Assessing posttraumatic stress disorder symptom clusters with the Minnesota Multiphasic Personality Inventory-3 in a forensic disability sample.

OBJECTIVE: Previous evidence indicates that scales from the Minnesota Multiphasic Personality Inventory (MMPI) family of instruments can measure self-reported posttraumatic stress disorder (PTSD) symptomology and differentiate symptom clusters, including in forensic disability assessments. However, limited research has examined assessment of PTSD symptoms with the MMPI-3, the most recent MMPI instrument. The goal of the current study was to identify the strongest MMPI-3 scale predictors of individual PTSD symptom clusters, measured via self-report. METHODS: Using a sample of 716 disability claimants (54.2% men; Mage = 42.98, SD = 10.87; 81.8% White), correlation, regression, and dominance analyses were performed to examine associations between scores on MMPI-3 scales and latent PTSD symptom cluster factors derived using confirmatory factor analyses from items of the Detailed Assessment of Posttraumatic Stress (DAPS), and to identify the strongest predictor of each symptom cluster when MMPI-3 scales were concurrently considered. RESULTS: Results indicate that conceptually expected MMPI-3 scale scores were meaningfully associated with PTSD symptom cluster factors, with the MMPI-3 Anxiety-Related Experiences (ARX) scale demonstrating the strongest and most consistent associations across symptom clusters. CONCLUSIONS: Results of the current study largely converge with previous empirical studies of self-reported PTSD symptoms in disability claimant settings with the MMPI instruments. Interpretive implications for the MMPI-3, limitations, and future research directions are discussed.

Virtuous victims: Disability claimants who over- and under-report.

Objective: The present study was the first to investigate the test performance and symptom reports of individuals who engage in both over-reporting (i.e., exaggerating or fabricating symptoms) and under-reporting (i.e., exaggerating positive qualities or denying shortcomings) in the context of a forensic evaluation. We focused on comparing individuals who over- and under-reported (OR + UR) with those who only over-reported (OR-only) on the MMPI-3. Method: Using a disability claimant sample referred for comprehensive psychological evaluations (n = 848), the present study first determined the rates of possible over-reporting (MMPI-3 F ≥ 75 T, Fp ≥ 70 T, Fs ≥ 100 T, or FBS or RBS ≥ 90 T) with (n = 42) and without (n = 332) under-reporting (L ≥ 65 T). Next, we examined group mean differences on MMPI-3 substantive scale scores and scores on several additional measures completed by the disability claimant sample during their evaluation. Results: The small group of individuals identified as both over-reporting and under-reporting (OR + UR) scored meaningfully higher than the OR-only group on several over- and under-reporting symptom validity tests, as well as on measures of emotional and cognitive/somatic complaints, but lower on externalizing measures. The OR + UR group also performed significantly worse than the OR-only group on several performance validity tests and measures of cognitive ability. Conclusions: The present study indicated that disability claimants who engage in simultaneous over- and under-reporting portray themselves as having greater levels of dysfunction but fewer externalizing tendencies relative to claimants who only over-report; however, these portrayals are likely less accurate reflections of their true functioning.

Examination of the MMPI-3 over-reporting scales in a forensic disability sample.

Objective: The aim of this investigation was to provide information about the utility of the newly revised and renormed Minnesota Multiphasic Personality Inventory-3 (MMPI-3) over-reporting scales in a forensic disability sample. Method: Participants consisted of 550 non-head injury disability-related referrals (i.e. 95.6% for worker's compensation) and were primarily diagnosed with an adjustment disorder, depressive disorder, or posttraumatic stress disorder. Criterion measures included performance validity indicators and non-MMPI symptom validity indicators. Results: Correlation analyses showed that validity scale F was most strongly associated with non-MMPI symptom validity indicators, whereas F, Fs, FBS, and RBS were comparable to each other in their associations with performance validity indicators. Group mean comparisons between Pass versus Fail PVT groups showed that RBS consistently yielded the largest effect sizes. Using established structured criteria for Malingered Neurocognitive Dysfunction (MND), additional group mean comparisons showed that RBS, followed by Fs, F, and FBS, performed well in differentiating genuine responders from MND examinees. Classification accuracy estimates indicated that the MMPI-3 over-reporting scales performed well in the prediction of Probable/Definite MND and, as expected, to a lesser degree of Possible MND. Conclusions: Practical applications, study limitations, and directions for future research are discussed. The overall findings from this study provide empirical support for the utility of the MMPI-3 over-reporting scales in detecting negative response bias in forensic disability evaluations.

A comparison of the MMPI-2-RF and PAI overreporting indicators in a civil forensic sample with emphasis on the Response Bias Scale (RBS) and the Cognitive Bias Scale (CBS).

The Cognitive Bias Scale (CBS; Gaasedelen, Whiteside, Altmaier, Welch, & Basso, 2019) was developed as a Personality Assessment Inventory (PAI) indicator of poor performance on Performance Validity Tests (PVTs) in a neuropsychological context. The current study aimed to investigate the effectiveness of the CBS in a forensic disability sample through a series of analyses by comparing it to other PAI validity scales and the Minnesota Multiphasic Personality Inventory (MMPI)-2-RF overreporting scales with an emphasis on the Response Bias Scale (RBS), which guided the development of the CBS. The participants in this study were drawn from an archival dataset containing 588 consecutive civil disability claimants. Findings showed the RBS and the CBS yielded similar patterns of negative correlations to PVTs, with RBS effect sizes being somewhat larger in most comparisons. Results of ANOVAs showed that the RBS produced the largest effect sizes in distinguishing between incentive only versus probable/definite malingered neurocognitive dysfunction (MND) groups, followed by the CBS. Estimates of sensitivity and specificity were comparable between the RBS and CBS at liberal cut scores, but the RBS was more specific to detecting Probable/Definite MND at more conservative cutoffs. Hierarchical logistic regression analyses showed that RBS accounted for 6% variance over CBS in the probable/definite MND classification, whereas the CBS accounted for 2% variance beyond the RBS. Overall, the results of this study support the utility of the CBS as the most effective PAI validity scale for detecting MND in a civil disability sample, and the RBS generally outperformed the CBS to some degree in all analyses. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Inconsistent responding on the MMPI-2-RF and uncooperative attitude: Evidence from cognitive performance validity measures.

It is generally well understood that possible reasons for inconsistent responding on the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF), as measured by the Variable Response Inconsistency (VRIN-r) and True Response Inconsistency (TRIN-r) scales, include reading or language limitations, cognitive impairment, and intentional random responding; however, the interpretive recommendations for the test suggest that higher scores on these scales can also result from an uncooperative test-taking approach. This study utilized a sample of 3,457 predominately non-head injury disability claimants to examine the association between inconsistent responding on the MMPI-2-RF and performance on cognitive tests as well performance validity tests (PVTs), an independent indicator of uncooperative test-taking attitude. Analysis of variance found that both VRIN-r and TRIN-r were associated with statistically lower cognitive test scores. These analyses also supported that TRIN-r was associated with poor performance on collaterally administered PVTs in a subsample of individuals with average reading levels. Illustrating the practical effects of these results, in follow-up relative risk ratio analyses, individuals with elevations on TRIN-r were at up to five times greater risk of PVT failure than those without elevations. Overall, the results of this study provide some support for the interpretation that inconsistent responding on the MMPI-2-RF is associated not only with cognitive/reading problems or limitations but also an uncooperative test-taking approach, particularly for elevated TRIN-r scores. (PsycINFO Database Record

Trial 1 versus Trial 2 of the Test of Memory Malingering: Evaluating accuracy without a "gold standard".

This study examines the accuracy of the Test of Memory Malingering (TOMM), a frequently administered measure for evaluating effort during neurocognitive testing. In the last few years, several authors have suggested that the initial recognition trial of the TOMM (Trial 1) might be a more useful index for detecting feigned or exaggerated impairment than Trial 2, which is the source for inference recommended by the original instruction manual (Tombaugh, 1996). We used latent class modeling (LCM) implemented in a Bayesian framework to evaluate archival Trial 1 and Trial 2 data collected from 1,198 adults who had undergone outpatient forensic evaluations. All subjects were tested with 2 other performance validity tests (the Word Memory Test and the Computerized Assessment of Response Bias), and for 70% of the subjects, data from the California Verbal Learning Test-Second Edition Forced Choice trial were also available. Our results suggest that not even a perfect score on Trial 1 or Trial 2 justifies saying that an evaluee is definitely responding genuinely, although such scores imply a lower-than-base-rate probability of feigning. If one uses a Trial 2 cut-off higher than the manual's recommendation, Trial 2 does better than Trial 1 at identifying individuals who are almost certainly feigning while maintaining a negligible false positive rate. Using scores from both trials, one can identify a group of definitely feigning and very likely feigning subjects who comprise about 2 thirds of all feigners; only 1% of the members of this group would not be feigning. (PsycINFO Database Record

The Generalizability of Overreporting Across Self-Report Measures: An Investigation With the Minnesota Multiphasic Personality Inventory-2-Restructured Form and the Personality Assessment Inventory in a Civil Disability Sample.

Elevated overreporting Validity Scale scores on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) are associated with higher scores on collateral measures; however, measures used in prior research lacked validity scales. We sought to extend these findings by examining associations between elevated MMPI-2-RF overreporting scale scores and Personality Assessment Inventory (PAI) scale scores among 654 non-head injury civil disability claimants. Individuals were classified as overreporting psychopathology (OR-P), overreporting somatic/cognitive complaints (OR-SC), inconclusive reporting psychopathology (IR-P), inconclusive reporting somatic/cognitive complaints (IR-SC), or valid reporting (VR). Both overreporting groups had significantly and meaningfully higher scores than the VR group on the MMPI-2-RF and PAI scales. Both IR groups had significantly and meaningfully higher scores than the VR group, as well as lower scores than their overreporting counterparts. Our findings demonstrate the utility of inventories with validity scales in assessment batteries that include instruments without measures of protocol validity.

An Examination of the Word Memory Test as a Measure of Memory.

This study examined the utility of the Word Memory Test (WMT) as a measure of verbal episodic memory by comparing select WMT subtests to the California Verbal Learning Test (CVLT) First and Second Editions (CVLT-II) across two samples. Correlations between the WMT and CVLT/CVLT-II subtests were statistically significant in the expected direction. Effect sizes were examined to assess the degree to which the WMT memory subtests and the CVLT First Edition subtests discriminated between groups of people who would be expected to differ from each other in verbal memory abilities. Comparison groups included cases of mild, moderate, and severe traumatic brain injury, mixed neurological patients, healthy adult controls, and patients with possible early dementia. Once invalid data were removed by studying only those who passed performance validity testing, it was found that the effect sizes between these groups were comparable. The WMT, CVLT, and CVLT-II were found to discriminate to about the same degree between people differing from each other in age, intelligence levels, and gender. Based on these data from a total sample of more than 3,000 cases, it is concluded that select WMT subtests are commensurate with the CVLT subtests as measures of memory within primarily disability-seeking samples.

A Bayesian approach to mixed group validation of performance validity tests.

Mental health professionals often use structured assessment tools to help detect individuals who are feigning or exaggerating symptoms. Yet estimating the accuracy of these tools is problematic because no "gold standard" establishes whether someone is malingering or not. Several investigators have recommended using mixed group validation (MGV) to estimate the accuracy of malingering measures, but simulation studies show that typical implementations of MGV may yield vague, biased, or logically impossible results. In this article we describe a Bayesian approach to MGV that addresses and avoids these limitations. After explaining the concepts that underlie our approach, we use previously published data on the Test of Memory Malingering (TOMM; Tombaugh, 1996) to illustrate how our method works. Our findings concerning the TOMM's accuracy, which include insights about covariates such as study population and litigation status, are consistent with results that appear in previous publications. Unlike most investigations of the TOMM's accuracy, our findings neither rely on possibly flawed assumptions about subjects' intentions nor assume that experimental simulators can duplicate the behavior of real-world examinees. Our conceptual approach may prove helpful in evaluating the accuracy of many assessment tools used in clinical contexts and psycholegal determinations.

Association between the MMPI-2 restructured form (MMPI-2-RF) and malingered neurocognitive dysfunction among non-head injury disability claimants.

The current study examined the over-reporting Validity Scales of the MMPI-2 Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008/2011) in relation to the Slick, Sherman, and Iverson (1999) criteria for the diagnosis of Malingered Neurocognitive Dysfunction in a sample of 916 consecutive non-head injury disability claimants. The classification of Malingered Neurocognitive Dysfunction was based on scores from several cognitive symptom validity tests and response bias indicators built into traditional neuropsychological tests. Higher scores on MMPI-2-RF Validity Scales, particularly the Response Bias Scale (Gervais, Ben-Porath, Wygant, & Green, 2007), were associated with probable and definite Malingered Neurocognitive Dysfunction. The MMPI-2-RF's Validity Scales classification accuracy of Malingered Neurocognitive Dysfunction improved when multiple scales were interpreted. Additionally, higher scores on MMPI-2-RF substantive scales measuring distress, internalizing dysfunction, thought dysfunction, and social avoidance were associated with probable and definite Malingered Neurocognitive Dysfunction. Implications for clinical practice and future directions are noted.

Memory complaints inventory and symptom validity test performance in a clinical sample.

Previous work in a disability-seeking sample has demonstrated that as symptom validity test (SVT) scores decline, there is a corresponding increase in subjective reports of memory problems as measured by the Memory Complaints Inventory (MCI). The current archival study examined this relationship in a clinical sample of active and retired military service members and their adult family members without overt potential for secondary gain (n= 191). General support for the previously evidenced relationship between SVT performances and MCI responses was found. Select MCI subscales (i.e., Amnesia for Complex Behavior and Amnesia for Antisocial Behavior) were not as strongly correlated with SVT scores as in the previously studied disability-seeking groups. The relationship between performances on an embedded effort measure and MCI scores was not nearly as robust as the relationship between MCI profiles and stand-alone SVTs. The potential clinical implications for these findings are discussed.

Estimating the accuracy of neurocognitive effort measures in the absence of a "gold standard".

Psychologists frequently use symptom validity tests (SVTs) to help determine whether evaluees' test performance or reported symptoms accurately represent their true functioning and capability. Most studies evaluating the accuracy of SVTs have used either known-group comparisons or simulation designs, but these approaches have well-known limitations (potential misclassifications or lack of ecological validity). This study uses latent class modeling (LCM) implemented in a Bayesian framework to estimate SVT classification accuracy based on data obtained from real-life forensic evaluations. We obtained archival data from 1,301 outpatient evaluees who underwent testing with the Computerized Assessment of Response Bias (CARB), the Test of Memory Malingering (TOMM), and the Word Memory Test (WMT) in a forensic evaluation context. Under various data models, Markov chain Monte Carlo methods implemented via WinBUGS converged to target distributions that permitted Bayesian estimates of SVT accuracy. Under the most plausible model (conditional dependence in test results), classification accuracies (expressed as area under the "trapezoidal" receiver operating characteristic curve ± standard deviation) were as follows: CARB = 0.765 ± 0.030, WMT = 0.929 ± 0.020, and TOMM = 0.771 ± 0.034. At decision thresholds that hold false positive rates at 0.02, the SVTs would detect invalid responses (true positives) at rates of approximately 35%, 65%, and 49%, respectively, for the 3 tests. Though LCM methods have limitations, this study suggests that they offer an approach to SVT evaluation that avoids methodological pitfalls of known-group research designs while retaining ecological validity that is absent in simulation studies.

Differentiating PTSD symptomatology with the MMPI-2-RF (Restructured Form) in a forensic disability sample.

The current study was designed to explore models of assessing various forms of Post-Traumatic Stress Disorder (PTSD) symptomatology that incorporate both broad and more narrowly focused affective markers. We used broader markers of demoralization, negative activation, positive activation, and aberrant experiences to predict global PTSD scores, whereas more narrowly focused markers of positive and negative affect were used to differentiate between PTSD symptom clusters. A disability sample consisting of 347 individuals undergoing medico-legal psychological evaluations was used for this study. All participants completed symptom measures of PTSD and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) (from which MMPI-2-RF scores were derived). The results indicated that demoralization was the best individual predictor of PTSD globally, and that more narrowly focused MMPI-2-RF Specific Problems scales provided a differential prediction of PTSD symptom clusters. Theoretical and practical implications of these findings are discussed within contemporary frameworks of internalizing personality and psychopathology.

Examining the potential for gender bias in the prediction of symptom validity test failure by MMPI-2 symptom validity scale scores.

Using a sample of individuals undergoing medico-legal evaluations (690 men, 519 women), the present study extended past research on potential gender biases for scores of the Symptom Validity (FBS) scale of the Minnesota Multiphasic Personality Inventory-2 by examining score- and item-level differences between men and women and determining the extent to which FBS scores were able to correctly identify men and women who were divided into credible responders (n = 837) and noncredible responders (n = 372) on the basis of performance on symptom validity tests. Results indicated that women had slightly higher raw FBS scores than men (d = .29), and significant differences between men and women in item endorsement were demonstrated for 14 FBS items. Step-down hierarchical logistic regression procedures indicated predictive bias (χ²Δ = 23.72, p < .001). Follow-up analyses indicated intercept bias (χ²Δ = 23.51, p < .001) but not slope bias (χ²Δ = 0.22, p = .64). However, using the test publisher's recommended FBS cutoff scores (Ben-Porath, Graham, & Tellegen, 2009), classification accuracies were similar for women and men (T > 80, h = -.02; T > 100, h = -.22, respectively). On the basis of these results, we conclude there is no evidence of clinically meaningful bias in predictions of symptom validity test failure made using FBS scores for men and women.

Memory Complaints Inventory results as a function of symptom validity test performance.

The extant literature has consistently outlined a limited relationship between peoples' subjective reports of defective memory and their corresponding performances on objective measures of memory functioning. Several variables have been proposed to explain this finding, but few studies have investigated test-taker effort as a variable of interest. The primary aim of the current study was to examine reported memory problems as a function of symptom validity test (SVT) performances in two independent samples comprising individuals involved in disability claims. The findings demonstrated that as various SVT performances worsened there was a corresponding increase in subjective reports of memory complaints as assessed by the Memory Complaints Inventory. Data also supported the previous literature demonstrating non-significant correlations between subjective reports of memory problems and objective memory functioning in those who passed SVTs. The potential implications for these findings are discussed.

Sensitivity of the test of memory malingering and the Nonverbal Medical Symptom Validity Test: a replication study.

The current investigation sought to replicate and extend the findings of Green ( in press ), which demonstrated superior sensitivity of the Nonverbal Medical Symptom Validity Test (NV-MSVT) relative to the Test of Memory Malingering (TOMM) in the detection of suboptimal effort during neuropsychological assessment. Nearly twice as many examinees failed the NV-MSVT than the TOMM. Profile analyses of the NV-MSVT demonstrated patterns suggestive of inconsistent effort in those who failed the NV-MSVT but passed the TOMM. A classification analysis employing the Word Memory Test and Medical Symptom Validity Test as external criteria for poor effort showed that the NV-MSVT is substantially more sensitive to poor effort than the TOMM and maintains an acceptable false-positive rate. Overall, results closely matched those of the Green ( in press ) study and extend the evidence that the NV-MSVT possesses better sensitivity to poor effort than the TOMM.

Associations between Symptom Validity Test failure and scores on the MMPI-2-RF validity and substantive scales.

This study examined the association between Symptom Validity Test (SVT) failure and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008), in the Forensic Disability Claimant samples described in the MMPI-2-RF Technical Manual (Tellegen & Ben-Porath, 2008 a, 2008b). SVTs used included the Word Memory Test (Green, 2003), the Computerized Assessment of Response Bias (Allen, Conder, Green, & Cox, 1997), the Medical Symptom Validity Test (Green, 2004), and the Test of Memory Malingering (Tombaugh, 1996). SVT failure was associated with significant elevations throughout the MMPI-2-RF overreporting validity scales and substantive scales. Pairwise contrasts between groups failing 0 and 3 SVTs revealed predominantly large effect sizes for the overreporting validity scales (d = 0.78-1.11), and many of the substantive scales, including the Cognitive Complaints (COG) scale. Results of this study demonstrate an association between SVT performance and elevated scores on the MMPI-2-RF. These results suggest that exaggeration of cognitive symptoms as demonstrated by SVT failure is also associated with overreported emotional, somatic, and neurocognitive complaints on the MMPI-2-RF.

Further validation of the MMPI-2 and MMPI-2-RF Response Bias Scale: findings from disability and criminal forensic settings.

The present study extends the validation of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) Response Bias Scale (RBS; R. O. Gervais, Y. S. Ben-Porath, D. B. Wygant, & P. Green, 2007) in separate forensic samples composed of disability claimants and criminal defendants. Using cognitive symptom validity tests as response bias indicators, the RBS exhibited large effect sizes (Cohen's ds = 1.24 and 1.48) in detecting cognitive response bias in the disability and criminal forensic samples, respectively. The scale also added incremental prediction to the traditional MMPI-2 and the MMPI-2-RF overreporting validity scales in the disability sample and exhibited excellent specificity with acceptable sensitivity at cutoffs ranging from 90T to 120T. The results of this study indicate that the RBS can add uniquely to the existing MMPI-2 and MMPI-2-RF validity scales in detecting symptom exaggeration associated with cognitive response bias.

Incremental validity of the MMPI-2-RF over-reporting scales and RBS in assessing the veracity of memory complaints.

The Response Bias Scale (RBS) has been found to be a better predictor of over-reported memory complaints than Minnesota Multiphasic Personality Inventory-2 (MMPI-2) F, Back Infrequency (Fb), Infrequency-Psychopathology (Fp), and FBS scales. The MMPI-2-Restructured Form (RF) validity scales were designed to meet or exceed the sensitivity of their MMPI-2 counterparts to symptom over-reporting. This study examined the incremental validity of MMPI-2-RF validity scales and RBS in assessing memory complaints. The MMPI-2-RF over-reporting validity scales were more strongly associated with mean Memory Complaints Inventory scores than their MMPI-2 counterparts (d = 0.22 to 0.49). RBS showed the strongest relationship with memory complaints. Regression analyses demonstrated the incremental validity of the MMPI-2-RF Infrequent Responses, Infrequent Psychopathology Responses, Infrequent Somatic Responses, and FBS-r scales relative to MMPI-2 F, Fp, and FBS in predicting memory complaints. This is consistent with the development objectives of the MMPI-2-RF validity scales as more efficient and sensitive measures of symptom over-reporting.