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Base Rates of Malingering and Symptom Exeggeration
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2002
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Traumatic Brain InjuryPsychiatric EvaluationClinical NeurologyDiagnosisNeuropsychiatryNeurological InjuryCognitive RehabilitationClinical InjurySymptomatic TreatmentBrain InjuryNeurologyNeurorehabilitationHealth SciencesPsychiatryNeuroepidemiologyMild Head InjuryBase RatesMedicinePsychopathology
The study analyzed 33,531 annual personal injury, disability, criminal, and medical cases, using multiple evidence sources—severity, pattern, test scores, record discrepancies, interview inconsistencies, test score changes, and personality validity scales—to diagnose probable malingering and symptom exaggeration. Probable malingering and symptom exaggeration occurred in 2–4% more cases when referral source variance was controlled, with rates of 29% in personal injury, 30% in disability, 19% in criminal, 8% in medical cases, and 22–39% across specific conditions such as mild head injury, fibromyalgia, chronic pain, neurotoxic, and electrical injury claims.
Base rates of probable malingering and symptom exaggeration are reported from a survey of the American Board of Clinical Neuropsychology membership. Estimates were based on 33,531 annual cases involved in personal injury, (n = 6,371), disability (n = 3,688), criminal (n = 1,341), or medical (n = 22,131) matters. Base rates did not differ among geographic regions or practice settings, but were related to the proportion of plaintiff versus defense referrals. Reported rates would be 2-4% higher if variance due to referral source was controlled. Twenty-nine percent of personal injury, 30% of disability, 19% of criminal, and 8% of medical cases involved probable malingering and symptom exaggeration. Thirty-nine percent of mild head injury, 35% of fibromyalgia/chronic fatigue, 31% of chronic pain, 27% of neurotoxic, and 22% of electrical injury claims resulted in diagnostic impressions of probable malingering. Diagnosis was supported by multiple sources of evidence, including severity (65% of cases) or pattern (64% of cases) of cognitive impairment that was inconsistent with the condition, scores below empirical cutoffs on forced choice tests (57% of cases), discrepancies among records, self-report, and observed behavior (56%), implausible self-reported symptoms in interview (46%), implausible changes in test scores across repeated examinations (45%), and validity scales on objective personality tests (38% of cases).