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

INTERNATIONAL LIBRARY OF ETHICS, LAW, AND THE NEW MEDICINE

Founding Editors

DAVID C. THOMASMA†

DAVID N. WEISSTUB, Université de Montréal, CanadaTHOMASINE KIMBROUGH KUSHNER, University of California, Berkeley,

U.S.A.

Editor

DAVID N. WEISSTUB, Université de Montréal, Canada

Editorial Board

TERRY CARNEY, University of Sydney, AustraliaSØREN HOLM, University of Cardiff, Wales,United Kingdom

GERRIT K. KIMSMA, Vrije Universiteit, Amsterdam, the NetherlandsDAVID NOVAK, University of Toronto, Canada

EDMUND D. PELLEGRINO, Georgetown University, Washington D.C., U.S.A.DANIEL P. SULMASY, Saint Vincent Catholic Medical Centers, New York, U.S.A.

LAWRENCE TANCREDI, New York University, New York, U.S.A.

VOLUME 56

For further volumes:http://www.springer.com/series/6224

Gerald Young

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

Implications for Practice and Court

ISSN 1567-8008 ISBN 978-94-007-7898-6 ISBN 978-94-007-7899-3 (eBook) DOI 10.1007/978-94-007-7899-3 Springer Dordrecht Heidelberg New York London

Library of Congress Control Number: 2014931398

© Springer Science+Business Media Dordrecht 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.

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Gerald Young Glendon College York University Toronto, ON , Canada

www.springer.com

v

Pref ace

Introduction

This book is a lengthy one consisting of 34 chapters arranged into two major sec-tions. The fi rst section of the book gives the basics in the area of psychiatric/psycho-logical injury, malingering, and its detection and assessment, focussing on posttraumatic stress disorder (PTSD). The second section adds material, in particular, on pain, on traumatic brain injury (TBI), on therapy, and on ethics, as well as supplements for study and education.

Content

Specifi cally, this work is about the detection of malingering, feigning, and related response biases expressed by evaluees in forensic and related disability evaluations, in general, and in psychological and psychiatric injury cases, in particular. Psychological injury involves PTSD, chronic pain, TBI (especially mild, MTBI). This book is the fi rst authored (as opposed to edited) broad-coverage book in the fi eld on malingering. Also, it covers other areas of psychological injury, such as the injuries themselves (PTSD, pain, TBI) and their assessment and treatment. Another major focus of the book is on ethics. The work looks dispassionately at the science in the fi eld, and points out inconsistencies, while proposing solutions to facilitate both practice and testimony for court. This book adopts a middle-of-the-road and state-of-the-art perspective that makes it ideal for use in both the latter contexts.

The fi rst part of the book analyzes and discusses the inconsistencies in defi ni-tions that mark the fi eld of study of malingering and related terms, as well as indi-cating the diffi culties in establishing the prevalence or base rate in psychological/psychiatric injury populations in forensic disability and related contexts. It analyzes extant models related to malingering/feigning, (a) especially that of Slick et al. (1999), which is on Malingered Neurocognitive Dysfunction (MND), and (b) its

vi

modifi cations suggested by Rogers et al. (2011a, b) and Boone (2011), as well as (c) another malingering-related model on pain, MPRD, Malingered Pain-Related Dysfunction (Bianchini et al. 2005). Based on these two models of malingering in neurocognition and in pain (MND and MPRD, respectively, as well as the proposed revisions by Rogers et al. and Boone), and (d) on a fourth major source, the work of Rubenzer (2009) on testing for malingered PTSD, the author of the monograph developed a new diagnostic system applicable to PTSD cases. Then, based on this PTSD model, he revised the MND and MPRD models to develop his own. Therefore the three proposed malingering-detection systems are quite uniform, except for some critical examples (the revised MND and MPRD models are presented in depth in the supplementary/appendix section later in ends the book).

The present work also describes a model of the distribution of malingering and other response biases, as well as a questionnaire based on it. They that can be used in surveys of professionals undertaking evaluations related to malingering and other response biases. The types of response biases in the questionnaire are compatible with the three malingering diagnostic systems created. The distributions obtained in surveys with the questionnaire could help clarify the prevalence or base rate of the various types of credible and noncredible response styles in the questionnaire. If used in surveys this way, the results could help practice in the area both for mental health and legal professionals, as well as court. In addition, the fi rst part of the book includes a review of an important test in the area, the MMPI-2-RF (Minnesota Multiphasic Personality Inventory, Second Edition, Restructured Form; Ben-Porath and Tellegen 2008/2011).

The second part of the book includes monograph literature review, focusing on the work of (a) Larrabee (2012) and (b) Reynolds and Horton (2012) on the topic of malingering in neuropsychology. Also, it focuses on recent work on malingered PTSD. This part of the book concentrates on controversies/contrasts, the adversarial divide and law, stringent research (the work of Rogers), as well as the question of gold standards in malingering diagnostic systems and assessment. It gives the practitioner much material to work with, such as differences in more plaintiff-related and defense-related approaches to malingering, chapters that help in detecting malingered PTSD, and discussion of law and causality.

The third part of the book looks at assessment and the most recent journal litera-ture. First, it examines even-handedly evaluator and evaluee factors that infl uence dis-ability evaluations, including biases such as confi rmatory bias. It focuses on expert report writing/testimony. As for the journal literature review, it examines recent articles published in the fi eld (in 2012).

The fourth part of the book examines the psychological injuries of MTBI and chronic pain, as well as conversion disorder. There is a chapter on pain feigning, which includes a proposed instrument to assess it.

The fourth part of the book then continues discussing psychological injury, malingering, ethics, and law, examining the most recent book on the topic. It ana-lyzes in much depth the book on TBI by Carone and Bush (2013), and the most recent articles published in the fi eld (in 2012). The book by Carone and Bush and the most recent literature review both include sources consistent with the present approach, as well as others that are examined critically when they are not.

Preface

vii

The last substantive chapters of the book are in this fourth part. They shift gears into areas that are more general than psychological injury and law. They consider therapy and ethics within the psychological injury context, but also deal with general issues in psychology. In these chapters, after reviewing relevant, recent literature, the book presents broad models that allow for expert practice and refl ection. The second therapy chapter of this part presents a transdiagnostic therapeutic module based on belief in free will and change processes. The second ethics chapter of this part presents a model of ethical thought and ethical decision-making.

The fi fth part of the book is comprised of supplementary material and appendices. There are two chapters on tests and testing and three on tables presenting the specifi c malingering diagnostic systems created in the present work.

The sixth part of the book includes three chapters on education and study, including one on a glossary of terms. The fi rst chapter outlines a course proposal for the area of psychological injury and law, for which the present book could serve as its textbook (e.g., graduate; upgrading; continuing education). The next chapter provides study questions to help review its contents.

The concluding two chapters to the book fi rst present guidelines to cut scores for PTSD tests when working in the area of psychological injury and law. Then the last chapter considers the most recent articles relevant to the book that were published in the journal Psychological Injury and Law . A brief overview of the book. It ends with recommendations.

Conclusion

Overall, the present book has much to offer to the reader. (a) It gives a comprehen-sive overview of the fi eld of psychological injury and law. (b) Also, it indicates that progress is being made in meeting court admissibility criteria of good or acceptable science compared to poor or “junk” science. This progress includes movement toward the development of “gold standard” models and criteria related to malinger-ing and related response biases, but much research remains to be done. It empha-sizes that the proposed system developed by the author can be used by psychiatrists and other mental health professionals, not just psychologists. It should be noted that the systems should be used with caution until shown to be suffi ciently valid for assessment and court purposes. (c) Further, the book expands into the useful areas of appropriate therapy and ethics in the fi eld. It includes ethics material related to assessment and malingering, in particular, and to working in the area of psychiat-ric/psychological injury and law, in general. To conclude, the present book argues for a comprehensive, impartial, and scientifi cally-informed approach to assessment in the area of forensic disability and related contexts involving psychological inju-ries, including of malingering and related negative response bias detection. Moreover, by having such an approach to all areas of practice in the area, including in therapy and ethical decision-making, the professional will facilitate functioning effectively in the fi eld and also avoid some of the pitfalls in the area.

Preface

viii

References

Ben-Porath, Y.S., and A. Tellegen. 2008/2011. MMPI-2-RF: Manual for administration, scoring, and interpretation. Minneapolis: University of Minnesota Press.

Bianchini, K.J., K.W. Greve, and G. Glynn. 2005. On the diagnosis of malingered pain-related disability: Lessons from cognitive malingering research. The Spine Journal 5: 404–417.

Boone, K.B. 2011. Clarifi cation or confusion? A review of Rogers, Bender, and Johnson’s a critical analysis of the MND criteria for feigned cognitive impairment: Implications for forensic practice and research. Psychological Injury and Law 4: 157–162.

Carone, D.A., and S.S. Bush, 2013. Mild traumatic brain injury: System validity assessment and malingering . New York: Springer.

Larrabee, G.J. 2012. Forensic neuropsychology: A scientifi c approach . New York: Oxford University Press.

Reynolds, C.R., and A.M. Horton Jr. 2012. Detection of malingering during head injury litigation . New York: Springer.

Rogers, R., S.D. Bender, and S.F. Johnson. 2011a. A critical analysis of the MND criteria for feigned cognitive impairment: Implications for forensic practice and research. Psychological Injury and Law 4: 147–156.

Rogers, R., S.D. Bender, and S.F. Johnson. 2011b. A commentary on the MND model and the Boone critique: “Saying it doesn’t make it so.” Psychological Injury and Law 4: 162–167.

Rubenzer, S. 2009. Posttraumatic stress disorder: Assessing response style and malingering. Psychological Injury and Law 2: 114 – 142.

Slick, D.J., E.M.S. Sherman, and G.L. Iverson. 1999. Diagnostic criteria for malingered neurocog-nitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist 13: 545–561.

Toronto , ON , Canada Gerald Young

Preface

ix

Acknowledgments

David Weisstub, who co-heads the book series International Library of Ethics, Law, and the New Medicine for Springer SBM (Science + Business Media), has offered unwavering support throughout the project and deserves many thanks for his support. We share the same vision to bring excellence in science, utmost impartially, and fundamental ethics to the fi eld of mental health and law. He was assisted ably by Adriana Nigro. Many thanks to Chris Wilby at the editorial offi ces of Springer SBM, who offered much encouragement. Joyce Chan, Fanchea Lau, and Jenny Wang deserve multiple kudos; they most ably assisted me with references, tables, dictations, and patience! A team of students headed by Brandon Pierre (also Nataliya Murzenko, Zacharie Collins, Anna Vehter, Masha Koroleva, and Danielle Magri) most ably undertook the subject index and deserve many thanks (and much rest!). Much appreciation to Aviva Sirotinsky, too, who helped with dictation. In produc-tion, the team headed by Rathika Ramkumar, and Nelly Hemink did a superb job, as evidenced by the layout. My senior co-editors at Psychological Injury and Law always give me good advice and support; many thanks to Andrew Kane and Eric Drogin. As well, my superiors at Glendon College, York University, the Chair Timothy Moore and the Principal (Dean) Ken McRoberts, have always supported my work and deserve my appreciation. My family always gives me the room and support needed to get through all my academic tasks, and I thank them so much, including the new granddaughter!

Note that I have no confl icts of interest to report with respect to this book, although I do receive mostly plaintiff referrals, rather than defense.

xi

Contents

Part I Psychological Injury, Malingering, Defi nitions,Gold Standards, Models

1 Introduction: Psychological Injury, Malingering, Ethics, and Law ......................................................................................... 3 1.1 Introduction ...................................................................................... 3 1.2 Book Summary ................................................................................ 4 1.3 First Part ........................................................................................... 5 1.4 Second Part ...................................................................................... 7 1.5 Third Part ......................................................................................... 8 1.6 Fourth Part ........................................................................................ 10 1.7 Fifth and Sixth Parts ......................................................................... 10 1.8 Conclusions on the Book’s Contributions ........................................ 11 1.9 The Field of Psychological Injury Defi ned: Wikipedia

Entry by the Author (Modifi ed) ....................................................... 13 1.10 Psychological Injury and Law ......................................................... 14 1.11 Assessment and Malingering ........................................................... 15 1.12 Diagnosis and Treatment.................................................................. 15 1.13 Major Psychological Injuries ........................................................... 16 1.14 Disability and Return to Work ......................................................... 17 1.15 Psychological Testing and Tests ....................................................... 18 1.16 Causality .......................................................................................... 19 1.17 Value of the Field and Validity of the Injuries ................................. 19 1.18 Chapter Conclusion .......................................................................... 20 References ................................................................................................... 20

2 Malingering: Defi nitional and Conceptual Ambiguities and Prevalence or Base Rates .................................................................. 25 2.1 Introduction ...................................................................................... 25 2.2 Conceptual and Defi nitional Ambiguities ........................................ 27

2.2.1 Introduction .......................................................................... 27

xii

2.2.2 Different Approaches to the Same Terms ............................... 28 2.2.3 Comment ................................................................................ 30

2.3 Recent Literature on Malingering and Related Response Biases ................................................................................. 31 2.3.1 Inconsistent Conceptualizations ............................................. 31 2.3.2 Consistencies .......................................................................... 34 2.3.3 Comment ................................................................................ 38

2.4 Research on Prevalence of Malingering and Related Response Biases ................................................................................. 41 2.4.1 Malingering Minimized ......................................................... 41 2.4.2 Malingering Maximized ......................................................... 42 2.4.3 Malingering Balanced ............................................................ 44

2.5 Chapter Conclusion ............................................................................ 46 References ................................................................................................... 47

3 Toward a Gold Standard in Malingering and RelatedDeterminations .......................................................................................... 53 3.1 Introduction ........................................................................................ 53 3.2 The 2011 Rogers (and Colleagues) and Boone Exchange

in Psychological Injury and Law ....................................................... 56 3.2.1 Rogers .................................................................................... 58 3.2.2 Boone ..................................................................................... 60 3.2.3 Comment ................................................................................ 61

3.3 Malingering/Feigning Detection Instruments and Related Tests and Scales in Psychiatric/Psychological Injury ........................ 62 3.3.1 Evidence for Malingering/Feigning

and Related Testing ................................................................ 62 3.4 Tests of Malingering/Feigning and Related Biases ........................... 65

3.4.1 Personality Tests ..................................................................... 65 3.4.2 Stand-Alone Tests .................................................................. 67 3.4.3 Embedded Neuropsychological Indices ................................. 68

3.5 Malingering in the Forensic Neuropsychological Context ................ 69 3.5.1 Introduction ............................................................................ 69 3.5.2 Explaining SVTs During Consent Seeking ............................ 69 3.5.3 Defi ning Malingering and Its Prevalence ............................... 70 3.5.4 How SVTs Work .................................................................... 70 3.5.5 How SVTs are Validated ........................................................ 71 3.5.6 Considerations in Test Selection and Administration ............ 71 3.5.7 Discounting Failed and Passed SVTs..................................... 72 3.5.8 Review of Select Tests............................................................ 72 3.5.9 Comment ................................................................................ 73

3.6 Toward New Malingering Diagnostic Systems .................................. 74 3.7 Chapter Conclusion ............................................................................ 77 References ................................................................................................... 78

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4 The MMPI-2-RF Personality Inventory in Psychological Injury Cases ............................................................................................... 89 4.1 Introduction ........................................................................................ 89 4.2 The MMPI-2-RF Personality Inventory ............................................. 91

4.2.1 Description of the MMPI-2-RF .............................................. 91 4.2.2 Validating Research on Using the MMPI-2-RF

with Psychological Injury Evaluees ....................................... 93 4.3 MMPI-2-RF: More Details ................................................................ 98 4.4 Chapter Conclusion ............................................................................ 100 References ................................................................................................... 103

5 New Models of Malingering and Related Biases, Presentations, and Performances ............................................................ 109 5.1 Introduction ........................................................................................ 109 5.2 Models Related to Systemic Infl uences and Surveys ......................... 111

5.2.1 Dimensions ............................................................................. 111 5.2.2 Curves .................................................................................... 113

5.3 Analyzing Existing Models and Criteria of Malingering and Related Response Biases ............................................................. 119 5.3.1 Introduction ............................................................................ 119 5.3.2 Details of the MND Model .................................................... 121 5.3.3 Details of the MPRD Model .................................................. 122 5.3.4 Examples of Inconsistencies/Discrepancies ........................... 122 5.3.5 Comparing Inconsistencies/Discrepancies

in the MND and MPRD Models ............................................ 125 5.3.6 Rubenzer’s (2009) System for PTSD ..................................... 128

5.4 Creating a New Malingering Detection System for PTSD ................ 129 5.4.1 Principles ................................................................................ 129 5.4.2 Specifi c Changes to the MND/MPRD Systems ..................... 131

5.5 Criteria for a System of Detecting Non-credible, Feigned, or Malingered Posttraumatic Stress Disorder Related Disability/Dysfunction (F-PTSDR-D) ............................................... 133 5.5.1 The F-PTSDR-D Model ......................................................... 133 5.5.2 Major Parameters of the F-PTSDR-D Model ........................ 133 5.5.3 The 60 Testing Rules of the Present System .......................... 139 5.5.4 Integrating the Ratings of the Models .................................... 140

5.6 Chapter Conclusion ............................................................................ 141 References ................................................................................................... 143

6 Diagnostic System for Malingered PTSD and Related Response Biases: Details in Tabular Format .......................................... 145 6.1 Introduction and Conclusion .............................................................. 145 References ................................................................................................... 165

Contents

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Part II Malingering Detection, Law, Causality

7 Deconstructing Favorable and Unfavorable Malingering-Attribution Perspectives ................................................... 169 7.1 Introduction .................................................................................... 169 7.2 Malingering Unfavorable Perspectives .......................................... 171

7.2.1 Initial Issues ..................................................................... 171 7.2.2 Critical Issues ................................................................... 177

7.3 Malingering Favorable Perspectives .............................................. 179 7.3.1 Initial Issues ..................................................................... 179 7.3.2 Testing Issues ................................................................... 184 7.3.3 Critical Issues ................................................................... 187

7.4 Chapter Conclusion ........................................................................ 192 References ................................................................................................. 194

8 Other Contrasting Approaches to Malingering Detection .................. 201 8.1 Introduction .................................................................................... 201 8.2 The Ambiguity of Malingering ...................................................... 202

8.2.1 Factors Infl uencing Malingering Determinations in Faust et al. (2012a) ...................................................... 202

8.2.2 Factors Infl uencing Malingering Determinations in Faust et al. (2012b) ...................................................... 212

8.2.3 Conclusion ....................................................................... 217 8.3 Further Contrasts on Malingering Detection.................................. 217 8.4 Chapter Conclusion ........................................................................ 222 References ................................................................................................. 223

9 Posttraumatic Stress Disorder: Controversies, Diagnosis, and Malingering ...................................................................................... 229 9.1 Introduction .................................................................................... 229 9.2 PTSD: Issues and Assessment ........................................................ 232

9.2.1 Issues ................................................................................ 232 9.3 Chapter Conclusion ........................................................................ 252 References ................................................................................................. 252

10 Psychological Injury: Law and Causality ............................................. 263 10.1 Introduction .................................................................................... 263 10.2 Other Approaches to Malingering .................................................. 265

10.2.1 Review ............................................................................. 265 10.2.2 Interim Conclusion .......................................................... 267

10.3 Malingering in Court and Practice ................................................. 268 10.3.1 Review ............................................................................. 268 10.3.2 Interim Conclusion .......................................................... 272

10.4 Evidence Law ................................................................................. 274 10.5 Tort and Related Law ..................................................................... 277 10.6 Causality ......................................................................................... 279

Contents

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11 Leading the Field in Understanding and Testing Malingering And Related Response Styles: The Work of Richard Rogers ............. 293 11.1 Introduction .................................................................................... 293 11.2 Review ............................................................................................ 294

11.2.1 Interim Conclusion .......................................................... 311 11.3 Chapter Conclusion ........................................................................ 313 References ................................................................................................. 314

Part III Psychological Injury, Assessment, Most Recent Literature

12 Assessing Psychological Injuries and Malingering: Evaluator Considerations ....................................................................... 319 12.1 Introduction .................................................................................... 319 12.2 Components of the Comprehensive Psychological/

Psychiatric Injury Assessment ....................................................... 320 12.3 Indications, Inconsistencies, and Incontrovertible Evidence ......... 321 12.4 Evaluator Biases and Errors ........................................................... 328 12.5 Cautions and Appropriate Strategies in Assessment ...................... 334 12.6 Chapter Conclusion ........................................................................ 336 References ................................................................................................. 338

13 Assessing Psychological Injuries and Malingering: PTSD and Evaluee Considerations ........................................................ 341 13.1 Introduction .................................................................................... 341 13.2 Evaluating Malingered PTSD ........................................................ 342 13.3 Assessing Malingering: Evaluee Factors ....................................... 346 13.4 Chapter Conclusion ........................................................................ 357 References ................................................................................................. 358

14 Assessing Psychological Injuries and Malingering: Disability and Report Writing ............................................................... 361 14.1 Introduction .................................................................................... 361 14.2 Disability ........................................................................................ 362 14.3 Assessing Malingering: Integrations for Report Writing ............... 368 14.4 Legal Aspects and Testimony ......................................................... 373 14.5 Chapter Conclusion ........................................................................ 382 References ................................................................................................. 382

15 Slick-Sherman’s 2012–2013 Revision of the 1999 Slick et al. MND System ..................................................... 385 15.1 Introduction .................................................................................... 385 15.2 Revision of the MND ..................................................................... 386

15.2.1 Introduction ...................................................................... 386 15.2.2 Name Change ................................................................... 388

Contents

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15.2.3 Broadening the Criteria .................................................. 388 15.2.4 Comparing the Revised MND Model

to the Present Model ...................................................... 391 15.2.5 Conclusions .................................................................... 395

15.3 Differential Diagnosis .................................................................... 396 15.4 Chapter Conclusion ........................................................................ 399 References ................................................................................................. 399

16 Symptom Validity Assessment, MTBI, and Malingering in Carone and Bush (2013) ..................................................................... 401 16.1 Introduction .................................................................................... 401 16.2 Review of Carone and Bush (2013) ............................................... 403

16.2.1 History ........................................................................... 403 16.2.2 Clinical Judgment .......................................................... 403 16.2.3 Ethics ............................................................................. 404 16.2.4 SVTs .............................................................................. 404 16.2.5 Explaining SVT Failure ................................................. 405 16.2.6 Research on SVTs in MTBI Cases ................................ 407 16.2.7 Free-Standing SVTs ....................................................... 408 16.2.8 Embedded Cognitive SVTs............................................ 410 16.2.9 Personality Tests in Symptom Validity Assessment ...... 414 16.2.10 Response Bias Detection by Non-neuropsychologists .. 415 16.2.11 Assessing Non-credible Function Outside

of Memory in MTBI ...................................................... 416 16.2.12 The Brain in Deception and Malingering ...................... 417 16.2.13 Symptom Validity Testing for Pain and PTSD .............. 418 16.2.14 Special Populations ........................................................ 419


17 Most Recent Journal Article Review ..................................................... 431 17.1 Introduction .................................................................................... 431 17.2 Canons in Forensic Disability and Related Assessments:

Under the Gun and Turned on Their Head ..................................... 432 17.2.1 Introduction .................................................................... 432

17.3 Current Literature and Future Directions ....................................... 433 17.3.1 Symptom Validity Testing (In)Validity .......................... 433

17.4 Free-Standing Measures ................................................................. 436 17.4.1 MMPI-2-RF ................................................................... 437 17.4.2 FBS-r .............................................................................. 438 17.4.3 PAI ................................................................................. 439 17.4.4 Rorschach ...................................................................... 439

17.5 Embedded Measures ...................................................................... 440 17.6 Combined Measures ....................................................................... 441 17.7 Computer Measures ....................................................................... 443 17.8 Never the Twain Shall Meet ........................................................... 443

Contents

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17.9 Court ............................................................................................ 447 17.10 Conclusions .................................................................................. 448 References ................................................................................................. 448

Part IV Psychological Injuries, Therapy, Ethics

18 MTBI and Pain ........................................................................................ 455 18.1 Introduction .................................................................................. 455 18.2 Mild Traumatic Brain Injury ........................................................ 456

18.2.1 Issues .............................................................................. 456 18.2.2 Testing ............................................................................ 458

18.3 Chronic Pain ................................................................................. 461 18.3.1 Issues .............................................................................. 461 18.3.2 Testing ............................................................................ 466

18.4 Chapter Conclusion ...................................................................... 467 References ................................................................................................. 467

19 An Instrument to Detect Pain Feigning: The Pain Feigning Detection Test (PFDT) ............................................ 471 19.1 Summary ...................................................................................... 471 19.2 Introduction .................................................................................. 473

19.2.1 Absence of Pain Feigning Instruments .......................... 473 19.2.2 Pain Feigning ................................................................. 473 19.2.3 Checking Pain Feigning ................................................. 474 19.2.4 Understanding Pain ........................................................ 481 19.2.5 Proposing the Pain Feigning Detection Test (PFDT) ........ 482

19.3 Rationale for the Instrument ........................................................ 482 19.3.1 Primary Goal .................................................................. 482 19.3.2 Other Considerations ..................................................... 483 19.3.3 What the Instrument Is Not ............................................ 484

19.4 Instrument Development .............................................................. 484 19.4.1 Overview ........................................................................ 484 19.4.2 Structure ......................................................................... 485 19.4.3 Scores ............................................................................. 485 19.4.4 Deriving Scores .............................................................. 486

19.5 Validation ..................................................................................... 487 19.6 Using the Instrument .................................................................... 487

19.6.1 Introduction .................................................................... 487 19.6.2 Analyzing Scores ........................................................... 488 19.6.3 Comparing Scores .......................................................... 488 19.6.4 Interpretation .................................................................. 489

19.7 Other Proposed Pain Malingering Detection Instruments ........... 490 19.7.1 The LAQ ........................................................................ 490

19.8 Chapter Conclusion ...................................................................... 495 19.8.1 Instrument Development Program ................................. 495

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19.8.2 Cautions/Limitations ...................................................... 496 19.8.3 In Court .......................................................................... 497

Appendix ................................................................................................... 497 References ................................................................................................. 505

20 Confusions and Confounds in Conversion Disorder ............................ 511 20.1 Introduction .................................................................................... 511 20.2 Conversion Disorder ...................................................................... 511 20.3 A Problematic Diagnosis: Conversion Disorder ............................ 512

20.3.1 Diagnosis ....................................................................... 512 20.3.2 Recommendations for Change ....................................... 513 20.3.3 Comment ........................................................................ 516

20.4 History and Models ........................................................................ 518 20.4.1 History ........................................................................... 518 20.4.2 Models ........................................................................... 521

20.5 Expanded Biopsychosocial Model ................................................. 524 20.5.1 Biological Factors .......................................................... 526 20.5.2 Psychological Factors .................................................... 527 20.5.3 Ecological Factors.......................................................... 527

20.6 Recommended DSM Approach to Conversion Disorder ............... 528 20.7 Chapter Conclusion ........................................................................ 528

20.7.1 Summary ........................................................................ 528 20.7.2 Commentary .................................................................. 529

References ................................................................................................. 531

21 Therapy in Psychological Injury ........................................................... 535 21.1 Introduction .................................................................................... 535 21.2 Introduction to Therapy.................................................................. 536 21.3 The Biopsychosocial Approach to Therapy ................................... 536

21.3.1 Model ............................................................................. 536 21.3.2 Stress .............................................................................. 537 21.3.3 Comment ........................................................................ 537

21.4 Therapy and Court ......................................................................... 538 21.5 Evidence-Based Therapy in Psychological Injury ......................... 539 21.6 Major Schools of Practice of Psychotherapy ................................. 540 21.7 Componential Approach to Psychotherapy .................................... 542

21.7.1 Psychoeducational, Instructional ................................... 542 21.7.2 Physiological .................................................................. 543 21.7.3 Behavioral ...................................................................... 545 21.7.4 Action Tendencies, Inhibitory Control .......................... 547 21.7.5 Cognitive ........................................................................ 547 21.7.6 Affective, Emotional, Intrapersonal ............................... 548 21.7.7 Social, Relational, Interpersonal .................................... 549 21.7.8 Self Esteem, Motivational .............................................. 550 21.7.9 Coping, Problem Solving ............................................... 550 21.7.10 Broader Cognitive Constructions ................................... 550 21.7.11 Conclusion ..................................................................... 551

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21.8 Rehabilitation ............................................................................... 551 21.8.1 Models ........................................................................... 551 21.8.2 Recent Research and Reviews ....................................... 553 21.8.3 Comment ........................................................................ 555

21.9 Transdiagnostic and Unifi ed Approaches to Psychotherapy ............ 556 21.9.1 Models ........................................................................... 556 21.9.2 Research ......................................................................... 558

21.10 Chapter Conclusions .................................................................... 558 References ................................................................................................. 561

22 Ethics in Psychological Injury and Law ............................................... 567 22.1 Introduction .................................................................................. 567 22.2 Ethical Guidelines and Practice ................................................... 568 22.3 Ethical Thought and Decision Making ........................................ 581

22.3.1 Introduction .................................................................... 581 22.3.2 Ethical Concepts ............................................................ 581

22.4 Ethical Decision Making .............................................................. 583 22.5 Ethical Practice ............................................................................ 586 22.6 Broad Ethics: A Model for Psychological Injury and Law .......... 587 22.7 Chapter Conclusion ...................................................................... 588 References ................................................................................................. 589

23 A Transdiagnostic Therapeutic Module on Free Will and Change ...................................................................................... 593 23.1 Introduction .................................................................................. 593 23.2 Free Will in Psychotherapy .......................................................... 593 23.3 The Transdiagnostic Psychotherapeutic

Module on Free Will Belief and Change ..................................... 594 23.4 Chapter Conclusion ...................................................................... 606 References ................................................................................................. 608

24 A Model of Ethical Thought and Ethical Decision-Making ................ 611 24.1 Introduction .................................................................................. 611 24.2 Ethical Thought and Decision-Making ........................................ 612

24.2.1 The Kitcheners’ Model .................................................. 612 24.2.2 Young’s Model ............................................................... 612 24.2.3 Extensions of Young’s Model ........................................ 617

24.3 Models of Free Will and Controversies ....................................... 621 24.4 Chapter Conclusions .................................................................... 624 References ................................................................................................. 626

Part V Supplements – Testing, Systems

25 Selected Tests and Testing in Psychological Injury Evaluations I ................................................................................ 629 25.1 Introduction .................................................................................. 629 25.2 Testing .......................................................................................... 630

Contents

xx

25.3 PTSD .............................................................................................. 632 25.3.1 Overview .......................................................................... 632 25.3.2 DAPS and TSI-2 .............................................................. 634 25.3.3 PTSD Criteria .................................................................. 638


26 Selected Tests and Testing in Psychological Injury Evaluations II .............................................................................. 645 26.1 Introduction .................................................................................... 645 26.2 Testing ............................................................................................ 647 26.3 Personality Inventories ................................................................... 655

26.3.1 MMPI-2 ........................................................................... 655 26.3.2 The Rorschach ................................................................. 656

26.4 A Symptom Validity Test: The Victoria Symptom Validity Test ................................................................... 658


27 Diagnostic System for Malingered PTSD Disability/Dysfunction and Related Negative Response Biases: User Version and Worksheet .................................... 667 27.1 Introduction .................................................................................... 667 27.2 The PID-FMR-S Systems .............................................................. 669 27.3 Conclusions: Review of Contributions of Part I of the Book......... 669 Worksheet .................................................................................................. 703 Worksheet for Non-Credible System Feigned Posttraumatic

Stress Disorder and Related Disability/Dysfunction ............................ 703 References ................................................................................................. 709

28 Diagnostic System for Malingered Neurocognitive Disability/Dysfunction and Related Negative Response Biases .......... 711 28.1 Introduction .................................................................................... 711 References ................................................................................................. 740

29 Diagnostic System for Malingered Pain Disability/Dysfunction and Related Negative Response Biases ............................ 743 29.1 Introduction .................................................................................... 743 References ................................................................................................. 772

Part VI Terms, Education, Study, Conclusions

30 Glossary and Discussion of Terms ......................................................... 777 30.1 Introduction .................................................................................... 777 30.2 Chapter Conclusion ........................................................................ 792 References ................................................................................................. 793

Contents

xxi

31 Education ................................................................................................. 797 31.1 Introduction .................................................................................... 797 31.2 Case Examples (Hypothetical) ....................................................... 798 31.3 Psychology Graduate Course Proposal .......................................... 799

31.3.1 Fundamentals of Psychological Injury and Law............ 799 31.4 Syllabus .......................................................................................... 801

31.4.1 A Half-Course in 30 Modules (2–3 Modulesper Lecture) ............................................. 801

31.4.2 Psychological Injury and Law Practicum ...................... 809 31.5 Chapter Conclusion ........................................................................ 810 References ................................................................................................. 813

32 Study Guide Questions, Teaching Objectives, and Learning Outcomes ......................................................................... 815 32.1 Introduction .................................................................................... 815 32.2 Overview ........................................................................................ 817 32.3 General, Review, and Thinking Questions ..................................... 818

32.3.1 General Questions (Chaps. 1, 2, 3, and 4 Mostly) ......... 818 32.3.2 Core Questions (Chaps. 5 and 6 Mostly) ....................... 819 32.3.3 Assessment .................................................................... 820 32.3.4 Tests ............................................................................... 821 32.3.5 Terms ............................................................................. 822 32.3.6 Overview ........................................................................ 823

32.4 Specifi c Study Questions (on Details, Some Thinking Questions) ....................................................................... 824 32.4.1 Chapter 1 ........................................................................ 824 32.4.2 Chapter 2 ........................................................................ 824 32.4.3 Chapter 3 ........................................................................ 826 32.4.4 Chapter 4 ........................................................................ 828 32.4.5 Chapter 5 ........................................................................ 828 32.4.6 Chapter 6 ........................................................................ 830 32.4.7 Chapter 7 ........................................................................ 831 32.4.8 Chapter 8 ........................................................................ 832 32.4.9 Chapter 9 ........................................................................ 832 32.4.10 Chapter 10 ...................................................................... 833 32.4.11 Chapter 11 ...................................................................... 834 32.4.12 Chapter 12 ...................................................................... 835 32.4.13 Chapter 13 ...................................................................... 835 32.4.14 Chapter 14 ...................................................................... 835 32.4.15 Chapter 15 ...................................................................... 836 32.4.16 Chapter 16 ...................................................................... 837 32.4.17 Chapter 17 ...................................................................... 838 32.4.18 Chapter 18 ...................................................................... 839 32.4.19 Chapter 19 ...................................................................... 840 32.4.20 Chapter 20 ...................................................................... 840

Contents

xxii

32.4.21 Chapter 21 ...................................................................... 840 32.4.22 Chapter 22 ...................................................................... 842 32.4.23 Chapter 23 ...................................................................... 843 32.4.24 Chapter 24 ...................................................................... 843 32.4.25 Chapter 30 ...................................................................... 844 32.4.26 Chapter 33 ...................................................................... 846 32.4.27 Chapter 34 ...................................................................... 846

32.5 Final Conclusion ............................................................................ 847 References ................................................................................................. 847

33 PTSD and Malingering: Tests, Diagnostics, Cut Scores, and Cautions ....................................................................... 855 33.1 Introduction .................................................................................... 855 33.2 Testing ............................................................................................ 857 33.3 Cut Scores ...................................................................................... 859

33.3.1 Introduction .................................................................... 859 33.3.2 MMPI-2-RF ................................................................... 860 33.3.3 MMPI-2 ......................................................................... 863 33.3.4 PAI ................................................................................. 864 33.3.5 Forced-Choice Tests....................................................... 866 33.3.6 Structured Interviews ..................................................... 867 33.3.7 Self-Report Measures .................................................... 871

33.4 Literature Review ........................................................................... 872 33.5 Chapter Conclusion ........................................................................ 874 References ................................................................................................. 874

34 Book Conclusions .................................................................................... 881 34.1 Introduction .................................................................................... 881 34.2 DSM-5 ............................................................................................ 881 34.3 Final Research Review ................................................................... 882

34.3.1 Research ......................................................................... 882 34.3.2 Comment ........................................................................ 885

34.4 Conclusions .................................................................................... 886 34.4.1 Overview ........................................................................ 886 34.4.2 Recommendations .......................................................... 887

34.5 Addendum ...................................................................................... 888 34.5.1 Disability Evaluations: Psychologist ............................. 888 34.5.2 Disability Evaluations: Psychiatrist ............................... 890 34.5.3 Problematic PTSD and Assessment ............................... 891 34.5.4 Malingering and SVTs ................................................... 892

References ................................................................................................. 893

Index ................................................................................................................. 899

Contents

xxiii

Brief Bi ography

Gerald Young, Ph.D., is an Associate Professor at Glendon College, York University. He is Editor-in-Chief of Psychological Injury and Law and President of the Association for Scientifi c Advancement in Psychological Injury and Law . He has published other works in the area (e.g., Causality of Psychological Injury: Presenting Evidence in Court , 2007). His other area of research is in child development ( Development and Causality: Neo-Piagetian Perspectives , 2011), which was referred to in a review as his “magnum opus” and as “remarkable.” His most recent trade book is called You Can Rejoin Joy: Blogging for Today’s Psychology (2013; rejoiningjoy.com). He may be reached at [email protected].

xxv

Abbreviation Name Source(s)

MMPI-2-RF Minnesota Multiphasic Personality Inventory, Second Edition, Restructured Form

Ben-Porath and Tellegen (2008/2011)

MND Malingered Neurocognitive Dysfunction Slick et al. (1999) MPRD Malingered Pain-Related Disability Bianchini et al. (2005)

Table of Terms and Sources

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