Malingering

There is no single test of malingering (i.e. consciously motivated deliberate underperformance on tests). Rather, a pattern builds up which gradually raises the suspicion of malingering. Features of test performance which raise the issue are as follows:

1. a degree of deficit that is disproportionate to the severity of the injury (laboratory studies of people who are asked to feign deficits or act as if they have a certain brain injury consistently find that participants exaggerate or inflate the severity and breadth of symptoms, even when a warning about this is given (50));

2. bizarre errors not typically seen in patients with genuine deficits (the implication being that the person has made an uninformed guess at what the symptoms might be);

3. patterns of test performance that do not make sense (e.g. doing as badly on easy items as hard items);

4. not showing expected patterns (e.g. being as bad on recognition recall as on free recall, failing to show any learning whatsoever on auditory-verbal learning tasks, suppression of the first half of items on list learning tasks, discrepancies between scores on tests measuring similar processes);

5. inconsistencies between test performance and behaviour in real life (e.g. unable to repeat short digit strings or short sentences, but in general conversation being able to respond to multistage instructions; extreme retardation, slowing, in answering test questions but converses normally and gives the history normally);

6. inexplicable claims of remote memory loss even for important life events like weddings; (5.!>

7. random responding on forced-choice tests(23> (if true this would suggest that the person had no brain at all);

8. below random responding on forced-driven tests, i.e. suggesting that the person must know the right answer in order to give the wrong one; (52>

9. poor performance on tests that look hard but are in fact easy, like the Rey 15- or 16-item test;(53,)

10. the absence of any sign of severe anxiety or profoundly low mood such as might cause a collapse in performance;

11. after head injury, the absence of any improvement or indeed a worsening of performance over time;

12. failure to report deficits following a brain injury when in retrospect those deficits are claimed to have been severe;

13. relative absence of a history of somatization or related disorders.

Do Not Panic

Do Not Panic

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