological Injury and Law: Concepts and Review Abstract The cry for help is one of the explanations of results indicating negative impression management on symptom validity tests (SVTs) and respondent validity scales of personality and related inventories used in the area of psychological/psychiatric injury and law. One common interpretation of scale/test findings like these is that respondents are exaggerating, and their symptoms are due to feigning or even malingering. However, research shows that patients with scale/test results on these measures and inventories that indicate symptom over-reporting might be expressing genuine extreme psychopathology or emotional distress. A related possibility is that the respondents are catastrophizing, thinking the worst, desperate and pleading for understanding and help. That is, they might be “crying out for help.” The cry for help motivation in the context of psychiatric forensic disability and related psychiatric/psychological evaluations is poorly defined in the literature, leading to contradictory research results and interpretations. Also, certain conditions and disorders that are relevant to forensic disability evaluations and related contexts might, in and of themselves, include a cry for help, complicating the forensic conclusion (e.g., dissociation, somatic symptom disorder). The present paper addresses definitional issues related to the cry for help, including its conscious/unconscious status, reviews the literature on it, suggests ways of measuring it (and the prevalence of malingering), indicates the ethical scope of when it should be used, and offers research strategies to improve the reliability and validity of its use in the forensic disability and related evaluation context.

Psychometric Characteristics of the Persian Version of the Injustice Experience Questionnaire Abstract The present study aimed to determine the psychometric characteristics of the Persian version of the Injustice Experience Questionnaire (IEQ-P). Data were collected from 230 participants (122 females and 108 males between 20 and 60 years of age) with chronic musculoskeletal pain. Principal component analysis was used to test the factor structure of the questionnaire. Construct validity was assessed by investigating Pearson correlations among the IEQ-P and other related questionnaires. Internal consistency was indicated by Cronbach’s alpha, and test-retest reliability was examined through the intraclass correlation coefficient (ICC) in 48 participants within a three-week period. To examine the differences in the IEQ-P total scores by categorical independent variables, the Kruskal-Wallis test was used. A two-component solution was yielded with good internal consistency (Cronbach’s alpha .86). The IEQ-P was correlated significantly with the Pain Catastrophizing Scale (PCS), r = .62, p < .01; McGill Pain Questionnaire (MPQ), r = .44, p < .01; Pain Disability Index (PDI), r = .5, p < .01; Tampa Scale for Kinesiophobia (TSK), r = .48, p < .01; and Beck Depression Inventory II (BDI-II), r = .4, p < .01. Regression analyses revealed that the IEQ-P contributed significant unique variance to the prediction of pain severity, β = .28, p < .001; self-report disability; β = .26, p < .001; and depression, β = .21, p < .001. The obtained results demonstrated an excellent test-retest reliability (ICC = .95). Age, duration of pain, occupation, and educational level were related to the IEQ-P total scores. The IEQ-P was found to be a reliable and valid assessment tool.

Use of Validity Indicators on the Personality Assessment Inventory to Detect Feigning of Post-traumatic Stress Disorder Abstract This study examined the ability of several Personality Assessment Inventory (PAI) validity indicators to detect feigning of post-traumatic stress disorder (PTSD). Participants included 491 individuals recruited through Amazon Mechanical Turk (MTURK): 44 participants were asked to feign PTSD, 25 participants carried a diagnosis of PTSD and demonstrated at least moderate levels of current symptom, and 422 served as control subjects. Results indicated that all of the PAI negative distortion validity indicators significantly distinguished the true PTSD from the feigned PTSD group. The indicators with the largest effect sizes were the Hong Malingering Function and the Multiscale Feigning Index, both of which demonstrated moderate sensitivity to feigned PTSD with specificity above 90%.

Examination of Select Psychometric Characteristics of Independent Living Scales Factors Abstract The purpose of this article was to examine select psychometrics of two factors—Performance/Information and Problem Solving—of Managing Money and Health and Safety, two subscales of the Independent Living Scales (ILS). These two factors are designed to assess different cognitive functions. We examined (1) the internal reliability of the subscales and (2) correlations of these subscales with other neuropsychological measures in two samples. One sample consisted of college students (N = 105) and the other of individuals undergoing a court-ordered competency assessment (N = 71) with a range of various developmental, psychiatric, and/or neurological disorders. For both factors on both subscales, we found that the internal reliabilities for the college sample were poor but adequate for the competency-based cases. In contrast, our findings were similar for the correlational analyses for both subscales, where the pattern of correlations was generally not significantly different between both factors and several neuropsychological measures. These tests varied across samples but were assessed a range of abilities including intelligence, attention, processing speed, set shifting, mathematics, verbal fluency, and executive functioning. Implications of these finding are discussed as are ideas for future research.

Determination of Competency for High-Gravity Life-Death Decision-Making Abstract Just as the number of developed countries now legally permitting physician-assisted suicide (PAS) continues to grow, so too does the number of legal terms and definitions of medical assistance in dying and associated decisional capacity standards, illustrating the diversity of opinions on this topic. Of particular concern is the lack of a standard framework for clinical assessment of an individual’s competence to make this life and death high-gravity decision. This article provides context by reviewing background literature, current terminology, definitions, and evaluation models, as well as legislation regarding competence determination for choosing physician-assisted suicide and medical assistance in dying in general. A review of relevant current research is presented, with suggestions for future research and practice advances to fill the gap of much needed elucidation of this intensely debated topic. Finally, we note considerations for the development of a forensic assessment framework to assist professionals who may find themselves in the position of having to assess an individual’s competence in relation to this high-gravity decision-making process. Our conclusions are limited by current available evidence and observations, which may lack scientific precision of methods for determination of decisional capacity, and have limited validity, reliability, or fairness, thus increasing the potential for bias and abuse of vulnerable persons.

Demographically Adjusted Validity Cutoffs on the Finger Tapping Test Are Superior to Raw Score Cutoffs in Adults with TBI Abstract This study was designed to develop validity cutoffs within the Finger Tapping Test (FTT) using demographically adjusted T-scores, and to compare their classification accuracy to existing cutoffs based on raw scores. Given that FTT performance is known to vary with age, sex, and level of education, failure to correct for these demographic variables poses the risk of elevated false positive rates in examinees who, at the level of raw scores, have inherently lower FTT performance (women, older, and less educated individuals). Data were collected from an archival sample of 100 adult outpatients (MAge = 38.8 years, MEducation = 13.7 years, 56% men) consecutively referred for neuropsychological assessment at an academic medical center in the Midwestern USA after sustaining a traumatic brain injury (TBI). Performance validity was psychometrically defined using the Word Memory Test and two validity composites based on five embedded performance validity indicators. Previously published raw score-based validity cutoffs disproportionately sacrificed sensitivity (.13–.33) for specificity (.98–1.00). Worse yet, they were confounded by sex and education. Newly introduced demographically adjusted cutoffs (T ≤ 33 for the dominant hand, T ≤ 37 for both hands) produced high levels of specificity (.89–.98) and acceptable sensitivity (.36–.55) across criterion measures. Equally importantly, they were robust to injury severity and demographic variables. The present findings provide empirical support for a growing trend of demographically adjusted performance validity cutoffs. They provide a practical and epistemologically superior alternative to raw score cutoffs, while also reducing the potential bias against examinees inherently vulnerable to lower raw score level FTT performance.