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8302438
Freedland, Kenneth Elliot
THE DETECTION OF FAKING ON NEUROPSYCHOLOGICAL TESTS
University ofHawaii
UniversityMicrofilms
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PH.D. 1982
Copyright 1982
by
Freedland, Kenneth Elliot
All Rights Reserved
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THE DETECTION OF FAKIN~ ON NEUROPSYCHOLOGICAL TESTS
A DISSERTATION SUBMITTED TO THE GRADUATE DIVISIO~ OF THEUNIVERSITY OF HAWAII IN PARTIAL FULFILLMENT
OF THE REQUIRE!ENTS FOR THE DEGREE OP
DOCTOR OP PHILOSOPHY
IN PSYCHOLOGY
AU:; UST 1982
By
Kannath E ll.~,ot Freedland
Dissertation committee:
Ian M. Evans, ChairmanJohn Digman
Ricnard Mar~off
Gilfred Tanabe.1/ ill~am r susn Laa
Page 8
iii
ACKNOijLEDG~~EKTS
This project ~ould no~ nave been poss~ble wi~nout tnd
support and assistance of several people. I especially wish
~o ~banK Jim C~aine, w~ose skill and ir.gecuity in tO~6nsic
assessment inspired my inte~est in this topic. Ln addition,
I am particularly indebt.ed to Ian Evans fo~ nLs hel pat.
eva~y stage in t.he progress of my dissertation. I
appreciate the valuable co~ments and suggestions provided by
Je~ry Brennan, John Digman, Richa~d ~arkoff, Gil Tanabe, and
Bill Tsushima, as vell as the equipment, lab space, and
otne~ ~esources prOVided by Jerry Boyar, John Gr~ffitn, Dick
Kappenherg, and A~thur staats. I am grateful to Robert
aaa ecn for pl:ovidi:1g access to his data during t.ll·: pilot
phase of this study. Finally, I vish to thank Neil
Ho~omoco, Mark Noza~i, and Leo ~ascua, who served as
research assistants.
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i'l
aBSTRACT
The presant .:i"Cudy was a test of several h y po t hea-es
derived from a theoretical model of faKing behavior and
faking detection techniques in neuropsycholog~cal
assessmen~. The ~o~el proposes ~ha~ pa~~~rns ot faEi~g on
neuropsychological test batteries can be analyzed in terms
of ce Lae Lcn sm ps aa on q (a) ~he sc phLa t Lca t a cn of the
sub ject; (b) the events to which the sub ject a ttributes his
or her apper en e dysfunctions. (c) the sympeollls and problems
which the subject illtends to fake; (d) strategies used in
at~emp~ing to fake believable defici~s vithou~ get~ing
caught; and (e) the perceived risks and potential benefits
of fakinge The 1Il0del predicts ~ha~ sUbjec~s tend to
selectively fake only tests which are perceived as be~ng
rel~vant to the intended symptoms, implyin~ that ~he results
of tests used ~o detect faking (such as the ~MPI) may not
correlate with patterns of faking on other tests in the
ba~ter1. An alterna~ive approach would be to develop
measures of faking which are intrinsic to th~ tests of
interest, based upon principles of faking de~ection. The
present exp~riment tested the selective faking hypoth~sis
and several ~ntrinsi= faKi~g detection measures. Sixty-ni~e
neurologically normal undergraduates were randomly assi~nad
to one of three conditions: (1) Honest Normal control: (2)
Spec~fic Faking (ius~ruc~ion~ to faKe specl£ic sensory-mo~cr
:ieficits secondary to head trauma: or (3) s Loba L Faici:lg
(ins~ruc~ions ~o faka unspecifiad symp~oms of t=~umatic
Page 10
v
brain i~jury.) A bat~ery of n~uropsychological a~d
extrinsic faking detection tests was ad~inistcr~d to all
subjects; detailed questionnaires and interviews were also
administered to the faking groups. The results ganer~lly
support the faking selectivity hypo~hasis, confirm
lim~tations in the use of extrinsic faking datectors, and
provide ~nitial data on a set of intrinsic measur~s.
Page 11
TABLE OF CONTENTS
ACK~OQLEDGE~E~TS. • • · . . . • • • • • • · . . . · . . l.J.i
DE~OGRAPHIC COMPOSITION OF SAMPLE ••••• 99
PRETEST AND I?OSTTEST QUESTIONNAIRES •
GROUP MEANS AND STANDARD DEVIATIONS
ADMINISTRATION AND SCORING RULES ••
1
'Iii
102
10 6
113
115
117
120
121
128
129
• 55
• 94
• iv
. .
. .
• • • • L4 9
• • • • 76
· . .
• • •
· . .· . .
· . .
• • • •
. . . .
• •
. . .
. . .
• • • • • • •
• • Q • • • •
• • • •
• • •
• • • • • • •
. . .
• • •
• • • • • • •
· . '"
· . . .
· . . .
o • •
. . .
• • • •
• • • •
· . . .
· . . .
. .
• • • •
• • • •
• • •
· . .· . . . . . .
• •
• •
• •
QUESTIONNAIRE FREQUENCY TABLES.
DISCUSS IO N. •
SUMHARY AND CONCLUSION.
CLASSIFICATION OF M~PI PROFILES
I!ETHOD.
oaDEa OF TESTING. • 0 • • •
RESULTS •
INSTRUCTIONS TO SUBJECTS. •
INTRODUCTION. •
ABSTRACT. • • • •
BIBLIOGRAPHY•••
REFERENCE NOTES •
CHA PTER I.
eHA PTER II.
CHAPTER III.
CI1APTER IV.
CIiAPTER v.
AI?P'ElNDIX 1.
APP ENDIX 2.
APPENDIX 3.
APP ENDIX 4.
APPENDIX 5.
APP EN DIX 6.
APPENDIX 7.
API? ENDIX 8.
LIST OF TASLES••
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vii
LIST 0 P' TABLES
Table Pagl::
CiANOVA for Other 'rests \lith Motor Components. • · · til
MANOVA for Cogni tive Nonlllor.oric Tests • 62
~ANOVA for Ex'trinsic Detection Measures • · • · • · b4
I1ANOVA for Intrinsic Dominant Measut'es. · · · · 65
MANOVA for Intrinsic Nondom.inan t C1easu.res · 66
MANOVA for Intrinsic Cognitive 1'!easures • • • • • • 07
Frequency of Reported NUlibers of Tests Faked. . • · 69
1 i1ANOV~ for Do aa na nt, Motor Performance ••••••• 59
2
3
1+
5
6
7
8
9 Breakdown of Nonlateralized Faking Score Maans••• 70
10 Breakdown of Lateralized Faking Score ~eans • • • • 72
11 superordinanr. M~PI validity Classifications •• 75
12 Sex CompositJ.on of Groups ••••••••••••• 99
Gt'oup Means and Standard Deviations •••••••
Detailad MM~I validity Classifications.
Self-Raported Faking Criteria Ft'equencies •
Selected Posttest Itam Ft'equencies. • •••
• • • •
100
117
120
121
125
• • 99• •
· . .
· . .
· . .
. . .. . . .. . .
Ethnic Composition of Gt'oups.
Sample Mean Ages by Group • •
13
14
15
16
17
18
Page 13
1
CHAPTER I
INTRODUCTION
Mal~ngering nas long been re~ognizad as a diagnos~ic ~r.d
management challenge in medicine, psychia try, and
pSyChology. Trad~tionally, it has been a probl~m .~~hi~ ~hd
~ilitaIY and the criminal justice system. In recen~ decad~s
i~ has also been the basis for many fraadu~en~ at~~mptS to
obtain unwarranted compensation in personal inJury,
disabili t y, and malpraci:.ice sui ts (Boyds·tun, 1980; McMahon &
Sa t z, 198 1) •
Numerous techn~ques for ~h€ de~ection of malingering have
been proposed, especially in neurology, ophthalmology,
audiology, and psychopa~nolo9Y. Until recently, bo~ever,
this sUbje~t has been almost completely neglacted in
cl~nical neuropsychology, despite incraas~g demand for
exp€rt neuropsychological testimony.
Clinical psychologis~s were granted expert .itness s~atus
in regard to brain dysfunctions in Buckl~r~. ~~cl~ir
(1966) and ~1~~. Qlli!~ ~~~ (1962). Until the
pub.Lication of Heaton, Smith, Lehma.n, a nd VO:j~15 (197d)
study demonstrating the fakability of ~opula~
neuropsychological tests, it had been ~idely ~ssumed ~ha~
such tests could not be used to fake r~alis~ic d7Sfur.ct~vns
(Z~sJCin, 1901). Th.lS e s s ua pc Lcn is yial(li~g to s xap e i c i s a
about the validity of test ~esults in cas~s in Jhich ~h2=c
are incer.tiv~s ~o malinge~. There have np.v~rthelass b8~r.
Page 14
2
few concom~tan~ s~udies on techni~ues fo~ toe d8t~c~ien of
faking on neuropsychological t~sts.
Mos~ of ~he ~2chniques publisned to date ~e~e inte:.d~d
for use ~ith specific symptoms such as various typ~s of
hea.c1.:l9 or vas i on impaJ.rme:lt. It has .carely been sugge::i~<i!d
that techniques designed to assess one typ~ of symptom might
also be useful wieh very different types of symp~oms. The
special lenses and filters used to detect faking in
op~ometric examinations, for example, have no apparent
relevance to the diagnostic challe~ges facing audiologis~s.
There has accordillgly been re.latively littla ti00ling of
ideas across specialties in which malingering is an issue.
A review of these diverse techniques suggests, however, that
most of them are variations on the same few underlying
strategies. The development of a theoretical frameworK
defining these st~ategies could enhance research on
malJ.ngering across specialties by enabling specialists 1.n
one area to benefit from findings in other areas. In
par~icular, such a framework could po~en~ially accelera~e
work on this problem within neuropsychology. Furthermore,
some tech~J.~ues have been based on unexplained yroup
dif ferences bet'tleen the test results of volun tl::-dJ:' pseudo
mali~gerers and patients wi~h genuine impair~en~s. SUCh
f~ndings are often difficult to ~eplicate dnd in any ~v2nt
de ~ot prcvide very persuasive evidence of malin~~J:'~r.g, i~
contras~ to tecn~~quas based en clear ra~~onal8s.
Page 15
3
! I~~£~l Anal.!ill 2i [~king, Q~:t1.Q.ll
Classifica~i~ 12§yg2
~alingering is jefined i~ DSMILI as the volu~~ary
presentation of false or grossly exaggerated physical or
psychological symptoms in pursui~ of ar. obviuus,
recognizable goal. Malingering is contrasted ~i~h
Fac~itious Disorders, which are also voluntaIy simulations
of symptoms, but which are generated in pursuit of lass
obv ious or ada pei ve goals. It is also dif feren tia~ed fro m
Conversion and other Somatoform Disorders over which the
individual presumably exercises no voluntary contxol a~d
which may in fact impair certain aspects of physical
functioning. Malingering therefore encompasses all
deliberate faking of disorders in pursuit of such goals as
financial compensation, whetner the symptoms are ~otally
fabricated or, as is often the case, exaggerations of
genuine pathology. Individuals with mild, worx-rela~ad
hearing losses, for ~xample, might grossly exaggerate thei=
sym ptoms in order to bolster disability claims. Al1:hough
part of the apparent bearing loss has a genuine organic
basis, thiS .culJ nevertheless be labell~d mal~~gcri~g.
The DSM-III definition of malingering ~s a narrow ~n~
ijn~ch encompasses only one of three Jiffer~nt tY2~s of
fak~~g descr:t.bed in t ne litera~ure. i1alin:jeJ:ing, H. ':3::3
DSM-I.II sense, has also been ca Lled faking bad, s i auLa t i.c n ,
and nega~ive mal~ngeri~g. The second ~ype nas bee~ ca:~eJ
Page 16
~
faking good, dissimulation, and positive malingering. !hesa
ra~ar ~o affor~s on ~he ~ar~ ot a pa~~e~~ wi~h a ;enu~ne
disorder ~o cover up pataolcyy anJ ~o ap~ea= ~o~]al.
~aling:ring also includes a third typa of faking which is
called "misat~ributionn. The symp~oms sean a n c ases of
misattribution may be genuine or exaggerated. In ~i~h~r
casa, the disorder is delibera~ely and talsely a~~Iibuted ~o
a particular etiology. It may be claimed, for example, that
a recent accident caused a disability which in teality was
the result ot an old illness.
So~e patients exaggerate their symptoms during
examina~ons as pleas for help or in order to ensure that
their problems will show up on the tests. Although this may
involve deliberate faking, it is usually ~o~ classified as
malingering or as a factitious disorder. In general, the
following discussion will emphasize the process and
evaluat~on of the types of del.ibera~e fan:illg wbicn ar a
usually labelled faking bad, malingering, or some equival:nt
term.
Although the psychiatric community has decided tha~
malingeriI:g is an appropriate diagnostic ca caqc r y , U1a~y
professionals disagrae (Hoplcinson, 1973; Kinstl:?I:', 1971;
zas z , 1970). T11e ~erlD "mali:lgeI:i.:::.~1t impl~:=s t aa e
intentional, conscious iaki~g ~s involvad. It is di£f~c~~t
at uest to aa ke valid inferences a bouc intent on t he La s i.s
of overt bahavior.
Page 17
5
a ~oral or legal verdict which usurps jUdicial author~ty.
Pinally, disorde~s which appear co be puraly psycnogecic or
manufactured someti~es have ~ndiscov~rsd organic ~tiologies.
In medical prac~ice, no nor qaa i c diagnoses sucn as
mal~ngering must accord~ngly be basad on defiui~J.ve,
positive evidence, not on rUling out organic etiologies dua
~o lac~ of ~vidence to the contrary. For chese reasons, as
well as to avoid libel and slander suits, many practicioners
avoid the use of the term. There are basically ~.o
al t ernat i ves. One is to use a diagnostic label which is
ambiguous in regard ~o the etiology or ~he authenticity of
an impairment. Audiologists, for example, use the terms
"!lonorganic hearing loss", "fu=.ctional hearing loss", or
~pseudohypacusisq. These lab€ls are broad enough to
incorpora~e conversion disorders, inten~ional fa~ing, and
other nonorganic etiologies. The second alternative is to
suspend judgment: In deposition or ~es~imcny on~ states
that valid test results were not obtained and that it is
tnerefore impossible to reach any conclusioas aDout ~ne
patient's status.
Although chis paper describes a variety 0: stra~egias a~d
techniqu~s for detection of "faking" or "malingering", the
above-me~tioned problems in ~he use of chas~ cer~s must be
taken seriously. This holds s ve n 'F1._ a bl a t a n.t ,
U!lm~s~akeable pacter~ of faking emerges d~ri~g c~3ti~~.
Page 18
The goal of malingeri~g ~s ~o simula~e believable
sym~toms and to do so ~ithout get~ing caught. This implias
~hat sophis~ica~ed faKing involves more than just ~ne
voluntary simulation of symptoms o~ intentionally poor t~st
performances. At least tbree other elemen~s may also be
present in addition to the simulat~on of deficits ~er s~:
attributions, faking criteria, and disguises.
Attribu~ions. Faking during a clinical examina~ion
usually begins during the taking of history. At this poin~,
the patient describes a scenerio ~hich is designed to make
the presenting complaints seem plausible ~o the examiner.
"Attribution" in this context thus refers to the patient's
assertion that his or her problems were caased by a
particular event or in a particular manner.
~akin9 criterl~. The implicit standard of ~erformance
for honest, cooperative, properly motivated pat~En~s is ~o
perform optimally on every test. This standard
~heoratically ~emains s~able ~hroughou~ ~he prOCESS of
assess~ent, assuming testing conditions ~hich ar8 conducivA
~o optimal performance and cocpe~ation. ~al~nger9rs; ~~
con trast, do not ha ve "best-effo!:'t" standards for t he Lr
~2riormances. They must ins~ead determine the ~ud:~ties a~d
~ev~rity of the symptoms they ~ish to fake. For ~xampl~,
someone ~ho ~ishes to claim toat a m~ld blow to ~he head aas
caused some degree of crain jamage must j~cije what ki~ds of
Page 19
7
symptoms ~o manifes~, wha~ they should looK liKe, and now
severe they should be. These criteria may be basad on
guesses, stereotypes, medical knowledge, or practical
cocsidera~ions such as ~he level of d1sab~lity rey~irej to
qualify for partic~lar benefits. The criterion for symptom
severity may also reprase~~ an attempt to maKe tne severity
of the faked symp~oms commensurate with the report=d
seriousness of the trauma to which the symptoms are
att~ibuted.
The TOTE (Tas~-Operate-Tes~-Exit) unit proposed by
Mille~, Galanter, and Prib~am (1960) provides a useful model
for the relationship betw~en covert faKing criteria and the
overt simulation of symptoms. The purpose of the initial
test phase in a TOTE is to determine whether a particular
operation (in this case, a response to a diaynostic
procedure or on a psychometric scale) is appropriate. A
second tast determines whether the operation was executed in
a manner congruent with the first phase criterion. Th1S
process continues in the form of a recursive feedback loop
until any incongruities have resolved, at wh~ch point ~xit
from the loop occu~s. New TOTEs are entered as additional
items or procedur~s are encountered. The relationship dmon~
these TOTEs is hierarchical, since criteria for a g~ven
procedure
res~onses
or item may be
(also see Staats,
shaped
1975
in part by ~rev~ous
fo~ a J~scussion of ~h~
discr~mi~a~ive stimulus p~oper~~es of pr~or responses i~
~esponse sequenc~s or chains.)
Page 20
8
In texms of the faking model proposed h9re, initial
symptom criteria are es~ablished. TaSK demands wittin the
examination context are compared to these cr~te~~a to
determina the performance characteristics which will (it is
hoped) pto'lide con vincing ev idence that 't:he sym p t om s exist.
and that they are not fake. The actual test performance is
monitored to determine whether it matches th= raquis~te
c l1a rac te r ist ics.
Some simulated symptoms resemble pathological phenomena
which are quite unlike normal functioning. OtDar symptoms
are manifested as apparent decrements in normal functions.
Some examples of the former aLe seizures, tinnit.us (r~nging
or other noisas in the ear), and scotomas (blind spots).
Examples of the latter are myopia (near-sightedness) or
part.ial deafness. Tne criterion for a simulated decreme~~al
symptom is a crudely estimated fraction of the person's
ac~ual abili t.y.
~~qui~. Belatively sophisticated malingerers are
aware tnat t.hey will not aChieve their goals if they are
caught. In some circumstances, detection may result in some
form of penalty or punishment such as court ~art~~l.
Soph~sticated malingerers accordingly attempt to appear
cooperative, as though they are trying their b=s~ but
nevertheless failing. They may use 3. vari=ty of aea ns to
disguise their fak~n3 behavic~ in ordar to m~Ka ~n~ir
deficits seem aore r-aalistic and t o avoid detaction. rhis
Page 21
9
is not mea~t ~o im~ly tha~ disguises are ueces3a~ily
discrete respons~s which diverge topogra?hically from the
faked deficits. A patient who fakes paralysis of a. limb,
for example, disguises h~s faking by simply not ~ov~ng ~t ir.
the presence of the axaminer. In other cases, however, th~
disguise may be completely sepe~ate tram the simulatic~.
Par instance, someone faking a hearing loss might pretend to
s~rai~ to hear relatively loud sou~ds. Facial and postural
expressions, no~ the auditory system, ar~ employed in this
particular disg~se.
The fear of getting caught may also affect the 5el~ction
of faking criteria. This occurs for two different reasons.
Pirst, mild deficits are easier to fake than severe ones;
therefore a mild faking criterion is less likely to be
questioned by an examiner. Second, choices of criteria may
be influe!lced by the effeC't:s they will have on the patie4t's
lifestyle~ For exam~le, fake unilateral deafness is seen
more often than faKe bila~eral deafnass. Bilatera~ jeaf~css
might merit a larger compensatory settlement, but the
patient wiShing to avoid later charge~ of fraud might nave
to ieign to~al deafness indefinitely. unilateral deafnass
is ~orth less money bat the patia~t is able to e~gage in
most of his oc her favocite activiti~s without arousing
suspicion.
Page 22
10
Sophistication. The ability to out~it tests is usua~ly
called "sophistication" in the literature on faki~g. The
operational definition of sophistication varias across
s~udies. !~ usually ~ncludes one or more of ~he follo~~r.g
elelDents: (a) intalligence as quantified by IQ scores,
wnich presumably correlates with such unmeasured vaLiaDles
as the ability to guess the purpose of and to outwit
unfamiliar ~est.s; (b) advanced familiariqr '.lit.h, ex pos uz a
to, or practice with the tests in question; and (c)
inst.ruc't.ion in techniques foz ou~wJ.tt.ing the tests.
Until re~atively recently, few studies directly examJ.ned
the effects of sophistication on the fakability of tests.
Anthony (1976) found a moderat.e posi~ive correla~ion bet.w~en
IQ scoras and the ability to fake pathological MMPI
profiles. Monro and Mart.i n (1975, 1977) demonstra t.ed ~ hat
practice and preparation can improve the ability of
volunteer subjects to simulate hea~ing losses
(ps~udohypacusis) on some t.es't.s, alt.boug~ other tas~s were
lass susceptible.
Sophis~icat.ion may affect any of tha aspect.s of faking
descr~bed above. _ieh t.he tight Kinds of ex~erier.ce,
pre par ati o n, or practice, some indi vid ua 1s e r e abl~ to
select be t t er att.ribut.ions and c r Lt ac La , La pc cv e t a e i r
5y~ptom simUlations, and disguise their dece~tions more
c c n va nca :".. g ly.
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11
Fax ing strategies. No si ngle faking stra teg y is ad.:q'l at ~
when an individual is confronted with an ent~r~ bat~~ry of
tests. Malingerers have to devise criteria, si~ulations,
and disguises which match the dema~ds of ~pecific t=StS a~j
diagnostic procedures. Some of these strategies are
p~edictable and, fortunately, leave ~easurable traces.
One such strategy, fract~1 ~!g£!, entails perfor~ance
at a crudely estimated fraction of actual abilities,
especially on tasks aeasured by interval or ratio scales.
In ter~s of the current ~odel, the individual attampts to
match his or her pe.rformance to a covert criterion which is
some frac~ion of ac~ual abilities. The standard whiCh is
selected is a compromise between the incentives to simUlate
impairmen~ and to appear cooperative.
A second strategy, giving s22rox~~atE S~~~2 to
questions, is often used in conjunction with open response
tests. The response to the question nHow ~uch is two plus
two?n might, for example, be five instead of four. In tnis
case, the si~ulation is an answer sufficiently incorrect to
be considered wrong. The disguise is the choice of an
answer which is approximately correct rather tha~ compl~t?ly
off base. Lik8 the fractional effort strategy, t h.i.s is
intended to g1ve the appearance t~at the icd~v~jual 1S
trying his best to solve the problem but is unable to.
The Ganser syndrome is s c aec i ae s I:2t;I:'I:~d 'to a s "th.:
syndrome of apPI:ox~mate answers" (Boydstu~, 19B1) • I t a s
Page 24
12
now classified as a factitious disorder rather than as
mal~ngering. It would 3evertheless seem apparent tnat
giving approximate answ~rs is an appealing faking st=at~gy.
It ~s probably inappropriate to rule out ~ali~gering OC the
basis of this pattdrn alone.
Anot.her ~nteresting strategy is to distributs !l~~~,
especially on forced-choice tests. Tn~ result is a
scattered pattern of errors interspersed .it~ correct
responses. The purpose of this strategy is to disguise
~n~entional ~rrors by "hiding" t.hem among correct answeIS.
This once again is intended to give the impression that the
individua~ is cooperative.
A corollary to this strategy is that malingerers often
begin making errcrs early in t~e course of a test.,
especially if they do not know in advance how many it=ms
will be adminiStered. Tbis ensures that there will be
sufficient opportunities to make plenty of mistakes
interspersed witn a comfortable numb~r of correct responses.
Another implication of this str~t2gy is that fakers
generally try t.o control the percentage of errors made on
such tests, and do not. guess randomly. Tue tandom t~spo~se
set is often associated with lack of coop~ration, although
it may occur for other re~sons including inability to t2ad
test questions. Its effects on the ~/'!PI are well kncv n
(Cott.l'3 s Powell, 1951; Dahlst..rcm,IIel':;h, & p a nLsr ron ,
1972). Faking and lack of cooperation dI:= £om<?t:':n,:;s
Page 25
13
considered to be synonymous. Althougn faking i~plies lack
of cooperation, 110 wever , it is a s pec La L case 0 f
un=ooperativeness which re~uires dctive, careful imprassion
management. Faking good, faking bad, and random respond1ng
result i~ very d1ffarant ~aPI profiles (Dahlstrom at al.,
1972). Furthermore, random respond~ng on an ability test
and random r~spo~ding on a self-report inventory such as th~
MMPI are vary different processes. It is essentially
impossible to "guess" when one already knows the correct
answer to an ability tes~ item. Knowlsdge of t~e correct
answer makes it necessary to decide whether to respond with
the correct answer or with an incorrect on~.
Research on faking strategies may eventually help to
resolve the long-standing problem of how to differentiate
deliberate malingering from other ~nonorganic" categories
SU=h as convexsion disorders. It is possible, for example,
that patients who exaggerate disorders in order to plead for
help, whether they are aware of doing so or not, may use
fractional effor~ strategies (which would be relatively easy
to rational~ze) rather than makiL9 deliberate errors of
commission. This would suggest that distributed ~rrors, for
example, may be more common malingerers than a~ong oth~r
nnonorganic" groups. Analysis of faking strateg1es ~ay also
illuminate the characteristic differences bet~e:n symptoms
of co~ve~S1on diso~ders a~d equivale~~ faKed symp~c~s.
Page 26
, £4
~~ection ~rateg~
The primary goal of most faking detec~ion stra~egies is
to establish ref~rence standards for ex~ected p~rformanc=s
wnicn make faked symptoms appear dev~ant, susp~cio:J.s,
improbable, or illogical by comparison. A cc up Leae nt ar y
strategy is to compare ~he test results or symptoms of tha
individual in ~uestion to patterns identifiAd as baing
cnaracterist~c of malingerers. The goal nere is to U!£.h a
reference standard rather tnan to find a deviation from one.
~ost faking detection strategies utilize one of four
differ.ent types of reference standard: (a) the test
profiles, norms, response curves, or symptomatologi~s wh~ch
are characteristic ofpatiants with genuine disorders; (b)
response curves or patterns based on well-established
empirical findings, principles, or laws of probability,
psychopbysics, learning, physiology, etc.; (C)
l;:)gic (at least rules of Aristotelian logic); and (d) t he
individual's own responses u~der a specified set of
conditions or on a particular time~ occasion, or trial.
There are tWO different '<HYs to fi nd
discrepancies between reference s c aa d ar ds a:ld
performances of individuals who are faking or ~xaggerating
their dysfunctions:
that the? cccu c,
wait for them ~o occur, or mak~ sure
Various detec~ion tecbnilu2s may b~ 3aij
~c be loca~ad somewnare along a co~tir.uum wbich Lan~es trcm
relatively naturalistic to relat~vely manipulative. .'\ t the
Page 27
15
~xtremely man~pulative and of ~he spec~rum ard teChni~u~s
which May be considered medically or psycnvlcgically
invasive or which may violate the individual's right to
pri vacy or other civ~l liberties.
Manipulative techniques are designed to disrupt or
discredit one or more of the ele~en~s of faxicg (i. a.,
attributions, criteria, si2ulations, and disgUises). To the
extent tha~ these elements are indapendent within a
particular context, they may be individually targeted by
various detection techniques. They are probably never
completely orthog~nal, however, and are sometimes clOSely
related or even inseparable.
Most f~ing detection ~echniques are based upon ona of
theee different strategies for finding deviations from
various reference standards~ the use of sUbtlet~es,
handicaps, and passively evoked responses.
SubtleS1i~. The goal of faking, as men~ioned earlier, is
to simulate believable symptoms without getting caught.
Fakers, in other words, try to present symptoms which ar: as
realistic as possible. Fake symptc~s v~ich seem ~lausibld
to a La ype r aon , however, may not seem rc:alistJ.c to an
experienced professional. Few nonspec~alists are awaI= of
all of the obscure principles, research findings, ani SUbtle
nuances wb1Ch ara known to their exami=ers. Via La t.~ or;s c f
th~se SUbtletieS rarely occur in the ~sse~swent of ~8=son~
.ho have genu~ne, ucaxagyecated dysf~nc~~or.s.
Page 28
16
Many fakers anticipate the barrier which lack ~f
sopn~sticatio~ ~ill present, and prepare by read~~g
textbooks, practicing, etc. Others, despite aot havi~g
prepared in ~4is manner, are nevertheless able to f~~ure ou~
what to do in the testing situation. As a g~naral =ule
~harefore, the more sophisticated the patient is, the more
subtle the examination must be in order to discriminate fake
from genuine disorders. Some clues are so SUbtle, or
require such a high level of technical e~pertise to
understand, that they remain vir~ual secrets outside of the
specialty. Anyone sophisticated enough to outwit these
probably deserves whatever he or she wants anyway.
Subtle techniques are relatively naturalistic, and their
primary targets are the patient's faking criteria. They do
not hinder simula.tions. On the contrary, the examiner may
even encourag2 simulations because they provide
opportunities for subtle violations to be observed.
DisgUises are also sometimes the targets of subtle
detection techniques. Experienced examiners can often spot
common disgUises. Some disgUises also are associated with
characteristic signatures on particular tests.
SUbtle teChni~ues are the most common means of ob~ai~~~g
deviations from three of the types of refe=ence standards
mentioned above, ~.e., genuine dysfu~ctions, rules ai lc~~c,
ana laws, principles and empirical findings. Su~tld
~echni~u~s are also used in ~atching individual p8~fo~~all~8s
Page 29
eo· cbarac~er~stic paeeerns of fakingu
17
Tnis incluues cr.e of
the most pervasive methods, behavioral observa~ior. of
pae~ents during testing. For e xa apLs , it has b e-e n
freyuently repor~ed (e. g. DeJong, 1979) ~hae ma:inger:ars
tend to act "defensive" during examinations wherea.s pa t Le nt s
w1eh conv~rsion disorders may se~m indifferent or may ~ven
welcome repeaeed diagnostic testing.
Many of the techniques used in psychological teseing are
subele ones. Some ocher professions rely on a broade~ range
of detection strategies, although subtle techniques a"' Q--perhaps the most frequen~ly used ones in aUdiology,
ophthalmology, and neurology as well as in psychology.
Some of the best known subele eechni~ues were developed
for the ~MPI. One of these involves comparison of subtle
versus obvious item endorsements (Anthony, 1971; Burkhart,
Gynther, & Chriseian, 1978) • Item subtlety on the ~MPI
refers to the degree to ~hich an item's content has any
apparent psychopathological connotation (Burkhart at 011.,
1978) • Fakars usually fail to endorse many of ehe sub~le
items tha.t are associated with the pathologies th8Y wish to
sa au La ee, 4hile at t~e same time endorsing most ot ehe
obvious ones.
Several of subtle e ecnn i1:l11':S could be. ,
eaZ1~Y
adapted for use ':'n neuropsychological t~sting. A
part1cularly promis1ng subele eecnni~ue 1S based on a
probabilist.ic analog of Guttman scal~nlj (Golds1:o:i:1, 194'j;
Page 30
18
N'lnnally, 197~; Fre'=!dland & c ra Lr;e , Note 1). rha itaills in a
Guttman scala of an ability are dichotomous (paGs or fail)
and are graduated by difficulty. In a perfect Gl1ttma~
scale, honest subjects pass all of th~ items below a
particular level of difficulty ar.d m~ss all of the item£ at
or above that level. As previously discussed, fakdrs often
begin making intentional mistakes early in tha course of a
test and distribute errors throughout the test. On a
Gut~man scale, this produces a scattered pattern of errors
on items below the ceiling level (the most difficult item
answered correc1:ly.) In Guttman scala terminology, these
are called I'failed, should ha ve passed" (FSHP) errors. 0 n a
perfect Guttman scale of an ability it would be reasonable
to assert tha~ FSHP errors should ~ot occur, .given hO!l~st
respondinq. An FSHP sum score could then be added to the
obtained scala score to determi~e a SUbject's trua lavel of
ability, in a manner analogous to the use of the correction
factor (K) on the 11!'1.PI.
There are a nu~ber of problems with Guttman scalin9 Which
preclUde it from being applied in this way. First l it is
based on a deterministic scalir-g model which assum~s 't.h~t
every item is perfectly reliable, corr~lates perfectly ~ith
tAe partic~:ar at~ribute be~ng measured, and d~scrimir.atas
perfectly betwe~n p~ople at the level of ~bility it
represer-ts.
as s uup t Lons
Very tew scales
(Nunnally, 1970).
mee't: these ur, r ae l.as ti c
Page 31
1 9
In Gut~man scalogram ar.alysis, ~he i~de~ of
raproducibility is a measure of ~ne degree ~o whicb a se~ of
items departs from these deterministic assump~ions.
Technically, anything less ~han perfec~ raproducibili~y
violates the rigid assumptions of the model. P~rf~ct
reproducibility is almos~ never a property of ~on~rivial
scalas. Fortunately, pro~abilistic analo~s ot ~ha Gu~~m~n
model ~~ accomodate measurem~nt error. SCales based on
such models consist of dichotomous items graduated by
difficulty, as in Gu~~man scales. Absolute boundaries
between p.asy and difficalt items do not exist in
probabilistic scales, however. This implies ~nat honest
sabjects may miss some items which are easier than th~ir
ceiling level. FSHP errors per se would accordlngly r.ot
constitute deviations from a reference s~anda£d as they
would under the assumptions of the Gut~man model. An
unusually large number of such errors, though, would seem
suspicious. The reference standard for a probabilistic
analog of a Gu~~man scala could therafore be defined in
terms of th~ level of FSHP's typically produced by honest
respondents.
The second problem with this tQchnique is that the number
of oppcrtun~~ies ~o make FSHP errors is li~i~ed by ~ne
individual's true cailing. A practical solution to this
~robl~m ~s to ~xpaad tne range of the scale to include
easier items. The variability of tha ceiling across
i~dividuals also su~ges~s ~hac ~ercentage ?SHpfs shou:~ be
Page 32
20
used instead of raw FSBF scores. However, i~ is no~ ye~
known how variance due to tbe ceiling effect would affect
the dis~ributions of faked and honest FSHP scor~s.
A related problell is that the apparent ceiling i?roduced
by a faker may be below thG true ceiling. Unfortunately, a
false ceiliug cannot be differentiated from a true one.
There is no vay to kno1l whether a sUbject should have b ee n
able to answer any additional i~ems above the obtained
ceiling. But although there is clearly an incentive for a
fa~er to produce a low cai~ing, there is a countarvaling
incentive to disguise the faking by producing a somewhat'
bigher ceiling. This usually ensures that the subJect will
have an adequate number of opportunities for fSHP errors.
Finally, several of tests most Widely used in
nearopsychological practice consist of items wbich are
graduated by level of difficulty. The Information subscale
of the Wechsler Adult Intelligence Scale (iArS) is an
example. However, item characteristic curves for th=se
tests a~e derived from data on normal samples. In some
cases these curves may not generalize v~ry well ~o brain
damaged populations. Organic pathologies sometimes distort
tas~ difficulty hierarchies in surprising ways. For
example, it would be logical to assu~e that in a normal
population, the ability ~o read words ~s ra~u~si~= or. the
ability to r~ad letters. In one form of alax~a, how~ver, ~t
is possible to read words ~ithou~ being able to id~ntify the
Page 33
21
letters which comprise the words. There is no easy solution
to ~bis problem. ~s with other 5ub~la ~echniques, the
examiner ~ust be thoroughly fam~liar wi~h syndromes Which
produce test results like those seen in faking, especially
unusual syndromes. A seemingly excessive percen~age of ~sap
errors mus't not be treated as definite peoof of faking,
particularly not in isolation from other findings.
The Guttman and analog Guttman models do not fit forced
choice ability tests beca use some i tellS lIlay be answered
correctly by guessing. Never~heless, it is possible to ase
a deta~ion technique on such tes'ts ~hich is similar to the
one based on ~he probabilistic Gattllan !lodel. If a ceiling
can be arbitrarily defined, the typical pattern of scattered
errors on relati~ely easy items can be measuIed by tbe
proportion of sub-ceiling errors. Among tests commonly used
in neuropsychologi=al practice, the Peabody Picture
Vocabulary Tes't (PPV'r) is ideally saited for this purpose.
Freedland & Craine (Note 1) presented a case study
demonstrating the potential of the PPVT in this type of
application. 'rhe patient had a history of a relatively
severe traumatic brain injury. He was standing ~rial on
several felony charges and was axamined under cour~ order.
On initial testi~g, his PPVT IQ ~as 7~. It=m a~alysis
revealed the characteristic pattern of scatterad arro~s, and
the results of several other tests similarly suggest~d a
laCK of cooperatio~. The patient was confrontad ~ita ~~eSe
findings and admitted that he was intentionally =xagge=a~~ng
Page 34
Ids deficits.
22
Upon ratesting, his PPVT IQ was 135 and faw
sUb-ceiling 9rrors vere made.
The pJ:obabilisti:: Gut1:man technique is similar to the
analysis of in~IateS~ scatter. iatson (1965) compared wAIS
intrasubtest scatters of ~O male schizophrenics with those
of ~o patientS with evidence of cerebral lesions (diagnostic
criteria wera not described in any gIaa~er detail.) The
hypothesis was that cerebral damage produces a relatively
constant defici t manifested by failures on difficult items,
whereas 'schizophrenics' failures would result from lapses of
atten~ion or delusional interjections. It was predicted
that the scaizophrenics wo~ld show a scattered patteIn of
fai~ures on easy items. Two measures of intrasubt9st
sca~ter were used: number of runs and proportion of correct
responses. Runs were defined as any set of consecutive
correct or consecutive incorrect responses. (This measure,
it should be noted, is contaminated by differences in
ceiling levels and by relatively low reliability of
No significant differences between theindividual items.)
groups were found. For present purposes, it would be
important to know whether scatter .as lower than expec~ed
among schizophrenics or higher than expected a~onq brain
damaged patients.
available..
This information, unfortunately, is nOt
Anothar promising subtle technique is based on si9nal
detection th~ory (Green and Swats, 1966; Swets, 1973; 3~8tS
Page 35
23
and Green, 1978; Tanner and Swe'ts, 1954). Applicatior.s of
signal detection in the evaluation of fac~itious disorders
and faking have been reported by Chaiklin and Vent=y (1965);
Grosz and Zimmerman (1965); Hopkinson (1973); LezaK (1976);
Pankratz, Pausti, and Peed (1975); and Theodor and
Mandelcorn (1973). The basic principle und~rlying this
technique is that random guessing on forced choice t~sts
tends to result in a certain number of correct responses by
chance alone. rhe maaber of correct responses expected by
chance is eqaal to the namber of items divided by the number
of response alternatives. Over a sufficiently large number
of trials or ite.s f individuals who kn~~ none of the correct
answers or who can perceive none of the stimuli, will tend
to score at the level e%pec~ed bi chance because they are
guessi~g. Scores Which deviate significan'tly from chance
indicate that the person is not guessing. Usually, scoring
above chance suggests honest effort whereas scoring balow
chance suggests fa~ing.
ihen a malingerer is confroneed with a two-aleernative
forced-choice test, "there see II S to be an intuitive
perception 'that correctly answering half of the time is
excessive for someone with a disability" (Pankratz, Pausti,
& Peed, 1975, p. ,.. 22) • As a result, f a.lcers t end to cone rol
the percentage of errors so that fewer correct responses
occur than ~auld be expected by chance. Tais ~ould seem to
imply that fakers usually know when they are ~aking ~istakes
on such tas~s and that they ery to track ~he cumulative
Page 36
24
percentage of errors throughout tho: test. Lazak (1976),
bowever, suggests that feedback should be included in this
procedure. The feedback consists of a verbal cr other
signal iDdica~ing whether the preceding response was
correct. The comparative effectiveness of the signal
detection method with and without feedback has not been
systema~ically s~udied. Since f&edbact probably i~proves
one's ability to monitor and control cumulative percentages
of errors, it may increase the percentage of errors beyond
chance levels and it lIay promote consistency over repea ted
tastings. The former would be an asset in faking detection
whereas the latter w~uld suppress test-retest
inconsistsncies which might otherwise be found.
~ith or withoat feedback, departures from chance levels
of accuracy obviously provide valuable information about the
pa tieo t' s fllllctioning. Signal de'tection lIethodology,
however, could potentially yield more information than has
generally been recognized in 'this area of applicatio~. The
advantage of signal detection over classical psychophysical
methods is that it provides a means of separating two
different aspects of choice~ made under cond~'tions of
uncertainty. The first aspect is sensitivity, the
individual's ability to discriminate between the 'two
alternatives. The second is the individual's bias or
decision criteria fot Choosi~g ana al'ter~ative aV8t 'the
other on any given trial. sensitivity is measured by the £~
statistic, which indicates the Jistance between the signal
Page 37
25
and noise distribu~ions. Bias, O~ th~ decisio~ cri~ar~o~,
is indexed by a2SA. I~ Fisherian 5~atist~cal decisio~
theory, beta is equivalent to the probability of Typ~ II
error. Both of these statistics are easily derived with the
aid of published tables fro~ the probabilities of hits and
false alarms. A receiver operating charagteristic (ROC)
curve is obtained by plotting the probability of hits
aga~nst the probability of false ala~ms. The form of ~ne
curve is a f~nction of~. ihen ~ is equal to zero (i.e.
the subject is responding randomly), the curve is an
ascending linear diagona~. Curvilinear departures from ~he
diagonal represent increasing levels of sensitivity. ~
is represented as a single point along the ROC curve,
indicating the joint probability of hits and false alarms.
~ can be increased or decreased by ~anipulating the
payoff matrix, vhicn defines the rewards and penalties
associated vitn nits, misses, COIrec~ rejections, and false
alarms. It is assumed that ~ and~ are orthogonal, so
that manipalating payoffs alters decision criteria without
affecting sensitivity.
Most applications of signal detection th~ory to the
assessment of fa~ing have been restLicted to the a~alysis of
sensitivity and have failed to utilize the potentially
valuable i~formation prOVided by~. In tn: current
model, the payoff matrix depends upen tne pote~~~al ga~r.s tc
be accrued by faking d6£icits and the penalties for getting
Page 38
26
caught, a~ leas~ as these are unders~cod by tne pacien~.
The potential payoffs for faking rewaxd misses and penalize
ni~s. They may also penalize false alarms. If che sUbjec~
honestly does not know whether the stimulus is ~resent on a
par~icular trial, the safes~ way to feign impaiImen~ is ~o
respond "no". This would res~lt in a low false ala=m rate.
The po~en tial penalties for getting caught are avoided by
disguises, which are in this case mirror images of ~he
simulations. In otaer words, disguising probably ~ends to
!!~s~ the hi~ and false ~larm rates and reduce the rate of
lIisses. These are testable hypotheses. In one of the only
systematic studies of signal de~ection ~~ch~~ues in
functional hearing loss assessment to date, Chaiklin and
Ven~ry (1965) reported that pure-tone audiometry false alarm
rates were considerably higher among nonfunctional patients
than among patients diagnosed as having funC"~ional losses on
the basis of independent criteria.
Al~hougb signal de~ec~ion methodology may prove to be
valuable ~n this area of applica~ion, several fac~crs may
limit its contribution. First, the statistical assumptions
underlying tne signal detect~on model are seriously violated
in certain applications. In particulax, ~~ dnd ~ are not
alliays orthogonal (Long & llaag, 1981). In ot.he r words,
sen sa ti VJ. ty and bias are correlat.ed in some applica tio ns ,
I~ is r.o~ unlikely that the payoff [email protected] ~~ faKir.g
simultaLaous11 affect bias and apparent sansitivi~y ~~th~~
tnan bias alone. Faking on signal de~ec~ion ~aSKS, at~~t
Page 39
all, consists of artificial reductions in
27
apparent
sensitivi~y.
The second limitation is a practical one. ~umerous
trials under various s~imulus and payoff conditions are
!:'equired in order to fit an ROC curve. This pr oc edu r e is
accordingly too time-consuming for routine uSe. It is
possible to rule out guessing lii~hin a manageable number of
trials, however. As long as ~ is significantly greater or
less than zero at a single point, random guessing is highly
improbable.
Pinally, departures from chance levels of accuracy must
be interpreted wit.h caution. For example, there is a form
of scotoma (visual field deiect) in which the patient scores
well above chance on a signal detection task yet Donestly
reports being unable to see the stimulus on any of the
trials (ieiskrantz, iarrington, Sanders, & Marshall, 1974).
This discrepancy between performance and verbal report co uLd
easily lead an examiner to conclude that the patient has an
hysterical disorder or is malingering, yet the disoLder is
in fact due to a focal lesion in primary visual cortex of
the occipital lobe.
Handi£s22_ Onder normal conditions, some symptoms are
relatively easy to simulate. Subtle, ~aturalistic det~ction
strategi~s are therefore not always suffic~en~. An
alternative stratagy is to handicap the simulation. This is
usually done by maKing it difficult e~tn~r ~o match or
Page 40
28
maintain fa~ing criteria. Although faking cri~eria and
si~ulations are both targets of handicap techni~ues, i~
would be difficult in practice to ascertain whether a given
handicap affec~s ~he main~enance or ~he matching of a
criterion. Disguises are rarely the intended targets of
handicap techniques.
aandicap techniques must meet two basic requirements in
order ~o be diagnostically useful. First, ~he ~echnique
aust create a discrepancy between a reference standard and a
simula~ion wbich would not have otberwise occurred. Second,
the technique must no~ have a similar effect on genuine
symp~oaatology. Pake symptoms must be susceptible to the
procedure whereas genuine symptoms aust be imEerv~ous ~o it.
Since the purpose of the technique is to cause variance in
simulated symptoms, a~ underlying assumption is ~hat genuine
symptoms will remain relati~ely invariant. Soae symptoms
vary independently of ~he diagnost~c procedures used ~o
measure them, however. This implies that some handicap
teChniques may not be very useful (or mus~ a~ least be used
only with considerable caution) in evaluating the redlity of
symptoms which tend ~o be unstable in genuine cases.
Dozens of creative, ingenious handicap techniques hav~
been published, although relatively few hdve b~en stuJi~d
sys~ema~ically. For example, ~udiologists scmetimes use the
Swinging Story techni~ue to evaluate unilateral deain~ss.
In ~his procedure, a s~or1 is r~ad to the pat~eu~ t~rcugh
Page 41
29
stereo headphones. A word is f~rst presented to one ear,
ai~er Which ~he nex~ word is present=d ~o the opposite :ar.
This cycle repeats until the entire s~ory has been read. I~
reality, the SUbject is being presented with thre~ stories,
not just one: one story in each ear, and one consisting of
~he entire series of words combined. The patient is thp.n
asked to repeat the s~ory to the examiner. A patient with a
genuine unilateral hearing loss will repeat the story hea~d
in the intact ear. A patient who is faking such a loss,
however, will usually report the combined story. This is a
difficult test to ou~wit, even for a person Who understands
the technique.
An effective technique in ophthalmological practice
involves the use of polarized lenses. Patients complaining
of unilateral visual impairment are ins~ructed to look
through a binocular apparatus with both eyes open (the
examiner is able to tell if the pa~ient shuts one eye.)
They are then asked to read a paragraph out lOUd. The
examiner gradually rotates a polarized lens in front of the
good eye; this progressively impairs the visio~ on that
side. Patients who continue to read are using their
supposedly blind eye to do so. When carefully done, many
fakers are unaware of the t~ick that is being played on
them. A closely related technique involves the use of color
filters and stimuli. For exam pier the r~d letters on a chart
become i~vis~ble to an eye which is locking through a red
filter. The patient is instructeQ to read a char~ chat
Page 42
30
displays green and rad let~ers while green and red fil~ars
are placed in various ~onocular and b~nocular co~binations.
Another example is a techni~ue so~etimes used in
neurological examinations (DeJong, 1979) • It waries well
with patients who claim to be paralyzed in o~e arm with
tactile sensitivity preserved. The examiner taxes the
patient's arms and stretches them out so that the hands are
·bacx to back with the thumbs pointing down. The hands are
then crossed, clasped, and pulled up towards the patient's
chest as the hands are rotated upwards. The patient is then
inst.rlleted to try to move whichever finger the examine.r
touches. In' order to appear coopera~ive the patient must
move the fingers on the good hand When they are touched.
Bowever, it is very difficult to tell which hand a
particular f~nger is attached to when the hands are clasped
in this ~nusQal position. As the er.aminer rapidly touches
different fingers in a random sequence, patients who are
faking almost inevitably move the fingers on toe hand that
is supposed to be pa.ralyzed.
Special aandicap strateg1g§. Pour types of hand~cap
strategies warrant separate discussion. One of these is
~~~~ting. An assumption underlying this stratdgy is tnat
the passage of ~ime handicaps the maintenance of va ra cua
cr1=eria. It is quite difficult in seme cases to ~a~~ta~n a
consistent criterion over time and r~peated testings,
especially a fractional affort criterion. Th3 strategy
Page 43
3 1
depends on two other i~portant as~~mptions, however, whi=h
are often overlooked. Fi~st, the variance at~ribu~able ~o
critexion instability must significan~ly exceed ~he variance
due to the test-retest instability of the test or procedure.
Sacond, as with o~her handicap strategies, genuine symptoms
must be ~ore stable than their simulated counterparts.
Aside from the use of sUhtlety, retesting is one of th~
most commonly used strategies in psychological assessment.
This is an extension of the traditional interest in the
raliability of measurement in psycaology. Retesting is also
particularly illpo.rtant in the evaluation of faked motor
dysfunctions, since per~ormance instability ~s one of the
only readily available objective ~easures in this area.
The second noeewor~hy handicap strategy is the
int~asubject experiment or!=] ~~3~. The object is to
intervene in the faking process such that a difference
between baseline and intervention behavior or symptomatology
is observed. These procedures are rar~ly conducted as
formal single-subject experiments but are instead informal~
applications of the same principles.
The most cOllmonly used technique based upon the liithin-
subjec~ experimenc
requires sustained
strategy is ~§~~~gn.
concentration and effor~.
Faki:lg cf~en
Even un de r
optimal conditions, it is frequant11 difficult to
consiste:ltly match faking crit~ria and to maintain 8ffec~~ve
dis'} ui sas. 31 dis~rac~i~g ~he pati~nt or by setti~g up
Page 44
32
sicua~ions in which he or she will be caught off guard, the
examiner may hav~ the opportunity to observe behaviors which
contradic~ tae patient's claims. For ~xample, patients who
fail to ~aintain their balance during the Romberg tast (part
of the standard ~eurological axamina~~on) may be seen atter
the exa4ination p~tting their pants on without losing their
balance. Distraction is an especially valuable teal fer
discrediting relatively complex, demanding simulations which
involve elaborate role-playing.
A third type of handicap strategy, scrambling, is
addressed speci£ically to the problem of sophistication. It
is often possible for a sophisticated faker to maintain and
.a~ch realistic criteria during tes~ing procedures which
~ere developed for use with honest, well-motivated patients.
As a countermeasure, the examiner may alter the test to
confuse a patien~ suspected of faking. For example, the
methods of ascending and d~scending limits are among the
standard procedures for determining aUditory thresholds. An
aUdiologist vho suspects that a patient is fa~ing may
present a series of tones and randomly vary taeir
intensities across trials. iithout a smoothly ascending or
descending set of stimulus intensities, tbe patie~t is
unable to establish a stable faking criterion. As another
exa~ple, the order of items on a paper and pancil test m~gnt
be sc=ambled to confuse someone who is familiar w~th the
test.
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33
As these examples illustrate, scrambling is not purely a
handicap strategy but is a hybrid of handicapping and tha
ase of subtla~y. The purpose of scr~mblin9 is to render
useless the patientfs knowledge of subtle principles or
phe nomena ..
The problems of variability which were discussad in
connection with other strategies also pertaiL to tAe use of
scrambling. When a te st is scrambled, it is being presen ted
in a manner whicl1 differs from the test as it was or.igillally
standardized. The norms pUblished on the standard test may
not apply to the scrambled version of the test, and
scrambling may increase the variability of honest test
perfor~ance_ It would be therefore be useful to develop
separate norms for scraabled versions of tests.
The reference standard in ~ost handicap strategies is the
patient's own behavior at a particular time or under a
specific set of con1itions. As in other applications of
single subject methodology, the SUbject serves as his own
control. scrambling techniques are exceptions because ~OSt
of them use some of the reference standards usu~lly
associated with the use of subtlety_
This also pertains to a fourth type of handicap st~ategy,
!~lusorI ~~lldn~~. Illusory challenge tests are ~asy
enough that moderately or even severely i~pai=ad patient3
ought to be able to Jo relatively well on them. They are
presented in manner, however, which is intand~d tu make ~hem
Page 46
see~ more challenging than they really a~e.
34
The goal is to
trick fakers into ~stablishing faking c~iteria which are ~n
concert with the illusory level of difficulty rather than
~ith the actual leval. The Fifteen-Item ~emo~y Test (Lezak,
1976; Bey, 1964) is a good exa~ple of this technique. The
instructions to the sUbject repeatedly s~~ess that there are
fifteen items to be recalled. BOllever, the i "tems ar e
interre~ated and grouped such that they can be reconstructed
frolll as little as three bits of information.
fassi vel! eV9ked respoQ~ Wi). One of the least
fallible and most valuable de~ec~ion strategies is to elicit
an involuntary response ~hrough a supposedly dysfunctional
pathway. In evoked potential audiOMetry, for example, an
ele~roencephalographicrecording is made while the patient
is passively SUbjected to auditory stimuli. Extensive
biofeedback training might enable a patien~ to suppress some
types of evoxed potentials, but it is very unli~ely that
even this would be sufficient to outwit such a test.
lnother example is the testing of the pupillary reflex. The
pupil of a blind eye does not react to bright light, but the
pupil of a functioning eye will constrict.
Evoked rasponse strategies are becoming iucraasinjly
important as impressi va advances in diag nostic t ecnno Lcq Les
are made. Tbese tachni~ues a~e also valuable in test:r.9
young children and severely handicapped p~tients who are
unable to cooperate with mor~ active procedures. Or.. the
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35
other hand, some procedures have become con~rove~s~al,
labelled unethical, or sUbjected to regulation. Tbis is
par~icularly true of one type of galvanic skin response
alld:i.ometry. The pa tien t is classically conditioned to a
tone using electric shock as the acs. The GSR is then
measured during CS trials. A response indica~es that the
patient is able to hear the tene. This procedure, like the
llse of electric shock in behavior modification, has aroused
pllblic concern and has in fact been banned in Veteran's
Administration settings (Yates, Note 2).
Methodological Issues in Research on Paking
!Ipes ~ research
?akabilitI ~~. One of the classical defi~itions of
a valid test is that it meaSllres what it is intended to
measure. If the outcome of a test can be influenced by
intentional fa.king, its validity is threa~ened. Some
investigators have attempted to demonstrate that a
par~icular instrument is not influenced by faking, while
other have tried to de~onstrate the opposite.
Faking detec!i29. studie~. Since many tests have been
snown to be susceptible to faking, attempting to develop
fake-proof tests (except, perhaps, passively evoKed respo~se
tes ts) can be an exercise in futility. A more fle zLbl,e
tactic is to acticipate the fakab~lity of a test and bu~ld
faking detection measures in~o it. The best known e~ample
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36
of suc~ a tes~ is tha ~MPI, wbich includes three "val~di~y"
scales (L, P, and K).
A somewhat different approach is to develop tests whose
primary or even sole purpose is to detec~ faking. The
Fifteen-Item Memorization Test is an ~xample of such a test.
It has li~tla or DO diagnostic value as a test of memory,
but it may be useful as an indicator of fa~ing. SUCh tasts
are usually given in addition to the routine diagnostic test
ba~ter1, not in isolation.
There are tvo assuaptions in this approach vhich need to
be exaained. tirs~, it implies ~hat ~here is a general
faking set which permeates the sUbject's behavior throaghout
tas ting.. second , it assumes that if faJcing is evident on
one measure (or on a limited number of measures), one may
co~clude tna~ the sUbje~ is faking or exaggerating on some
or all of the other tests in the battery. Althougn these
assumptions may be warranted in many cases, they may be very
misleading in others because tney ignore individual
differences in sophis~ication and ~n fa~i~g criteria. Por
example, a person who wishes to fake a circumscribed motor
dysfunc~ion woald try to do poorly on tests of motor ability
but vould probably nave little incentive to fa~e bad o~
tes~s of vocabulary, arithmetic, or spatial relations.
The most widely used technique for detecting faking on
neuropSyChological tests is b~sed o~ the same ~enuous logic.
~an1 examiners rely on th~ validity scal:s of ~h9 ~MPI to
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37
determine whether patients are faking on neuIopsychological
batteries. Fake bad MMPI profiles are quite common among
patients Who have c~ear incentives to fake brain
dysfunctions on neuropsychological tests. In fact, Heaton
a"t aL, (1978) were able to discriminate between cooperati ve,
nonlitigating trauma victims and normal volunte~rs asked to
fake brain dysfunctions on the Halstead-Reitan Battary, with
lOu'; accuracy on elle basis of MMPI scores alone. Al~hougll
the same samples vere used for both analysis and
classification phases, this is nevertheless an impressive
finding. However, it should not be taken to imply that
fa~ing on the aalstead-Beitan (or any other
neuropsychologica~battery) is always accompanied by fake
bad profiles on the ~MPI. Tlle !MPI indicators reveal faked
psychopathology, not faked brain damage. Patients faKing
brain damage may also wish to fake various types of
psychopathology if they believe it wi~l bolster thair case
or if they naively believe that brain damage inevitably
causes Rinsanity". Sophisticated ma~ingerers with well
defined faking criteria, however, may see little to gain in
faking anything other than the particular symptoms they .isn
to be compensated for. Some may even fear that generalized
faking bad ~ould arouse suspicion, thereby jeopardiz~ng
their chances for success. In summary, failure to detect
faKing on tha ~MPI oc on tests develop~d especially fer tOG
detection of faking, does not nec~ssarily warrant the
conclusion that patients have g~ven tbeir best effort o~
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38
other tests in the battery. Conversely, an apparent pattern
of faking on one measure does not necessarily predict faking
on unrelated measures.
It is a mistake in the detection of faking to place too
much weight on individual ~es~s or techniques, including
ones which are backed up by impressive data. Negative
findings on one test cannot always be generalized ~o o~he~
tests. Also, as previous examples have illustrated,
suspicious test patterns which suggest faking or
exaggera~ion are sometimes caused by organic dysfunctions,
conversion disorders, or factitious disorders. Conclusions
about the validity of test results should be based on as
much information as possible. T~is is especially impor~ant
in neuropsychological assessillent. Due to the vast
heterogeneity of brain dysfunctions, judgments should be
based on the convergence of numerous indicators.
eersonali~y research. T~e goals of personality research
in the area of faKing are to illuminate the bacxgrounds and
motivations of known malingerers and to maKe it possibla to
predict who will fake disabilities and who will not, given
s~m~lar i~cen~ives. This has been a mostly fruitless li~a
of research and will not be discussed here in greater
detail.
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39
Research D~sign ~ ~nalxsis I~sues
At least six different types of designs have been used in
faka~ility and faking detection studies. These include
within-group, in~rasubject, and between-group designs.
Few investigators in this area have explicated their reasons
for choosing one design rather than another. Th~se designs
are not entl.rely interchangeable and the di£ferances among
them suggest that design choices in faking research should
be based on something other than caprice.
Within-group gesigns. In the most common withi~-group
design, normal subjects are instructed ~o fake pathology on
a particular test. They are later retested under optimal
effort instructions. Some studies have included random
assignment of subjects to different orders of testi~g to
control for possible order effects.
Although tbis design can provide valuable information
about th€ fakability of instruments, there are obvious
limits ~o the external validity of such s~udies. A partial
(and relatively uncommon) solution to this problem is to
test cooperative patients with known disorders under best
effort and exaggeration conditions (Dahlstrom & ~elsh, 1960;
Anthony, 1971). This is an improvement over the original
design, but generalization to actual patterns of fakir.g or
exaggez:ation is still not entirely warranted. It.ls a
reasonable compromise, however, in light of odds against
eliciting the cooperation of a SUfficiently large sample of
Page 52
mal ing erers.
A varie~y of s~atis~ica~ indices of fakability have been
ased in ~hese studies, including mean diffarence, ~ercen~
overlap, percent agree~ent, correlation, and variance of
difference scores. Gordon and Gross (1978) nave c~~~icized
these indices on the grounds that they exclude two impor~an~
sources of variance, namely rand oa error due to test
unreliabili~y and random error due to individual differences
in the perceived desirability of personality test items.
iithin the curren~ model of faking behavior, ~he lat~er
source may be generalized to incorporate individual
differences in faking criteria regardless of the nature of
tes~ (i.e., personality tests, ab~li~1 ~ests, diag:lostic
procedures, etc.) The ~uthors propose a variance statistic
whicA includes all of the known sources of variance in
repeated measure faking designs. Hone of the fakabili~y
studies published to date have utilized this index.
A third within-group design initially tes~s subjects
under a fake or exaggerate condition and later retes~s ~hem
under the same instructional set. The purpose of this
design is to demonstrate ~ha& subjects are u:lable to ta~e
the sams way twice.
Vari~nce at~ributable to measu.remen~ error is ouce agai~
a serious pr ob Le a in this design. Even if most sub j ec t s
cannot replicate thelr initial test resultS under a faKing
or exaggeration set, it would still be n~cessary t~
Page 53
41
es~ablish that they (or similaI subjects) could do so under
an honest set. If an Rhonest A control gIOUp is added on to
th~ design, between-group differences in test-retest
variability can be evaluated. Even if significant
diffeIences are found, however, overlap between the sample
distributions could result in an unacceptable proportion of
false positives in c~inical applications. Rejection of the
null hypothesis, in o~her words, might warrant the
conclusion that the test is difficult to faKe; but tnis
would Dot necessarily imply that SUbjects who fail to
perform the same way twice are faking.
Intrasubj!£! de§ign. On rare occasions, an examiner may
have an opportunity to confront an individual who has very
clearly attempted to fake pathology on a set of tests and to
retest him or her under more optimal conditions (Freedland &
Craine, Note 1). Except for the possible influence of
practice efforts, this permits a valid comparison of
performance under an actu~ fake or exaggeration set and an
honest set. In contrast to many sing~e-subject experiments,
tnis design may have some of the external validity t~at itS
~ithin-group counterpart lacks. pragmatic contraints
obviously limit the opportunities for employing this design,
however.
~~~n-gr~ ~i.9.!!2. The most common b€!tween-group
design compares the performances of volunteer malingerers
against patients judged to have a particular d~scrder ou toa
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42
basis of diagnostic criteria which are independent of the
teses in question. The criteria for inclus~on i~ the
patien~ group include the lack of any apparent incp.ntives to
malinger (e.g., case histories suggesting a low probability
that litigation will ensue.) This was the designed employed
in ~he study by Heaton et ale (1978) of the fakability of
the Halstead-aeiean battery. In some s~udies, a third group
consisting of nor.al (honest) controls is included.
This design, unlike ies wi~hin-group analog, nas the
advantage of comparing faxed resul~s with scores obtained by
patients who are believed to have genuine, unexaggerated
disordars. It also avoids the potential influences of
practice and order effects. On the other hand, questions
abou~ diagnostic reliability and val~dity in relation to the
"honest patientn group almost inevitably arise.
Purthermore, it is unfortunately difficult to recruit an
adequate sample of patien~s who have no incentives to
exaggerate (Hea~on, Note 3). The use of volunteer
malingerers limits the ex~ernal validity of the design to
some extent. An alternative is to use a sample previously
diagnosed as "malingerers Y , a strategy employed b~ 3ash and
Alpert (1980) in a s~udy of incarcerated felons. The
validity of independent diagnostic criteria, howev-ar, is
even more difficult to es~ablish in th~s design than in tne
previous one. The subjects in the Bash and Alp~rt st~dy,
for e~ample, were "diagnosed as ~cnpsycbotic or as a genuice
or feigned schizophrenic with or without concomitant
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43
audi tory oallucina t.ions, II ll2 psych ia1:rists" (p. 89,
emp~asis added.> No addit~onal information on diagnostic
procedures vas provided.
The exceptional heterogeneity of patterns of strengths
and weaknesses among brain-injured patients furt.ber
constrains the use of between-group designs in
neuropsychological faking research. Whether and to wbat
degree discriminable differences are found between fakers,
exaggerators, and honest patients depends considerably on
the combination of indicators and sample characteristics.
As an illustration of this point r assume that an
inves~igator designs an exper~ment using the signal
detection paradig. to discriminate neurologically-based
visual field defects from faked ones. The s~udy could have
widely divergent outcomes depending upon the composition of
the "neurclogicalQ sample. The responses of a group of
patients vith tempora-parietal optic tract lesions might
support tne use of tnis technique to det.ect faking, Whereas
responses of patients with focal lesions of the primary
visua~ corte~ might suggest the reverse. In summary, the
use of "honest" patient control groups without caraful
documentation of sample characteristics contribut~s
ce Lati ve1y li ttla to the genst:alizabili l:Y of significan t
results.
Page 56
SUbsta~~~ Issues ia Faking Research
~~s!~nts ~ faki~g behav~. Th~ presen~ Mod~l suggests
that faking behavior consists of attributions, criteria,
simulations, and disguises. All of the fa~ing detaction
strategies that have been reviewed capitalize on
relationships among these element~ Accordingly, research
on the co~ponents of faking behavior and on th.
relationships among these components is a necessary stage in
the develop.ent of Qffective faking detection techniques.
Attributions. To date, there has been little or no
research on the ro2e of attributions in faking. Very little
is Known about the factors wnich influence the formation of
attributions or about the ways in which faking criteria are
adapted to fit particular attributionsG
~akin~ criteri~. In clinical situations, faking criteria
are obviously well-guarded secrets and would generally be
inaccessible to research. In contrast, analog s~ud~es of
faking coQid incorporate cognitive assessment techniques to
evaluate covert faking criteria. Ques~ionnaires,
interviews, and other methods could be used to obtain data
on tne types of criteria that are devised in res pense ~o a
given attribution and on the processes by which SUbjects
attempt to manipulate tests to s1mula~e tn~se crit8ria.
Disguisas. Disguises
faking for two reasons.
are important in the analysi~ of
First, disgu1siny may d1rec~ly
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45
affect the severity of simulated symptoms, and it may also
influence faxing s~rategies. Second, disguising may produce
some of the only measurable traces of fak~ng. The
relationship between simulation and disguising is protably
influenced by ene faKer's perception of ehe potene~al
payoffs for successful faking, the risk of detection, and
the consequences of detection. Disguising may occur in the
absence of any apparent risks, however, among people who
expe~ience discomfort when they behave dishonestly or
deceitfully (assusing their discomfort is not too great to
p~event ehem from faxing altogether.) Accordingly,
experimental analysis of the role of disguises would require
observation of patterns of faking under three different
conditions: (a) nondecap~ive simulation (i.e., aSKing
subjec~s to perform the vay they thinX they probably would
if they actually had a given symptom, without any reference
to deceptive o~ dishones~ motives; (b) faxing with
instructions which would reduce or eliminate fears about
getting caug4t; and (C) faking with instructions ~hich would
enhance fears of getting caugh~. possible interaction of
the latter two conditions with varying levels of potential
payoffs for successful faking, sbould also be tested
experimentally.
S~mula~io~ and ~h~ ~in9 selecti~i~ hypothes1~. As
previously discussed, it is Widely assumed that faking
generalizes across tests. Faking on a neuropsycnolo9~cal
test battery is somBtimes inferred, for example, from
Page 58
,.6
devian~ responses on extrinsic faking de~ec~ion tas~s~ The
model proposed here contradicts this conventional wisdom:
malingerers probably establish different critaria for
differen~ tests, depending upon e he pa1:tern of deficits they
liish to portray. Relatively global symptoms (e.g.,
inabili~y to concen~rate) may ~~~ult in a broad patte~n of
faking across a wide range of tests, but only on those tests
which are relevant to the symptom. Relatively specific
symptoms p~obably result in fak~ng on only a narrow range of
relevant test.s. Disguising probably also increases the
likelihood of selective faking, because best-effor~
performances on criterion-irreleTclnt tests may be used to
enhance an image of cooperativeness. This hypot.besis could
be tested by providing SUbjects \lith a specific faking
cri~erion a~d then administering a battery which tests wnich
are relevant to the criterion and other tests which are
irrelevan1: to i~. Criterion-irrelevant fa.k~ng detec~ion
tests would~ it is hypothesized, be insensitive to faking
under these conditions.
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47
Sognistication. It is widely assumed tttat soph~stica~ion
is an important factor in faking# despite the fact that it
is not well defined and tha~ faw studies hava dir~ctly
examined its effec~s on faking behavior. It would also be
useful to ascertain what effect sopbistication bas on
individual measures of faking~ since as Monro and Martin
(1975, 1977) discovered, some tests are easier to outwit
than. others and sOlie tests are d.ifficul t even for hig hl Y
sophis~icated individuals to fake.
D~velopllent aad validation ~ faking measures. As
suggested by the review of faking detection s~Iategies, an
almost infinite variety of faking measures can be devised.
Proll the perspective of the lIodel proposed here, special
fa~ing detection tests that are extrinsic to the diagnos~ic
tests in a battery probably are of limited value. A
prollising alternative would be to develop faking detection
measures which a.ce intrinsic to the particular diagnostic
tests of interest.
In sumllary, nu~erOU5 issues in the analysis of faKing
behavior and in the development of faking detection
teChniques r~main to be investigated. 1he first priority in
this area is to develop an empirically validated model of
faking behavior and to explore the ways in wbich the
elaments of fa~ing interact with diagnostic tests and
proced uce s.,
Page 60
The present experiment was a test of the faking
selectivity nypo~hesis. One group of subjec~s was given a
set of specific faking criteria (i.e., dominant sensory-
mo~or dysfunc~ions) in order to determine whether ~hey would
fake any tests other than ones involving these functions.
The second group of subjects were given identical tes~s and
instructions except that tbey were not provided .i~h any
faxing criteria. It was predicted that these sUbjects
wou~d, in the absence of specific faxing criteria, fake less
selectively than the sUbjects in the first group. A control
group was instructed to take the saBe battery of ~ests under
standard (honest) instructions.
A secondary purpose of this experiment was to explore the
------.,.; .... , validity of several intrinsic faJting detec't.ionk"" .. o::a ........
measures. Tbese vere derived froll the principles of faking
detection discussed in the preceding review I and are
described in Appendix 5.
The study vas also designed to provide questionnaire and
interview data on ether questions that have been raised in
the preceding analysis. Subjects ~ere asKed ~o describe
their criteria, the process of simulating these criteria,
the disgUises that ~hey used,
individual tests.
and ~hair responses ~o
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49
CHAPTER II
~ETHOD
~12jects
The sUbjec~s were 69 undergraduate students (26 ~al~s and
~3 felllales) recrui ted frolll psychology courses a e 1:.he
University of Hawaii. Students who volunteered to
participa1:e in the study in exchange for credi1: 1:owa rds
their course grades were asked to complete a screening
ques~ionnaire. The eligibility criteria for inclusion in
the study were: (a) no significant history of
psychological, neurological, ar otber disorders Which migbt
affect neuropsychological test results; (b) cUlIlulative
college grade point average of at least 2.0, to prcmo~e
homogeneity of one aspect of sophistication; and (c) no
history of working with or living with head trauma victims,
again to con~rol for sophistication. Eight-one students who
met these criteria were randomly assigned by a research
assistant 1:0 oue of three groups: (1) Hones~ Normal; (2)
Specific Faking; (3) Global Faking. The e.xperillent
ter~inated when 23 SUbjects in each group had succp.ssfully
completed all of the procedures in accorda~ce with a plan
devised prior to the random assignment. A total of 76
SUbjects completed an informed consent agree~ent a~d were
given th~ instructions for the experiment. Four sUbj~cts
declined to ~ar1:icipate after reading the i~s1:r~ctio~s, tWO
failed to follow the instructions (i.e., they were assigned
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50
to one of the faxing groups but failed ~o fake any of ~h~
tests), and one ~as unable to complete the test battery due
to time constraints. Data on ~hes~ SUbJects ar~ not
included in the analySis. The sex and athnic composition of
the groups is described in Appendix 1.
Tests
A battezy of widely-used neuropsychological tests .as
adlli.llistered to all SUbjects. The battery was designed to
generate data relevant to the experimen~al hypotheses and
vas not intended to provide a thorough assessment of
neuropsychological functioning. It included (a) motor
!!!~: Finger Oscillation (Finger Tapping) and Band
Dynamometer (Grip Strengthj; (b) cognitive tests ilih. motor
components: WAlS Digit Symbol sabtest and Part B of the
Trailma.lting tas"t (Trails B); (C) coqnitbv8 tests !!!thout
relevs~ m2to~ components: WAIS Arithmetic and Digit Span
sabtes"ts, the Peabody Picture Vocabulary Test (PPVT), and
the iechsler lielllo.ry Scale (iMS) Associative Learning
subtest; and (d) extrinsic fakins ~etect~~n tests: Grouped
and Ungroaped Dot counting tests, the 15-ltem Memorization
test, word aecognition and aecal~ tests, the ~x-o~ version
of ~he F~ngertip ijriting test, and the ~MPl. All subjects
were given a pretest to ensure that they understood ~heir
instructions, and SUbjects assigned ~o ~he t~o faKing groups
were also given a posttest consisting of questions about how
they faKed ~he p~ecedin9 tes~s (see Appandix 2.)
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51
EIocedure
Upon arrival at an assessment labo~atory at the
Uni versi 1:y of Hawaii Departmeo1: of Psychology, subjee-ts ware
seated in a waiting room and given a consen~ form to r~ad
and sign. They ware also verbally instructed thal: l:hey were
free to terminate their participa tion at anytime. During
the pilot phase of this study, seven of the subJeCts who
ware given faKing instructions failed to exhibit any
indications of faking during the testing session.
Inte4views following the testing sessions revealed that
despite having be~n given permission under the informed
consent agreement to terminate part~cipation at any time,
they had been afraid to or unwilling to do so. These
snbjec~s reported tAat they were unable to pretend to be
dishonest, or to do less than their best on tests. Because
this phenomenon occurred with soae regularity uuring the
pilot phase, subjects in the present experiment were
strongly urged to witAdraw from the experiment without
penalty prior to the start of tbe testing session if for any
reason they felt they could not follow the e~perimental
insl:ructions.
Subjects ~ho opted to continue ijere then given a sel: of
wri1:ten i~structions, 1:he texts of which are presen1:eu in
Appendix 3. The subjects in the Honest Normal group were
told to do 1:heir best on all of the performance tests a~d 1:0
a.ns~er all self-report questions (i.e., on the ~~P!) as
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52
accurately as possible. The Specific Faking group subjects
were told to pretend that they had been in a~ automobile
accident and that they were suing the other driver's
insuranca company for damages resulting from a b~ad injury.
They had sutfered a ~ild, transient concussion which
resulted in temporary numbness and partial paralysis of
tbeir dominant hand and arm, and their lawyer subsequently
referred them for neuropsychological e~aluation. By the
time they arriYed for tes~ing, their symptoms had cornple~ely
abated; but to bolster their case, they would fa~e the ~ame
symptoms that they had experienced following the accident.
They were not told wnether to fake any o~ber sympto~s. The
instructions for the Global Faking group were identical to
those given to the specific Paking subjects. except that
their symptoms were not specitied.
After reading the inst~n~~iQns~ SUbjects in all groups
completed a preeest ques~ionnaire consisting of ewo short
essay questions. The first question asked for a restatem~nt
of the instructions. The second question for the Honest
~ormal group as~ed the subjects to speculate on t~e kinds of
tests they would be taking; for the two faking groups, it
as~ed wha~ symptoms they were planning to present and how
they were planning to fake them. SUbjects in all three
groups were then ask~d to read a s~mpl~fiad, numbered l~st
of the key points of their instructions (see Appendix J.)
Upon completion of these tasks, the subjects wera a~ain
asked to decide whether they wished to pai~icipa~e i~ ~he
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53
expet"iment.
Subjects WDO opted to continue were tnen in~roduced to
the examiner, who was blind regarding group ~embership.
They w~re next seace~ in the testing room and told tha~ they
wet"e going to take a battery of tests that a~e us~d to
gvaluate some of the symptoms that sometimes occur following
head inju~ies. During the pilot phase of this research,
savera~ subjec~s failed to fo~ow theiI faking instructions
during the first few tests because they did not believe that
~he tests had anything to do with the symptoms of haad
injuries. They wacs expecting something like a medical
checKup, in which the examiner would ask them about
headaches, check their vision, etc., and they were not
prepared for the routine nenropsychological tests which they
instead received. In the present experiment ic. was
accordingly emphasized that ~ll of the tests, starting with
the first one and including every other test in the battery,
"measure s~ills and abilities which mayor may not be
affected when a person has had a head injury. It
Subjects ~ere given three rest breaxs during ~he tes~ing
session at which tiMes they were asked to re-read the
numbered list of instructions. They were asked to
discontinue the session i£ they were not following all of
the instruct~ons or if they did not wiSb ~o continue; all
participants in the present study opted to continue,
although two of the faking sUbjec~s in fac~ taileQ to fc~low
Page 66
54
the ins"tructions. The exact order of test administration is
lis l:ed in Appendix ~.
Page 67
55
CHA I?TER III
RESULTS
In order to invastiga~e the hypo~hesis tha~ specific
faking criteria are associated with selective test faking, a
series ot ~~ltivariate analyses of variance ~as conduc~ed.
The dependent variables for the MANOVAs are divided into the
following se ven conceptual sets: (1) Standard :neassr~ 2£
dom~Bant mocor eer£ormance. These are the most direct and
obvious seasuras of the Specific Paking group's response to
~eir instructions to fake dominant mocor dysfunctions. (2)
~~~ measB;~s 2I nondominant motor perfo~~~nce aas 2i
cognitive ~~ts w;ta rele!~ ~~ components. This set
includes all of the ne~ropsychological tests, other than the
direct measures of dominant motor perfo~mance, which are
sensitive to motor dysfunctions. One question addressed by
this analysis is whether the specific group faked
nondominant m~~or dysfunctions, which were not included
among the faking criteria included in their instructions. A
second question is whether domi~ant motor faxin~ in this
group extended to tests which are slightly more subtle
measures of motor functioning. The tests i~cluded fer this
purpose are PaIt B of the Trailmaking Test and the WAXS
Digit Symbol Test. Both of these tests draw upon a wide
range of cortical functions, including motor s~ills. Tuey
are subtle in the sense that the cognitive aspects of the
tests divert a trtan t Lon frcm the the 1lI0toric as pe c c.s , (3)
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56
Standard measures 2! ~erfo£~~ ~ cognitive t~st~ ~~
~3lev~nt !S~2£ com2~~. This set ir.cludes ~be Peabody
Picture Vocabulary Test, the iAlS Arithmetic and Digit Span
subtests r and the Wechsler Memory Scale Associative Learning
sub test. These tests, like vir~ually all nearopsyc~clo9ical
tests, do involve ~otoric components such as eye movements
and vocalizations. Tbey do not, however, ~equire the use of
either the dominant or the nondom~ant hand. This analysis
accordingly addresses tbe question of whether faking
extended to include tests which are not related to motor
criteria. (~) Extrinsic faK~Dg detection measures. This
set includes the MaPI F-K raw score index, which is widely
used as an indicator of faking, and scores derived from Dot
Counting, Word Recognition, and Word Recall faKing detection
tests descr~bed by Lezak (1976). The faking specificity
hypothesis predicts that the Specific group would not differ
significantly from the aones~ Normal group on these
measures, because they are irrelevant to the faking
criteria. The measures mayor may not be sensitive to
faking in the Global group, depending upon tba faking
criteria which these subjects must establish in the absence
of specific instructions. (5) Intrinsic ~~~~ 2i
llQ~AI sensory ~~ mo~or ~akin3o This se~ examines
coefficien~s of variation over repea~ed trials of the Fiag~r
Oscillat~on and Hand Dynome~er tes~s for ~ne dominaut ha~d.
The coefficien~ of variation is the ratio of th~ standa=d
deviation ~o tbe mean. Finger tapping ar.d grip s~re~g~h are
Page 69
57
measured on ratio scales, so there is a floor eff~c~ on
variabili~y as the mean approaches zero. The ccefficien~ of
variation controls for this effect. The presen~ ~odel of
faKing predic~s ~bat both the maintenance and ~atching of
faking critetia int~oduce sources of variability ov~r
repeated tr1als that are no~ present in best-affor~
performances. The hypothesis for this set, therefore, is
that Specific group scores will be significan~l1 more
variab~e than Sonest Normal group scores. If sUbjects in
the Global group fake these tests, their scores should also
be lore variable than the Honest Normals'. This set also
includes the score for the Finger~p xo Writing test,
expressed as the signed percentage correct above or below
chance level accuracy_ The Specific group, hav~ng been
instructed to fake dominant hand numbness, should make
significantly more errors on ~bis test than ~he Honest
Normals. (6) IDtrinsic ~asures 2£ nondominant sensory ~
!~~ faking. This set is the nondominant equivalent of the
preceding set. Predic~ions for this set are conditional on
whether the experimental groups faked nondominant sensory
and motor dysfunctions. (7) Intrinsic measures 2! fa~ing £A
~gnitive tests. These measures quantify pat~erns of FSHP
errors on the Peabody ?icture Vocabulary and WAIS Arithmetic
tests, a~proximate answers on the WAIS Arithme~ic tast, and
decrements over trials on the _MS Associative Lea=ning test.
As discussed pra~iously, such measu~es a~e desig~ad to
capture subtle violations of referer.ce standards. Rulas fo~
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58
sco~ing and calculating these indices are des~ribed in
App~ndix 5.
Alpha
Duncan
was set at .05 for each multivariate analysis.
tests were used i~ each case with
alpha controllad at .05 per dependent variable.
Additionally, Tables 8 and 9 present post-test
guestior.naire findings ~h~cn pertain to the £a~~ng
specificity hy?othesis~ Table 8 is a frequency table of
self-reported numbers of tests faked among the Specific and
Global groups. Table 9 compares intrinsic and extrinsic
faking detection index results for Honest Normals versus
faking group SUbjects who reported faking the· test ve=sus
faking groups subjects who rep04ted that they did not fake
the test.
As shown ~n Table 1, the multivar~ate test for dominant
motor performance scores was significant as were the
univariate tests £0= dominant Finger Oscillation and nand
Dynamometer. The Honest Normal group tapped at a
significantly higher rate than the Specific group and the
Global Grcup. The Global group also tapped significa~tly
faster than the Specific group. On th~ Hand Dynamometer,
the Honest and Global groups beth gripped significattly
harde= than the Specific group.
Page 71
59
Table 1
Mul~ivariate Analysis of Variance forDominant Moter Performance Scores
~ultivariate Tests ~f No cverall Group £ffect
Tes1:.
Botelling-Lawley TracePillai's TraceWilks' Criterion
F (d f)
F(4,128) = 33.56****F(4,132) = 21.72****F(4,.130} = 27.40****
Univariate Tests
Source df MS F2
R Duncan Test
Dependent Variable: Dominan1:. FingeI Oscilla1:.ion Maxi~um
ModelErro=
266
8214.96128.16
64.10**** .66 1>3>2
Dependen~ VaIiable: Dominan1:. Ha~d Dy~amomater Maximum
Modelsr r or
266
1970.71101.60
19.40**** .37 1,3> 2
olC***p < .0001.
Page 72
60
As indica~ed in Table 2, there were signi:ican~
differences among groups en the performance scores :or
3vndominan~ moter ~es~s and cognitive tas~s with releva~t
motor comFonents. Groups did no~ differ, however, on the
nondominan~ Hand Dynamome~er Tes~. The Hones~ Normal group
performed significantly better than both faking groups on
the nendominant Finger Oscilla~io~ Tes~, Par~ E of the
Trailmaking Test, and the ~AIS Digit Symbol subtes~.
The multivaria~e resul~s presen~ed in Table 3 indicate
~hat there were significan~ differences ame~g groups on
cognitive tests that did not involve relevant motor
cemponen~s. The groups did no~ differ, however, on the ~AIS
Arithmetic sub~est. The Honest group ferformed
significan~ly bet~er than the Specific group on the Peabody
Pict~re Vocabulary Test, and sigr.ifican~ly be~ter than both
faking groups en both halves of the iAIS Digit Span sub~est
and on the WMS Associative Learning sub~es~. Table 4 shows
that there were also significant differences among groups on
the mul~ivariate ~es~ for ex~rinisic faking deteCtion
measures. No significant differences were found on ~he
Greuped-Ungrcuped Dc~ Counting Index,
Page 73
61
Table 2
Multivariate Analysis of Va~iance forPe=fo~mance Sco~es on Nondominant Motor Tests
And Cogn~~ive Tes~s Ni~h Relevan~ Mo~o~ Components
Mul~ivaria~e Tes~s of No ove~all G~ou~ ~ffect
Tes'\:
Hotelling-Lawley T~ace
Pillai's Tracewilkso cri~erion
F (df)
F(8,124) =F (8, 128) =F(8,126) =
9.03****6.15****7.56****
unLvar Le t e Tests
Source df 1'15 F2
R Duncan Tes~
Dependent Variable: Nondom~nant Finger Oscillation Maximum
Modelsrr or
266
2154.04102~ 15
21.09**** .39 1>2,3
Dependen ~ Variable: ~ondominant Hand Dynamome~8r Maximum
Model 2 80.06 1.00 .03E~ror 66 79 .. 68
Dependen~ Variable: Trailmaking Tes~ Par1: B Time
Model 2 17,828.39 5.91 ** .15 2,3>1Er~o~ 66 3,01e.59
Dependen~ Variable: Digi1: Symbcl Raw Score
Model 2 4,472.71 9.49*** .22 1>3,2Error 66 471.53
** p < .01***p < .')01
****p < .0001.
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62
Table 3
~ul~ivariate Analysis of Variance forCognitive Tasks ~ithout Relevant Motor Components
Multivariate Tests of No Cverall Group Effect
Test
Hotelling-Lawley TracePillai's Traceijilks' Criterion
F (df)
F(10,122) = 3.11**F(10,126) = 3.11**F(10,124) = 3.11**
Univariate Tes1:'.s
Source df MS F2
R Duncan Test
Dependent Variable: Pea.body Picture Vocabulary Total Score
Model 2 2380.48 3.81* .10 1> 2Error 66 624.42
Deper.de~~ Variable: ~iAIS Ari~hmetic Raw Score
Model 2 16.19 1.39 .04E1: r o r 66 11. 64
Dependent Variable: WArs Digit Span Foreward Score
ModelError
266
8.541.57
5.44 ** .14 1>2,3
Dependen ~ Variable: WArs Digi~ span Backward Score
Model 2 5.09 I~. 29* .12 1>3,2Error 66 1.19
Depender.~ Variable: ~MS Associate Le arn i n g Score
:1odel 2 112.06 9.35*** .22 1>2,3Error 66 11 .99
"l'? < .05.**p < .01.
***p < .001.
Page 75
63
although both faking groups scored higher than the Hones~
group on both of the individual Dot Counting indices. The
mean MMPI P-K raw score for ~hE Global Faking grouF was also
significantly higher than the mean for the Honest group.
Additionally, the Global group had a significantly lower
score than the Honest group on the Word Recogn~tion-~ecall
index.
Multi7ariate analyses for the intrinsic faking detection
measures are presented in Tables 5, 6, and 7. There were
significant differences among groups for the sensory-motor
set on both hands, but the multivariate ~est for intrinsic
cognitive measures was no~ significant. Dcmi~an~ hand means
for coefficients of variation on the Finger Oscillation and
Hand Dynamometer Tests and fer pexcentage of errers on the
Fingertip writing test were significantly greater for the
Specific group than for the other tWO groups. On ~he
nondominant eguivalents of these measures, howe7er, the
Global group made significantly more Fingertip ~ritir.g
errors than the other two groups and had a significantly
higher mean coefficien~ of variation for the Hand
Dynamometer T8st than the Honest group.
Page 76
64
rable 4
Mul~ivaria~a A~alysis of Variance forEx~ri4sic Faki~g Detection Measures
Mul~ivaria~e Tes~s of No Overall Group Effect
Tes~
Ho~alli~g-Lawley TracePillai's TraceWilks' Criterion
F(df)
F ( 10 , 122) = 4. 1 4 * ** *F(10,126) = 3.48***F(10,124) = 3.81***
Univariate Tests
Source df MS F2
R DUI:car. Tas~
Dependent Variable: MMJ?I F-K Raw Index
Model 2 484.01 5.87 ** • 15 3>1Error 66 82.45
Dependent Variable: Ur.grouped Dot Counting Index
Model 2 110.78 5.29** • 14 3, 2> 1Error 66 20.94
Deper.den~ Variable: Grouped Dot Counting I~dex
Model 2 81.32 1').51 **** .24 3, 2> 1Error 66 7.74
Dependent Variable: Gngrouped-Group€d Dot co un t Lnq Index
Model 2 205.93 1.13Error 66 181.88
Dependen~ Va=iable: word Beccgnition-Recall Index
Model 2 35.32 4.35 * .12 1>3E=ror 66 8. 12
* F < .05**p < .J1
***p < .001****p < .)101
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65
Table 5
Mul~ivariate Analysis of Variance forIn~rinsic Measures of Domi~a~t Ha~d
sensory and Motor Faking
Multivariate Tests of No Overall GrouF Effect
Test
Hotelling-Lawley TracePillai's Tracewilks' Criterion
F (df)
F(6,126} = 13 .. 69****F (6, 130) = 8.58****F(6,128) = 11.07****
Univariate Tests
Source df MS F2
R Duncan Test
Depende~t Variable: Dominant Finger OscillationCoefficient of Variation Over Trials
ModelError
266
578.04147 .. 41
3.92* • 1 1 2>3,1
Dependent Variable: Dominant Hand Dynamome~er
Coefficient of Variation Over Trials
ModelError
266
10584.03613.86
17.24**** .34 2>3,1
Dependent Variable: Dominant Fingertip xo writingDetection Index
ModelError
266
.26
.0120.22**** .38 2> 3, 1
*p < .05****p < .0001
Page 78
66
Table 6
Multiv~riate Analysis of Varia~ce forIntrinsic ~easures of Nondominant Hand
Sensory and Metor Faking
Mul~ivaria~e Tes~s of No Overall Group Effact
Tes~
Hotelli~g-lawley TracePillai's TraceWilks' Cri~erion
F (df)
F(6,126) =F (6,130) =F (6, 128) =
4.03***4.02***4.02***
un i var Lae e Tests
Source df MS F2
R Duncan Test
Dependent Variable: Nondominant Finger OscillationCoefficient of Variation Over T~ials
M.odelError
266
231.4195.84
2.41 .07
Dependent Variable: Nondominant Hand DynamometerCoefficient of Varia~ion Over Trials
ModelError
266
194.1942.23
4.60* .. 12 3> 1
Dependent Variable: Nondominant Fingertip XO Wri~ing
Detection Index
ModelError
*p < .05**p < .01
266
.011
.0025.81** .15 3>1,2
Page 79
67
Table 7
Multivariate Analys~s of Variance forIntrinsic Measures of Faking on cognitive Tests
Multivariate Tests of No Overall Group Effect
Test
Hotelling-Lawley TracePillai's TraceWilks' Criterion
F (df)
F(10,122) = 1.74F ( 1J , 126 ) = 1. 70F ( 10, 124) = 1. 72
aUnivariate Tests
Source df MS F2
R Duncan Tes't
Dependen't Variable: Peabody Pic'ture Vocabulary TestPercent FSHP Index
Model 2 .015 2.63 .07Error 66 .006
Dependent Variable: WMS Associative learning Easy I'temsFaking Index
Model 2 2.01 2.42 .07£rror 66 .83
De pend er. 't Var iable: IlMS Associa'tive Lear:ling Hard I'temsFaking Index
Model 2 • 10 .08 .003Error 66 1.23
Dependent Var iable: I'AIS Ar i thmet ic Percent FSHP Index
Model 2 864.41 6.56 ** .17 2>3,1Er:::or 66 131.32
Dependent Variable: WAIS Ari'thmetic Perce:l't Approxima'teA.nswers Index
Model 2 13.35 O. 10 .0033rror 66 136.05
aunivariatE resul'ts are prese~'ted fer the sake of
completeness but should not be interpreted as sign~r~can't
pursua:l't to 'the ~or.sig:lifica:l't mul'tivariate CUtCOmE.
Page 80
68
The =esul~s of the post-test it~ms asking which tests
were faked con~rast with some of ~he precedi~g findi~gs. As
shown in Table 8, the majority of sUbjects in both fak~ng
groups i~dicated ~hat they did not fake all of th8 tests.
This suggests ~ha~ some of ~he faki~g groups' mean
performance and faking scores were aff~cted by the inclusion
of best-effor~ cases. Inspection of Tables 9 and 10 reveals
that on mos~ faking measures, the faking and nonfaking
subgroup mea~s differ in this sample. Because decisions
regaIdi~g which m8asures to fake were no~ under experimen~al
control, the significance of these differences is not
evaluated. However, the means for Arithmetic Percent FSHP,
the Associative 18arning indices, ~he Fifteen Item Memory
Tes~, the Ungroup€d and Grouped Dot Counting indices, the
PPVT Percent FSHP, and the coefficientS of varia~ion for
Finger Oscillation and Hand Dynamometer all differed in the
expec~ed directions. On the other hand, tha Ari~hm8~ic
approximate answer index, the Ungrouped-Grouped Dot Counting
index, and ~he Fingertip XO wri~i~g indices did no~.
Inspection of individual cases in the Honest Normal group
reveals ~hat most of ~he errors made un Ari~hmetic und~=
bes~ e=for~ condi~io~s were approxima~e errors under the
rul~s described in Appendix 5G Questionnaire respons~s
ir.dicate ~hat subjects in ~he faking groups differed widely
in regard to how the Dot Counting tests were faked. Despite
differences in faking strategies, however, very few
subjects' ~otal Grouped times exceeded their Ungrocp~d
Page 81
ci a e s , l:' . • •_ ~n a.L.... y,
69
faking group subjec~s ~ended 1:.0 make mere
errors on one or both hands en the Fingertip ~riting T9St.;
bu~ most of ~hem scored a~ levels above (rather ~han below)
chance.
Table 8
Frequency Dist~ibution of Self-ReportedNumbers of Tests Faked, Excluding MMPI
(Collapsed Over Specific and Global Groups)
NumberFaked F~equency
CumulativeFrequency Percent.
CumulativePercent.
356789
101 112
1514356
101 1
167
111419253546
2. 1710.87
2. 178.706.52
10.8713.01+21.7423.91
2. 1713.0415.2223.9130.4441.3054.3576.09
100.00
Page 82
Table 9
Breakdown by self-Repor~ed Fake V~rsus Best-EffortSample Faking Sccre Dis~ribu~ions (No~la~aralized Tasts)
aGroup
70
Measure
W~IS Ari~hme~ic % FSHP
liAIS Arithmetic% Approxima~~ Answers
QMS Assoc. LearningEasy Items Index
QMS Assoc. LearningHard Items Index
15-Item Memory Test
Ungrcuped Do~s Index
Grouped Do~s Index
Ungroaped-Grouped Time
Means.d.(n)
Means.d.(n)
Means s d ,(n)
Means s d ,(n)
!'!eans s d ,( n)
Means , d.(nl
Means.d.(nl
Means.d.( n)
HonestNormal
7.577.04(23 )
7.2616.80
(23 )
0.220.52(23)
1. 430.73(23 )
14.830.65(23)
5.261. 29(23 )
2.351.07(23)
13.875.53(23 )
NetFaKed
12.118.39( 9)
5.445.83( 9)
0.300.48(10)
1.000.94(10)
14.351.23(20 )
6.622.14(13 )
4.082.6 J( 13)
14.085.35( 13)
Faked
16.5814.74
(36 )
7.448.36(36 )
0.831. 13(36 )
1.581.30(36)
13. 152.71(26 )
10.006.09(33)
5.823.55(3 3)
16.9718.74
(33)
(Continued on next page.)
Page 83
71
Table 9. (Continued) Breakdown By Self-Reported FakeVersus aes~-Effor~ Sample Faking Score Distributions
(Nor:.lateralized Tes~s)
aGroup
MeasureHenes tNormal
NetFaked Faked
iord Recogni~ion-Recall Mean q.48 2.80 2.58s.d. 2.52 3.58 2.. 92(r.) (23 ) (10) (36 )
PPVT % FSHP Errors Mean O. 11 0.11 J.17s ..d. 0.03 0.06 0.10(n) (23) (21) (25)
-----------------------------------------------------------aValues for the "No~ Faked ll and "Faked" g:coups are based
on the combined responses of ~he Specific and Global groups ..
Page 84
72
Table 10
Breakdown By Self-Reported Fake Versus Best-Effortsample Faking Score Distributions (Lateralized Tests)
Specific and Global Faking Groups
Honest Not DominantNormal Faked Faked
Ncn don , Both UnspecifiedFaked Faked Faked
Dominant Finger oscillaticn Coeff~cient of Variation
Mean 8.78 6.95 14.57 11. 27 15.52s.. d. 4.74 10.66 2.89 18. 14
(n ) (23) ( 1) (14 ) ( 0) ( 5) (26 )
Nondominant Finger Oscillation Coefficient of Variation
Mean 6.44 3.61 14.54 8.95 11. 17s.d. 2.90 16.14 1. 17 10.10
(n) (23 ) ( 1) ( 14 ) ( 0) ( 5) (26 )
Dominan~ Finger Oscillation Percent Increment FromMaximum Faking Trial to fest Effort Trial
Mean -.07 .60 .46 .41s.d. .31 .14 .24
(n ) (23 ) ( 1) (14) ( o) ( 5) ( 26)
Nondominant Finger Oscillat.ion Perce nt Increment. FromMaximum Fak~ng Trial to Best Effort. Trial
Mean -.02 .16 .36 .25s.d. .23 • 14 .19
(n ) (23 ) ( 1 ) (14 ) ( 0) ( 5) (26)
Dominant Hand Dynamometer Coefficient of Variation
Means. d.
(n )
5.803.37(23)
6.434.08( 6)
43.6840.65
(16)
7.94
( 1)
20.085.66( J)
28.6632.75
(20 )
Nondominan~ Hand Dynamometer Coefficient of Variaticn
Mean 5~64 5.42 7.66 12.91 12.21s , d. 3.51 2.04 3.66 4.67
(n) (23) ( 6) ( 16 ) ( 1) ( 3)
(Continued on nex"t. page. )
12.7610. 15
(20)
Page 85
73
Table 10. (Cont.inued) Breakdown By Self- Seport.ed Fake:Versus Best-Sffort Sample Faking Score Distributicns
(Lateralized Tests)
specific and Glocal Faking Groups
Honest Not Dominant80rmal Faked Faked
Nondcm. Both UnspecifiedFaked Faked Faked
Dom~nant Hand Dynamomet.er Percent Increment. FremMaximum Faking Trial to Best Effort Trial
Mean .04 .49 -.04 .36 .30s. d. • 10 .29 • 23 .27
(n) ( 6) (16) ( 1) ( 3) (20 )
Non dominant Hand Dynamometer Percent Increment. Fromtiaximum Faking Trial tc Best Effort Trial
Mean .01 -.02 -.02 .20 .07s.d. .09 .10 .30 .14
(n ) ( 6) (16) ( 1) ( 3) (20 )
Dominant Fingert.ip XO Writir..g Detectior.. Index
Mean .49 .49 .27 .50 .34s. d. .01 .01 .18 .00 • 15
(n ) (23) ( 9) (10) ( 2) ( 0) (25)
Nondcminant Fingert.ip XO Writing Detection Index
Mean .48 .48 .48 • 32 .45s , d. .02 .02 .02 . 11 .05
(n ) ( 23) ( 9) (10) ( 2) ( 0) (25 )
Page 86
74
Finally, Table 11 displays a cor.densed breakdown of MMPI
profile validity patterns based on Lachar's (1974, pp.
102-112) rules for classifying L, F, and K scale
configura~ions. The rows compare ~he Hones~ Ncrmal group ~o
the combined faking groups. The columns indicate "Faking
Bad" fer profiles classified under t.acha r r s rules as t y pas
1, 11\, or 9+9A, nFaking Good" for types 3, 5, or 6, and
"Valid" for ~ypes 7, 8, 9, and 14. It should be noted ~ha~
the superordinate categories presented i~ ~his ~able are :l0~
necessarily applicable to other contexts. For example, a
~ype 1 profile does not necessarily indicate malingering or
faking bad, according to 1achar. I~ may also indica~e a
"cry for help" or ether atypical response sets when the test
is adminis~ered in a clinical set~ing. For the purposes of
the present study, however, such profiles should probably be
in~erpre~ed as represen~ing malingering, since ~be sUbjec~s
(ex cept t he Honest Nor mals) ~ere instructed to fak e. A more:
detailed table of ~MPI validity ~ypes by greup is presen~ed
in Appendix 7.
Page 87
Table 11
Percen~ages By Group of MMPI P~ofiles ClassifiadAs Valid or Not Valid by lachar's (1974) Rules
75
Group
Hones1:Normal(n=23)
FakingGroups(n=46)
FakeBad
.00
• 15
FakeGoed
.09
.09
Valid
.91
.76
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76
CHAPTER IV
DISCUSSION
Because ~his experiment was a laboxa~ory analog tes~ of
hypotheses abou-t a clinical phenomenon, external validity is
a ques~ion which.mus~ be addressed before ~he resul~s can be
meaningfully in-te£preted. For several reasons, the
par~icular pa~1:ern of ~es~ results ob~ained in this sz ud y
should not be uncritically generalized to clinical
populations. The subjects were neurologically normal
volunteers who ~ere merely E£etendinq to be malingerers.
Actual malingering is i~self a kind of role playing in which
people exaggerate or invent probl~ms. There was, then, a
second level of pretense in this st udy that is IlO~ presen ~
in clinical behavior. Some sUbjec~s have difficulty role
playing even innocuous scenarios in a research context. The
scenerios given to the faking group subjects were not
entirely innocuous, either: the experimental demands to
engage in "dishonest" behavior and to perform poorly on
tasts conflicted with values expressed (much to their
credit) by many of the subjects. Given a strong incentive
and a low-risK opportun~ty to malinger in a clin~cal
context, many of these subjects reported that tney probably
would not do so. Fur~hermore, a group of pilot SUbjects
(n= 9) were ~i veIl in s eruce ions which were ideo. tical to the
ones given to the Specific and Global Faking subjects in tn~
preseut s~udy, except that they were told that "no on8 ~v~r
ge~s caugnt, a~d t4ere are no penal~~es ~ven if you do ~a~
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77
caught.~ S~rprisingly, their test scores were no worse than
~ose of subjects ~AO vere ~old that there wo~ld be severe
penalties for getting caught. Wh~~ askad why they did not
fake ~ore severe probleas, most either responded that ~ore
severe symptoms would not have been believable or that they
would feel guilty or embarrassed. Finally, none af the
SUbjects had ever had a head injury, and few hdd more than a
very vague concept of the kinds of sy~ptoms which can result
from cortical trauma. Clearly, there may be important
differences between the patterns of fa~ing exhibited by this
saAple and the faking behavior plaintiffs, defendants, or
anyone else with a cOllpelling incentive to malinger.
On the other hand~ the purpose of the study was to tes~
Ilypotheses about a general !lodel of faking behavior.
Although analog data supporting these hypotheses should not
be treated as evidence of how aalingerers necessarily
beAave, the present results do sugges~ some previously
unrecognized possibilities in addition to contradicting some
widely-aeld assullptions about faking. The outco~e of this
study accordingly does provide some clinically useful
intormation, despi~e being an analog. It also suggests th~
need to extend the proposed acd e L and for additional
research on the subject cf faKing.
The central question addressed by this study .as whether
a faking set ~ecessarily pervades the pa~fo~mance 0:SUbjects who a~e trying to fake symptoms of brain injury.
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78
The implici~ log~c of many traditional faking detection
teChniques depends upon the existence of such a sec. The
proposed model predic~ed ~hat although pervasive sets may
characterize the be.avior of some subjec~s, other subjects
~ay fake selectively. The Specific group was instructed to
fake dOMinant sensory and motor dysfunctions. They were not
told hov to do this or whether to fake any other symptoms.
~os~ of these SUbjects did fake one or more of the tests
that do no~ require the use of the dOMinant hand. However,
few of them faked every test, and there were numerous
instances in whicA extrinsic detection tes~s were not fa~ed.
In other words. the Specific group tended to fake
selectively rather than fake every test. The results also
indicate that the Global group tended to fake selec~ively.
Because they were not told what syllptoms to fake, it is
possible to rule out the alter~ative hypothesis that the
instructions artificially induced selective faking (as Might
have occurred in the Specific group.)
Lf subjects tend to fake selectively, why did so Many of
~he sUbje~s in the Specific group fake tests which were
apparently uar el,e ted to the SyM ptoms they were ins1:ruc::ted to
present? when intarviewed, they provided a variety of
differen~ reasons, some of Which were prediCted by the
model, and some of which were not. Post-test guestionnaire
items 17 and 20 (Appendix 8) also pe r t a.i n to chis <juest.J.on.
As predicted, so~e SUbjects gave best effort performances on
tests not involving Jominant sensory-motor functioning in
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79
order to disguise ~heir faking on o~ber ~ests. But o~her
sUbjects apparently believed that the most effective way ~o
disguise faking on sensory-motor tests would be to fake
other kinds of tas~s, and tha~ good performances on some
tests would stand out suspiciously in contrast to ~OOI
performances on others. Others used some of the tests to
reveal symp~oms which were supposedly collateral to the
sensory and ~otor symptoms. Of this SUbgroup, some felt
that symp~oms such as confusion and slowed reac~ions would
follow any Bead injury, and that these symptoms would
adve~sely affect cognitive and other test performances.
Those who had some knowledge (however limited) about the
functional latera~ization of the cerebral cortex tried to
fake symptoms associated with the hemisphere contralateral
to the affected limb; in most of these cases, faking
extended to problems with math and "erbal ability tests.
These approaches to faking were not predicted, yet they
again show that some sUbjec"ts haye rationales (which tb.ey
are able to articula~e) for faking selectively. Some
subjects, it should be noted, vere unable to articulate the
reasons why they did or did net faKe pa~icular tes~s.
Also, in many cases SUbjects reported (on the post-test)
b.av~ng faked symptoms ~hictt they had not originally thought
of (Le., at the time of tae pre-test). This suggests that
tb.e TOT~ component of the proposed model is tao rigid.
Symptoms to be fa~ed are ~ot always decided upon ahead of
time; some peopl~, in other words, do not know exactly ~b.at
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80
they are goi~g to faxe un~il ~hey find ou~ wha~ tes~s ~aey
have to take. The interaction between tests and symptoms is
apparen~ly more dynalllic t~an was originally thougnt.
It was originally assumed that the Specific group's
c~ieeria would include only the symptoms which they were
specifically instructed to fake (i.e., dominant sensory
~otor dysfunctions.) If no other criteria were present, it
would be relatively easy to determine whe~her ~he subjects
tended to fake only the tes~s which are di~ectly related ~o
these criteria. As discussed previously, however, some
Specific group subjects reported that ~hey had developed
additional faki~g criteria on their ovn. This makes it
difficult in soae cases to determine why tests unrela~ed ~o
sensory-motor dysfunctions were faked. In future
expeJ:illlents, criteria could be 1I0re carefully restric't.ed by
instructing SUbjects ~o fake only a given set of symptoms
and no others.
The unex~ectedly wide range of symp't.oms whicb were
presented suggests than an important source of variability
was left ou~ of the proposed model. ~os't. preVious studies
on faking have been limited to the examination of c&sponse
sets OD individual ~ests. Most malingerers, ho~ever, are
probably not interested in their ~es~ scores ~ ~ •
•Rather, they try to communicata with the examiner about
~beJ.r fic'~i~iaus symptoms t hr cu qh , among other ae d.ia , t es t
performances. In most cases, attributions directly suggest
Page 93
a symptom or syndrome for ~be person ~o fake.
81
For example,
a factory worker pressing a ~orker's Compensation claim for
the adverse ~ffects of working around loud machinery ~ould
probably faxe some kind of bearing loss or tinnitus. Given
similar circumstanc es, there lIlay nevertheless be
considerable variation among individuals in regard ~o tbe
particUlar form the fake hearing loss would take, and in the
particular manner a battery of hearing tests would be
manipulated to coamuBicate this symptom to the examiner.
PurtAecmore, the opportunity to attti.bute a disability to
working around loud .achinery doesn't necessarily lead to
the choice of auditory faking criteria (although this is the
most likely cacLces ) The same attribution could also
support claims of anxiety, sleep disorders, etc.
Nauropsyc401ogical malingerers hav.e an even greater freedom
of choice. No one symptom or syndrome necessarily follows
from the assertion that a person has suffered a brain
injury. This is particularly true for relatively
unsophisticated malingerers (meaning, in this context,
persons ~AO lack SUfficient knowledge about the effects of
brain daaaqe , ) Remarkably, some sUbjec~s i~ ~his Study
tried to fake symptoms which were the exact opposite of
symptoms thac oth~r subjects tried to por~ray. ~hereas one
person in the Global ,,,.,. """''l! n~-"""'I:'
expressed confidence that onl y
"mental" ~ests should be faked, another person stated that
only "physical" tests should be; some peopla ~ried to
perform as consistently as possible ovec trials to avoid
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82
deeeceion, and o~her people tried to perform inco~sisten~l!,
. because "~hae IS ilhat \iould hap pen if I bad brain damage,"
and so on. Fa.king brain damage requ~res mal.J.ngerers to make
decisions at several different levels: what symptoms to
presen~, whae ~ests to fake in order to communicate ~ne
symptoms, and hOil to fake those tests. Few if any faking
s~udies have previoasly examined the first tilO levels of
decision-making. The proposed model does address these
levels, but only to the ex~e~t of suggesting that they
exist. The model would have to be extended in order to
account tor the particular decisions made at these levels by
individual subjects.
The post-cest questionnaire resales, in addition ~o post
test interviews with faking group SUbjects, provided a
considerable amoun~ of informaeion abOUt the components of
faking behavior and the faking strategies which were
discussed in the proposed model. 'The present study was not
design€d to generate any data abcut attributions, the first
component of faking behavior proposed in the model, because
the instructions p~?vided an attribution which remained
consiseent across subjects in the faking groups.
Nevertheless, this attribution apparen~ly produced
differential effects vithi~ groups. As seen on the pre-
tes~, the symptoms which many sUbjec~s plan~ed to take were
ones which were at least partially intended to improve th~
plausibility of the attribUtion which was prOVided. For
example, 33~ of the faking group subjects included headaches
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83
among their pre-test symptoms. More importantly, the
apparent irrelevance of most of the neuropsychological
battery to tbe a~~ribution and to the subjec~ive symptoms
with which these SUbjects intended to support the
attribution, apparently disrupted the pcocess of test fa~ing
in SOMe cases. For example, many of the Global group
sUbjec~s vho entered the session prepared to complain about
headaches and double vision, were caught off guard by having
to take tests such as Finger Oscillation and Grip Streng~h
(a proble~ obviously not shared by subjects in the Specific
group.) One subjec~ in the Global group, in fact. stated
that she did not fake any of the tests except that she did
indicate some physical symptoms such as headaches on the
MMPI. She reaarked during the interviev tha~ none of the
other tests seemed related to the symptoms Which she thought
would result from a brain injury. It is in~eresting to note
that the Terbal instructions given to SUbjects at the
beg inning of the testing session (i. e. , "Every test,
starting with the first one and including every other tdst
you will take, measure s%i11s and abili~ies which Mayor may
not be affected .hen a person has had a head injury, II)
failed to prevent this.
The resul~s generally support the conceptualizat~on of
faking as a process of matching and maintaining faking
cri tar ia. The pcocass , as d Lscuas e d ear 1i er , is so aev na t
moce complex than originally anticipat~d. Some relatively
unsophis~~cated 5ubjac~5 have only ve~y vague ini~ial
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aq
criteria r and o~hers seem unable to generate any ini~ial
cri~aria. Suca sUbjec~s tend to u~ilize ~he tes~s ~hat they
take as a basis for for~ing their c~it~ria. Several
subjects who tepor~ed taKing this approach indicated that it
became very di.fficult to r eaaa.n consistent over the entire
test battery. Because they lacked a coherent set of symptoll
criteria, decisions aDOU~ which tests to fake were more
confusing for them than for SUbjects who had better-defined
criteria.
As mentioned earlier, SUbjEcts tended to fake only those
tests which appeaIed to be relevent to the particular faking
criteria which they had selec·ted. In sOllle cases, though,
sale:tivity resulted in faKing almost all of the tests.
~his apparent paradox can be expla~ed by examining the
effects of specific versus global criteria. Matching
specific criteria such as dOllinant hand weakness results in
degraded performances only on tests involvin9 ~he use of
that specific function. Matching 1I0re global criteria such
as "slowed raactionsu (which, incidentally, was a favorite
among the SUbjects in this sample) may instead affect
perfo~mances across a ~ide range of tests. In some cases,
such global criteria may result in faking along dimensions
of tests which are irrelevant to both test performance
scores and intrinsic faking measures. Some sUbjec~s WhO
faked pervasively slow reactions, for example, rasponded
very slo',l1y on the PPVT. Of these, SOGle made nUlDE:l:OUS
errors on the t~st, and others made very few 8rrors; the
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85
difference depended on whe1:her voc abu.l.a.c y er r or s would be
relevant to other criteria which may have been maintained in
tandem vi th "slowed reaetio os". Those who taJt.ed on ly s10 wed
reactions did, in a sense, fake the PPVT as part of a
pattexu designed to convince the examiner tnat they nad
suffered a brain injury; yet this form of faking had no
apparent affec~ on their PPVT scores because i~ is an
untimed test. The fact that many sUbjects operated with
~ultiple criteria further complicated 1:he patterns of fa~ing
which result ed.
Finally, the matching of some criteria affects the way in
which the subject interacts with the examiner during the
tes~ing session. this nrole faking d consists primarily of
nonverbal communications: acting tired, refraining from the
use of a "dysfunctional A limb, looking out t~e window as a
sign of impaired concentration, and pretending to have
trouble understanding the ezaminerfs instructions, are just
a few examples of the types of role faking observed during
this experiment. Some foras of role faking are closely tied
to test performance; e. g., acting ti.T:ed lila y re su I t in poor
performance on timed tests. 01:her role behaviors have ~o
discernible effects on any of the tests. For example, a fe'll
SUbjects rubbed their forenaads during the sess~o~ to
indicate that they had headaches.
Very few subjects who engaged ~n role fax~ng .era able to
make their role behavior fully compatibla with their tas~
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86
performances. Many o~her sUbjec~s did no~ engage in ~ole
faking; some lacked confidence in their abili~y as ac~ors,
and others were unawa=e that the examiner would be looking
for revealing discrepancies between ~est and role behavior.
As a result, test-role discrepancies turned out to be
relatively reliable indicators of faking. For example,
quite a few SUbjects turned ~he pages in the PPVT book much
more rapidly than they should have, given their poor
performances on the Finger Oscillation test. A few SUbjects
gripped the Band Dynamometer with less than a pound or two
of pressure on the "impaired" side, yet had no trouble
holding the gauge itself. And none of the subjects who ~ade
numerous errors on easy PPVT items had any trouble carrying
out complex verbal instzuctions.
These findings strongly suggest that a structured
behavioJ:al observation system, tailored to discovering
disc~epancies betweeB ~est pe~formances and role benaviors,
should be developed for ase in forensic neuropsychological
evaluations. This would enable examiners ~o capitalize on
the apparently co~mon differences in reactivity between
tes~s and role observa~ions. The ~esting situation should
be subtly designed to provide occasions for SUbjects to
engage in role behaViors whicn are inconsis~ent ~ith their
test perfor~ances. Some of the role demands could be set up
to place the SUbject in a ~double bind." A subJect wac
wishes to fake th~ ~~VT and ~ho also wishes to appear
coopera~ive, will usually turn the pages in the ~est bcc~la~
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87
when asked. While concent~ating on how to faka the PPVT,
~any SUbjects will forget that they had p~eviously pretended
to have mo~or dysfunctions which would have made i~
difficult to tarn the pages with ease. This is an example
of the way in which dist~acticn can be used in conjunc~ion
.ith behavioral assessment in the context of faking
detection.
~he questionnaire results also make it clear that
disguises are ~ore co~ple~ than originally anticipated. One
of the most interesting tactics described by several
subjects was that they purposely failed to lis~an carefu~yor
to concentrate on some of ~he test stimuli. In this way it
was possible to perform poorly on a test without having to
ma~e deliberate errors. This both enhanced the credibili~y
of the poor performance and reduced the discomfort
associated with lying. Although the litarature on fa&ing
suggests that malingerers prefer sUbjec~ive symptoms which
are hard to verify, some of the subjects in the present
sample indicated that they felt it would be too risky to
fake sUbjec~ive or "mental" symp~oms because they did not
know what the examiner would be looking for. They instead
chose ~o display lDora concr ee e prob Le ae , Fillally, JUSt as
some subjects faked symptoms which were the exact opposite
of the symp~oms faked by other subjects, soma subjects
e~ployed Jisguises that were the opposites of ones used by
other subjects. For example, some said ~ha~ it ~s impor~ac~
to look the examiner in the eye ~hen one is lying; others
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88
said to av01d eye contact. Some said ~hat ~hey tried ~o
appear calm~ and others tried to appear nervous. Similar
patterns vere observed for other types of disguises (see
Appelldix 8.)
The importance of role behavior in a comprehensive
analysis of faking suggests that future research should not
be limi~ed to the analysis of patterns of test responses, as
has generally characterized past research in this area.
There is a naed for research on the social psychology of
faking ~ with particular reference to the ways in which
fakers attempt to COMmunicate attributions and symptoms
within the context of medical and psychological
examinations~ and to the verbal and nonverbal ways in which
faking is disguised.
One of the primary objectiVes of the proposed Model of
faking behavior was to demonstrate the possible implications
of faking strategies for faking detection techniques.
Unfortunately, the present study was somewnat more
successful in clarifying the flaws in ~echniques already
used for the detection of faking than it was in establishing
~he validi~y of new techniques. Most of the subjects in ~he
faking groups did indicate that they used one or more of the
predicted stra tegies. aowever, a var ie"ty of ot he r
strategies were also reported, some of which may be
relatively difficult to transla~e into quantifiable faking
detection measures. The findi~9 tha"t some sUbjec~s used
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89
multiple strategies within individual tests poses yet
anoeher dilemma for the development of effective intrinsic
detection measures. Par example, the percentage FSHP scarp.
on the PPVT was used as an in~insic measure of faxing
because it was predicted that subjects would fake this tes~
by distributing errors. Some subj@cts who distributed
i.ntentional. urors th.T::oughollt the tese did not do so in
order to buffer their errors with correct responsds.
Instead, using the approximate answer straeegy, they li~ted
their errors to items which were Nambiguous". This applied
to word sounds as vell as to meanings, often in ways which
showed some imagination. ~~o sUbjec~s, for example, pointed
to the pictllre of a gun when given the word "block". When
they were later asked to explain this, they both said that
they were trying to pretend that c.hey had heard "lock"
instead of "block", and that the gun was the only object on
the page Which had a lock on it. Althougb this scrategy
does resu~t in a pat~ern of dis~ributed errors, it does not
produce an un1lsually large percent P'SfiP in cca pazLao a to
honest responding. Furthermore, the partiCUlar errors made
are one Which could easily be lIlade by a honest respondent.
woo has made a legitimate er~or. Thi~ also illustrates a
serious problem ~i~h the use of approximate errors as
intrisic faking detection measures: many of the genuine
errors made by honest responders are approximate a~s~ers.
Quite a few of the fakers in this study did indeed use
approximate answers to disgu~se their faking, but. not at
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90
levels which significantly exceeded those of the honest
group.
In contrast to the limitations of intrinsic cognitiie
decection measures, cde intrinsic moeor variaDi~i~y measures
generally worked as predicted, and in most cases for the
predic~ed reason (unscable criterion maintenance.) There
were some interesting exceptions to this, however. Very
poor performances on Finger Oscillation also tended to be
very s~able over trials. These sUbjec~s were able eo count
the number of times t~~y tapped each time, and accordingly
could repeatedly duplicate thei~ performance. There is no
equivalen-t form of cognitive mediation which can be used to
enhance the stability of Band Dynamometer performances over
trials, and noc surprisingly, ~be differences in
coefficients of variation between groups are much larger on
this test than on Finger Oscillation. Also, as mentioned
earlier, instability of motor performance was itself a
criterion cbosen by several subjects. In order ~o match and
maintain this criterion, all they needed to do was to
eXbibi~ variability rather tban s~ability over crials.
Their performances were unstable for a different reason than
was predicted, yet this variant of motor faking makes the
coefficient of variation an even more useful intrinsic
detection measure.
Co~trar1 ~o expectation, the Finger~ip ~riting adaptation
of the signal detection technique produced v8ry f~w below-
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9 i
chance levels of responding. ~any of ~he sUbjec~s who did
repor~ faking ~his tes~ said that it was too easy ~o ma~e
very many errors on. They tended to perform ~~, rather
tha~ below, chance accuracy levels. Even though they did
make more errors on the average ~han the Hon~st Normal
subjects, dbove-chance performances are only useful as
evidence of faking in ~he presence of explicit ve4bal claims
of total inability to detect the stimulus. Visual and
auditory ~ignal de'~ection tasks lIay prove to be more usaful
than the tactile version used in the presen~ study, but this
remains to be demonstrated.
Although there were significant differences between the
Hones~ and Faking groups on the extrinsic detection
measures, the hi~ rates for ~hese tes~s were very poor. The
mean M~PI F-K raw score =o~ the Global ~~oup was only .52,
and it differed from the Honest group only b~';ause the
lat~er's mean reflected a tendency towards higher K than F
scores. As for the extrinsic tests described by tezak
(1976), fakers averaged no more than four seconds worse on
both the ungrouped and the Grouped Dot Counting indices as
compared to the Honest group, and Grouped exceeded Ongrouped
total times in very few cases (even a~ong those who claimed
~o nave done their best on on the Ungrouped test and to have
faked the Grouped test.) The group differences on word
Recognition minus Becall again reflect relatively few cases
in which fakers recalled more words than ~hey recognized.
Finally, relatively few SUbjects in the faking groups ~issed
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92
any i~ems on the Fifteen Item Memory ~es~. These ~asts are
all designed to flag deviant responses ~hich sugges~ fak~ng.
In t he presence of these responses, faking is certainly a
hypo~hesis ~or~h considering. They appear to be relatively
insensiti?e measures, however, which failed to detec~ faking
on l;he part of many of ~he sub jeces who had been instructed
to simula~e brain injury.
The poor hit ra~e of the MMPI validity scales is
particula.rly interesting in light of Heaton et ale 's (1978)
successfu.l use of the MMPI to discriminate between volunteer
lIalingerers and cooperative brain inju.red patients, and
because many clinicians rely so heavily on these scales.
The reasons why so few of the Faking subjects produced a
classic nfake bad" ~MPI profile become clear when the
instrument is viewed as a medium ~hroagh which subjec~s
attempt to cOllmunicate an image of themselves to ~he
examiner. Few of the F scale items are rela~ed to the brain
injury symptoms that mos~ people ~ried to fake. Most of the
subjects who faked any psychopat~nlogy on the MMPI were
attempting to communicate a pattern of reac~ive rather than
secondary sylilptoms of brain injury. In o~her \lords, they
were likely ~o assert ~hat they were depressed (i.e., about
their injury), but unlikely to claim that the injury caused
~hem ~o experience psychotic symptoms or other ~nusual foems
of psycho pa t.no log y. Becau se ~he F scal.a ccns Lscs of r a r e l, y
endorsed items, it usually misses pecp l,e 'liho try to f ak e
common syml?~oms sueD as depression. E~ually i~porl:an~ is
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93
the finding that faking bad on the neuropsychological tests
can be accompanied by a form ot fak~ng good on the MM~I_
!any sUbjects used Land K scale items (and other items as
~ell) to show that they are much too honest and trustworthy
to do anytAing fraudulent or deceptive. or that they are
very nor~al, healthy people in all respects except for the
effects of their injury- Some sUbjects responded honestly
on most of the M~PI items, except those pertaining to
physical symp~oms such as headaches Which seG~ed to be
likely sequelae of head injuIies. It appears that faking
reactive psycAopathology, secondary psychopathology,
physical symptoas, exaggerated honesty, and exaggerated
nurmality can occur in various combinations on the ~MPI, and
that any of ehase patterns can occur in combination with
faking on neuropsychological tests. The traditional
assump~ion ehat neuropsychological faking tends to be
accompanied by "fake bad" MMPI profileS is very clearly a
gross oversi~plification. Additional research is needed in
order to determine the clinical scale and other correlates
of the patterns which have emerged in this study_
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CHA.PTER V
SU~!ABY AND CONCLUSION
The purpose of this experi4ent was to test some of the
elements of a newly developed model of faking behavior and
faking detection. Although the results tend to support this
model, they alE~ clearly show tha~ it is incomplete.
Further elaboration of the model is required in order to
account parsimoniously for conflicting responses to
identical conditions within groups.
The faking selectivity hypothesis (i.e., that malingerers
selectively faKe only the cests that are relevant to che
symptoms they wish to portray) was supported in ~any cases,
but the exceptions disconfirm the generality of this
principle. Apparently, malingerers who are generally
sophisticated (in the sense of being intelligent, well
educated, and skilled in taking cests) and, who ccnze cne a
testing situation with a reasonably clear and coheren t set
of faking criteria, tend to fake more selectively chan
SUbjects wita poorly developed criteria. Sophistication in
the sense of scaaa tifically accurate kr-owledge about
relevant dysfunctions and tes~s is clearly advantageous in
the process at forming criteria, but laCK of this kind of
sophistication does not preclUde the development of coherent
criteria and consis~ent faking strategies. Clear, cohere~t
criteria, however, sometimes result in patterns of faking
'.hien de not appear to be selec-cive. Tvo types of cc aer en c
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95
cri ter ia can produce nonselecti ve faking: (a) t.he criteria
include global symp1:ollls such as liinability to concentrate"
or "slow reactions" which can affect almost any t.est; and
(b) mUltiple criteria which result in faking lIultiple
symptoms. pu~thermore, unsophisticat.ed faking can produce
relatively nonselective patterns of fak~ng, especially if
the tests themselves are cues for the formation of faking
criteria. It. snouli also be noted t.hat. e~en subjects with
well defined i~itial criteria lIay modify these criteria
during testing when they are confronted with tests t.hey did
not expect to take or when they are not given tests that
the y did expect.
As predicted, disguising sOBetimes produces selective
faking, but this experiment showed that. sometimes it
produces nonselective faking. Disguising can also produce
MMPI validity configurations which would not be int.erpreted
as faking bad. Some criteria result in role behavior faking
and/or in faxing score-irrelevant dimensions of some t.ests
(e.g., responding slowly on untilled tests, circling answers
when asked to underline theill, etc.) Also, t.he criteria
themselves are partially a reflection of the subject I s
internal performance standards. Faking criteria wn~ch
consist of fractions of very high standards can result in
normal if noe outs-eal1ding test scores. (one of t ne aub je c t s
in this study, for example, vas a math major who "faked" the
WAIS Arithmetic test and yet achieved a perfect score. Her
way of faking this test vas to wait one or two seconds
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96
before responding, instead of answering immediataly--even
~hOUgA it is not unusual for well educa~ed subjects to be
unable to answer the ttarder items after one or ~wo minu~es!)
Role faking, sco~e-irrelevant faking, and ttte setting of
very high fa£ing criteria can all produce pa~terns wbich
reselllb19 selective faking, or which look like the pe.rson has
not fa·ked at a~l.
The perception of potential risks and rewards of faking
also appears to have complex effec~s on hov people faKe.
The belief that some tests are riskier to fake than others
can lead to a selective pattern of faking, but indiwiduals
differ videly in whi.ch tests the y t.hink they can fake
wi~hout unduly risking detection. Also, a variety of
internalized standards can apparently mediate the effects of
objective risks and rewards. For exaAple, a person who
strong ly wishes to avoid appearing JI stupid" or "crazy" may
choose to fake sensory and motor ~ests but may not fake
cognitive and personality tests..
These findings suggest that faKing involves a comple~
series of decisions about. what symptoms to fake and now to
communicate these symptoms to ~he examiner tnrougb various
aed La includ.i1lg at·tribu·tions, test performances, and role
behaviors. These decisions are complexly influenced by ~he
factors which are collectively termed usophistication", by
the pe rce pea ca of potential rewards for successful faKing
and risks of getting caught, and by fe€dback from the
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process of testing itself.
97
Even wnen these processes
converge on the decision to fake a particular test, the
response vill not appear to be deviant if the faking
criteria are too high or if faking takes place along a
score- irrelevant dille nsion.
This implies that even tbe bes~ extrinisic faking
deteC'tion measures (including the trusted !'1~l?I validity
scales) are probably poor predictors of faking on other
tests. they are not co.pletely useless, however. On the
contrary, deviant responses on extrinsic detection tests
soaetimes occur and when they do,
examiner to the possibility that
lIalingering.
they should alert the
th~ SUbject may be
Unlike the extrinsic tests, intrinsic tests are direct
measures of fa~i.ng on specific tests. Unfor~unately, ~ost
of the intrinsic measures developed so far seem to have
relatively poor hit rates due to the prevalence of faJcing
along score- ir.relevant dimensions as well as to the degree
to \lhicn the best effor~ and fuing dis"tribtJ~ions of tnese
measures overlap. The results of this study, however,
sugges~ that intrinsic techniques are potentially valuable
and deserve further ioves tigation. The coefficient of
variation over repeated trials, in fact, appears to be a
very promising intrinsic detector.
In conclusion# this study points to the inadequacies of
exis~ing fa~~ng Jetection techniques in ~europsychol09ical
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assessment and reveals so~e of the ~ays in which faking
detec~ion ~acnnolo9Y migh~ be improved. It is also ana of
the first studies to inve,stiga te faking be ha vior withi n a
comprehensive theoretical framework. The i~plications of
this framework are not confined to neuropsychology, bat are
ins'tead relevanot for other medical and lIental heal~h
specialties in which malingering occurSQ The results show
tbat fa~ing is a much mOIe complex process ~han has
heretofore been acknowledged, and tbat more resea.rch is
needed on tbe fac~ors vAich influence decisions made in the
process of faking. Nearopsychologists may find that
llnderstanding the "etiology" of a fake symptoll is as
important as understanding its genuine cOllnte.rpar~.
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APPENDIX 1
DEI!OGRA2HIC CO~l'OSITION OF SAl''iPLE
Table 12
Sex Composition of Groups
------~---~------~~--------------------
Honest NOJ:Els
Specific Pakers
Globa~ Pakers
Total
I!ales
8
9
9
26
Fellales
15
14
43
Group
Table 13
Ethnic Composition of Groaps
Caucasian Chinese Pilipino Hawaiian Japanese Other
HOlleS1:
speci fic
Global
Tot.al
5
11
12
28
2
1
1
o
1
1
2
o
1
o
1
12
9
5
26
o
8
Page 112
Table 1~
Sa.ple Mean Ages By Group
100
Group
Bones"t
Specific
Global
!!ean
19.78
20.65
21.13
S. D.
2.81
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101
APPENDIX 2
PRETEST AND ~OSTTEST QUESTIONNAIRES (REFORMATTED)
PRETEST QUESTrONNAIBE: HONEST NOR~AL GROUP
Please write a briefYOll have been given.
paragra ph Sllmm arizing the instruc~ions
~hat are you supposed to do?
So far, you don't know exactly what kinds of teses you'll betaking. But do you have any ideas about what kinds ofproblems and abilities are likely to be covered on thesetests? If sOr or if you would like to take a guess r pleasewrite your ideas below.
PRETEST QUESTIONNAIRE: PAKING GROUPS
Please write a brief statement summarizing the instructionsyou have have been given. What are you supposed eo do?
So far, you dOD't know exactlytaKing. But do you have anygoing to fake a brain injur y,YOI1 are going to try to fake?
what kinds of tests you'll beideas yet about how you are
and~ §ymetO!§ g~ eroblemsIf so, please explain below:
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POST-TEST QUESTIONNAIRE: FAKING GROUPS
Instructions~ Now that you have finished all of ~he tests,we want to find o~t what YOIl did and how you did it. Someof eha questions ~a1 seem redundant, but pleas~ answe~ allof them anyway. When you ~r~ finished, place youques~ionnai~e in ~he box. Thanks for participating in ~his
study. We appreciate your help and patience.
1. iha~ symptoms or problems did you ~ry to fake, and bowdid you try to fake them?
2. Please check ~True" or "False" for aach of ~he
following:
Some of the syaptolls & problems I tried to fake:
(a) weakness in -1 hands/arms.
(b) !loving slower than normal.
(c) loss of feeling in hands/arms.
(d) bei.ng "crazy".
(e) b9ing "stupid" or "ignorant".
(f) being confused.
(9) having trouble understanding.
(h) having trouble speaking.
(i) having trouble concentrating.
T_F_
T_F_
T_'l_
T_F_
T_F_
T_ F__
T_ F _
(j) having ~rouble cont~olling myself. T_ F _
(k) having trouble remembering things. T F___
(1) Other: (Descri be below).
3. Did YOll fake (do worse tha n YOI1 know yOI1 could ha vel onthe Finger Tapping test? (This was ~he ~est ~hich invol~ed
tapping your finger on a metal key). If yes, how did yOI1fake i~?
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i03
4. On the Digit Symbol Test, you vere asked to draw marks inrows of boxes benea~h a series of numbers. Did you fake~his, and if so, hov (eg. by making errors, going slow,etc.) ?
5. On the Grip Strength Tes~, you were asked to squeeze agrip strength lIetero - Did you fake this, and if so, how?
6. On the Trailmaking Test, you were asked to draw a lineconnecting a series of letters and numbers together. Didyou fake this, and if so, how?
7. On the lrithaetic Test, you vere asked to do some mathproblems in your head. Did you fake this, and if 50, hov?
8. On the Digit Span Test, you vere asked to repeat a seriesof numbers froD aamory--first in the same order as you heardthea, then backwards. Did you fake this test, and if so,lao.. ?
9. On the iord Pairs Tes~, you were given three chances tolearn a list of word pairs such as nme~al-iron" and nbabycries"g Did you fake this test, and if so, hov?
10. On the 15-I~em ~elDoriza~ion Tes~, you vere given a cardwith sOlie letters, nambers, and shapes to reDtellber. Did youfaka this test, and if so, hoy?
11.on athentJlis
On the Dot Counting Test, you vere asked to count dotsset of cards--firs~, dots spread around ~he card, anddo~s that vere grouped into patterns. Did you fake ontes~, and if so, how?
12. On the Fingertip Test, the examiner vrote X and 0 onyour fingertips. Did you fake on this test, and if 50 hov?
13~ On the Word Recognition and Word Recall Tests, you ~ere
asked to remember lists of vords that vere read outloud toyou. The first eime you vere asked eo underline the wordsyou heard on a sheet of paper. The next time, you vereaSKed to repeat a lis~ of words. Did you faka on tnesatests. and it 50~ how?
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14. On ~he Pic~ure 10cabalary Test, you ~ere shown a seriesof pages divided into four parts. Bach part had a drawingin it. and you were told to point to the drawing that fitt4e aeaning of a word that was read to you. Did you faKethis test, and if so, how?
15. On ~he ~MPI, you wera asked Dundreds of ques~ions likeNI get angry sometimes" and "1 like to cook n • Did you fakeon this test, and if so, how? If you did fake, whatsYIIptOIlS or prob~ells did you fake I and wha t kind o.f over allpicture of yourself did you try to presen~? Did you try toso~nd "crazyft? Did yoa claim to have any physical problells,and if so, wnat kinds?
16. Looking bacx on all of the tasts that you took, did youuse any of tte following tricks to fake problems orsy.ptolls? Under~ ansv~, ~ the names 2i ~ ~~(~)
~ ~ used each trick 2!!.
(a) I faked some tes~s by jus~ no~ trying veryhard. T_ F_
(b) I faked sOlie tests by g~v~ng answers thatwere alilost right--they were just a littlewrong but they were wrong anyway. T F___
(C) I faked so ae tests by uxing in·tentionalmista~es together with answers ~hat Itried to get correct. T F_
(d) I faked some ~ests by doing as poorly aspossible. T F _
(e) Other tricks that I used:
17. You were i~structed to make sura ~ha~ you wouldnft ge~
caught faking. How did you try to avoid getting caught?Did you try to hide or disguise your fa~ing--and if sc, how?Explain this both in terms of what you did on the tests youtook and ho~ you acted around the examiner.
18. Did you think that if you made your symptoms look 1£gbad, or that if you scored l2£ low on the tests, that you~ould get caught? 1e5 No___
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19. How did you try to make your symptoms seem bad enough tobe taken seriously, withou~ making them so bad that youwould get caught?
(a) Instead of completely failing certain tests,I scored just moderataly low. T F___
(b) I did very poorly on some tests and t.t ied todo a lot better on others to make up for it(to lIake it seem like I was reallytrying.) T F___
eC) Instead of getting every answer wrong onsome tests. I got some answers right to makeit look li~e I was trying to do my bestin spite of all the lIistakes. T F___
Cd) Instead of giving obviously wrong answers(such as 2 + 2 is 75), I gave answers tha~
were closer to being correct bu1:. stillwrong (SUCD as 2 + 2 is 5). T F___
(-8) Q'thers:
20. Did you try to do your best on salle tests? If so, why,and which ones?
21. Which tasts were relatively easy to fake?
22. Which testsimpossible to fake?
were relatively hard or ~ven
_hat made them hard to fa~e?
al.llost
23. Some of the tests were repeated (Finger Tapping, GripStrength, Word t»airs). If yOll faked on these, did you tryto be consis1:.ent each time (that is, try to tap at the samespeed, grip at the same amount of pressure, etc.) If so,why and how did you do it?
24. If you were ~he examiner, now would you ca~ch someonefaking on these tests (mention specific ~est5 if pos5ibl~).
25. Some of ~he tests you ~aok were specifically designed ~o
catch pea pIe faki ng, or have "faki ng de~ ectors" built 1 nz othe Ill. .ere you a ware of this? I f so, 'Ii hich tests did youthink were included for this reasor.?
26. Have you ever taken any of these tests before? If so,~hich ones? (Also indicate if yca are £a~iliaI with ~hem
for any other reason.)
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API?END.IX 3
INSTRUCTIONS TO SUBJECTS
HONEST NORMAL GROUP
Xhe purpose of ~his research is ~o determine how high youcan score on a Dumber of tes~s. These tes~s are ordinarilyused to evaluate so~e of ehe problems ~hae people may haveas a resalt of brain injury. Earlier, you were asked tofil~ out a ~ues1:ionnaire tha-,; asked scae ques~ions abcueyour health, hov you did in school, etc. You were asked topar~icipate in this study because you were doing well inschool and had no i.por~ant health problems. As a healthy,intelligent college stude~t, your teS1: results will serve asthe standard of good performance against which we will latercompare results obtained fro. people who have braininjar.ies.
Brain injuries are caused in ~ number of different ways.Our research is concerned primarily with injuries thatresult frail automobile accidents. Even though 1I0S~ of ustry not to think about it, many young, healthy people justlike yourself have been seriously injured in car crashes.It could happen to anybody. That is why your participationin this stUdy is so illpor~ant. We Deed ~o know how well youcan do on these tes1:s, so that ve can compare ehem to ~ests
taken by people who ~ere like you antil they were seriouslyinjured in autolllobile accidents. This information will aelpus to design aore effective treataent and rehabilitationprograms.
In sualllary, your job is to do the very best you can onall of the tests that you are about to take. Some of ~he
tes"ts will measure your skills. Do the best you can onthese. O~her easts will ask you about your feelings,opinions, etc. ~lease answer these as accurately as youcan.
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(The next section follows ~he p4etest.)
It is ve4Y impor~ant to remembex YOU4 instIuctions duringthe session. To help you to 4emember what to do, QOIE~LY
BEAD EACa OF TIfE FOLLOWING INSTRUCTIONS OUT LOUD. Be suzethat the examiner cannot hear you.
1. I will be taki.o. g a series ofevalua~e some of the problems thatresult of brain injuries.
tests that are used topeople may have as a
2. I am to try to do the very bes~ I can on all of thetests that I am about to take.
3. Some of the tests will measure skills.best I can on these.
I will do the
~. Some of the tests will as ae about my feelings,opinions, etc. I will answer these as accurately as I can.
If you duu!t ~hink you a4e willing to follow theseins~ruetions throughout the whole session, or if yoa do nothave enough ti~e to stay for the entire session, please letthe examiner know now.
PLEASE POLD THIS QUESTIONNAIBE IN BALF.FOLDEB
PUT IT BACK IN THE
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INSTRUCTIONS POR FAKING GROUPS
The purpose of ehis study is to determine how people fakedisabilieies on tests that are used to diagnose braininjuries. Why would anyone want to pretend that they had abrain injury? Usually for reasons that are against thelaw--such as for fraudulent insurance claims, or as adefense eactic in a criminal tria14
What we want you to do is to imagine that you were in a badcar c~ash a few Months ago. According to witnessas, theaccident was clearly the other driver's fau~t, and thepolice found ou~ ehat he was drunk. You hit your head onthe windshield and were knocked unconscious for a couple ofhours. After a faw days in the hospital, you were released.
(Inser~ the following paragraphs for the Specific group.)
FortunatelYr you did~'t have any really serious injuries.But you did no~ce some numbness in your right hand and youhad S08e trouble moving your right hand and arm (if you areleft-handed, pretend that the problem was with your lefthand and arm.) The doctors at the hospital told you thatthese problems were not caused by a direct injury to yourhand or arm--they were instead caused by a concussion(bruise) on the part of your brain that controls your handand arm. As a result, you decided to sue th( drunk driver'sinsurance company. Your lawyer then sent you to theUniversity of Hawaii Neuropsychological AssessmentLaboratory, which specializes in evaluating the effects ofbrain injuries.
Over the next hour or e wo, you are going to be eaking,som€ of the saae tests that are actually used in cases likethis. ie want you to pretend that you really were sent hereby your lawyer and that you are really taking these testsbecause you are going to use the resul~s in a lawsuit.
By nowr the problems with your hand and arm have almostcompletely cleared up--but you know that you can get a lotof money out of eha insurance company if you fake someproblems with your nand & arm Like th~ temporary ones thatwere caused by your bead injury. In order to prove yourcase and in order to win as much money as possible, you aregoi~g to pretend ~hat your arc a~d nand are even worse thanthey were right after the accident.
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(Inser~ ~he following paragrapns for the Global group.)
Fortunately, you didn't nave any really seriou~ injuries.But you did have a variety of mild symptoms and problems.The doc~ors at tnG hos~ital told you that these were causedby a concussion (bruise) on your brain that resnlted fromhitting your head. As a result, you decided to sue thedrank driver's insurance company. Your lawyer then sent youto the University of aawaii Neuropsychological Assessme~t
Laboratory, which specializes in evaluating the effects ofbra.ln in juries.
Over the next hour or t~o, you are going to be takingsome of the same tests that are ac~aally used in cases likethis. ie want you to pretend that you were really sent hereby your lawyer and that you are really taking ~hese testsbecause you are going to use the results in a lawsuit.
By nov, your syll E1toTis have al aos·t call pletely clearedup--but you know that you can get a lo~ of money out of theinsurance company if you fake a variety of syllptoms like thetemporary ones that were caused by your head injury. Inorder to prove your case, and in order to win as much aoneyas possible, you are going to pretend that your symptoms andprobleas are even worse than they vere righ~ after theaccident.
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(Tlle remaining paragraphs are given to botll faking qzcu pa s )
You must be extremely careful not to get caught faking,howeve r. If ehe doctol: e estifies in court that you werefaking, you will not only lose your case, but you could alsobe cited for perjury and contempt of court--and wind up witna heavy fine or jai~ sentence.
In 5ummaE~, lour job ~ l2 ~ belie!~ble symptoms 21 awiA injury without getting cijught. Remember, it is veryimpoItant that you follow these instructions carefully.Now, while you ara waiting to begin taXing the tests, tbintabout what you're going to do. You are going to be actingout. a role that you have neve.!; ex?erienced in real life.You won't have a script to te~l you what to do, so yOU'llhave to try to pre~end that yoa rea~1 were in an accidentand that you really are at. the Neuropsycbological AssessmentLaboratory at the request of your lawyer. pretend that ifyou fool the examiner, you vi~l win a lot of 1II0ney.~.but ifhe catches you faking, you could be in serious trouble.
I!POaT1NT! Please f~ld these instructions in ha~f 50 thatthe exaainer cannot see what you have been reading. QQ!QlTELL THE EXA!INER WHlT YOUR rNSTnUC~IONS ARE OR ASK aI~ ANYQUESTIONS ABOUT THE!. He does not know whether you havebeen told to do your best or to pretend tbat you have had abrain injury, and he should not find oat until after youhave finished taXing all of the tests. TaE EIA~INER WILLENCOURAGE YOU TO DO YOUR BEST, like he would with an actualpatient--BUT NO ~ATTER iRl~ HE TELLS YOU, CONTINUE TO POLLOiTHESE INS~RUCTIONS THROUGHOUT THE TESTING SESSION.
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(Administered after the pretest to the Specific Group.)
It is very impor~ant to remember YOUL i~structions duringthe sessioD4 To help you to remember what to do, QOIEl1lREAD EACH OF rHE fOLLOWING INSTRUCTIONS OUT LOUD. 8e surethat the examiner cannot bear you.
1. I will try to fake believable symp~oms cf a brain injurywithout getting caught.
2. My fake brain injury symptoms inclUde: my right hand isnumb, and I nave trouble moving Illy rigtlt. hand & arm. (IF YOUARE LEFT-HANDED, THE ~gOBLEM IS IN YOaR LEFT HAND & AR~.)
3. I will fake sy~ptoms and problems that are serious enoughto convince the examiner that I have a brain injury, so thatI will win my lawsuit.
4. I will pretend that if I get caught faking, I will be inser~OQS trouble--and so I will make sure tbat I don't getcaught.
5. Even though I may be too honest to do som~thing lik~ thisin ~eal life, I will try to fake a brain injury during thist.esting session.
6. All of the tests which I am about to take--startinq withthe first one--are used to evaluate the effects of braininj uz Les.,
7. 51: arcing now,viCtim. My lawyerhead injury.
I will pretend that rsent me here for test~ng
am an accidentbecause of :ny
Pr.EA5E FOLD TfiIS QUESTIONNA.IBE IN HALF. pur IT BaCK I~ 'rHZFOLDER AND LET rHE EXA~INEB KNOW Tg~T YOU dBZ RE1DY roBEGIN.
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(Adminis~e~ed afte£ the pretest to the Global group.)
It is very important to remember your instruc·tions dur ingthe session. ~o help you to remembe~ what to do,~I]!11
READ EACH OP THE FOLLOWING INSTRUC~IONS OUT LOUD. 8e surethat the examiner cannot hear you.
1. I will try to fake believable symp~oms of a brain injurywithout gecting caughc.
2. I will fake SYllptOlDS iUld. problems that are serious enoughto convince the examiner that I have a brain injury, so thatI will win 111 lawsuit.
3 • I will pretend that if I get caught faking, I will be inserious trouble--a~d so I wi~ make sure that I don't getcaugat.
~. Even though ! may be too honest to do somet4ing like thisin real life, I will t.ry to fake a brain in jury during thistas tin g session.
5. All of tile tests ",hicn I all abOI11: ~q take--starting with'the ~irst one--are used to evaluate the effects of braininjuries.
6. Starting nOll,victim. ~y lawyerhead injury.
I will pretend that I am an accidentsent ~e here for testing because of my
PLEASE FOLD THIS QUESTIONNAIRE I~ aALF. PUT IT SACK IN THEFOLDER AND LET THE EXAMINEE KNOW THAT YOU ARE READY TOBEGIN.
: •.
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APPENDIX ~
ORDER OF T~STING
1. Consent agreemen~
2. Instruct.ions
3. Pretes~
LJ. NUJIlbered rest.at.ement. of inst.ructions
5. Or~entation eo tas~ing and verbal ins~ruc~ions
6. Finger Oscillation t.rial '1 (both hands on every trial)
7. ~AIS Digi~ Symbol subtes~
8. Band Dynallolleter trial .1 (both hands on e very trial)
9. Word Recognition tast
10. F~nger Oscil~ation trial .2
11. WALS Ar~t~metic subtest
12. Band Dynamometer trial J2
13. Review of numbered instructions
14. W~S Associative Learning sUbtest
15. Finger Oscillation ~rial '3
16. iAIS Digit Span sub test
17. Rand Dynamome~er trial #3
18. angrouped Dot Counting test
19. Finger Oscill~tion trial #4
20. Grouped Dot Counting test
21. Hand Dynamometer trial #4
22. R~view of numbered instructions
23. Finger~i? XO ~ri~ing test
24. Fi nger Oscillation tria 1 #5
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11 ~
25. Pif~een-Itam ~emory tes~
26. Finger Oscillation trial J6
27. Word Recall tes~
28. Peabody Pi~ure Vocabulary Test
29. Trailma~ing Test, ~art B
30. Review of numbered ill.structions
31 ~ ti!!~I
32. Posttes-t questionnaire (faking groups only)
33. Best-effor-t Pinger Oscillation trial (fa.ldng groups only)
3~. Bes-t-effort Band Dyna.ome~er trial (faking groups only)
35. In~erview (faking groups only)
36. Debriefing and compensation.
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APPENDIX 5
SCORING ROtES, FORMULAS, AN 0NONSTANDARD RULES OF TEST ADMINISTRATION
WAIS ARITHMETIC NONSTA~DABD ADMLNISTRATION RULE: Adminis~er- ....-- -------- ---- - -----every item starting with J3 (in order to provide ~he maximum
namber of opportunities to make FSHP and approximate errors.
~ ARITHMET~C~ ERROR~:
~~iling lli!!: Last item answered corre~ly ev~n if time
Ii_it vas exceeded.
!~1!l ~rrors: Incor.rec~ answers on any sUbceiling itell. Do
no~ count as an PSHP error if ~he correc~ answer was given
af~er the ti~e liMit.
Total FSHl? errors divided by
ceiling item number.
Ceiling~: Always use Item J1ij.
A~proximate ~~: Count errors as approximate answers if
(1) the answer is within 10~ of the correct answer, or (2)
no more than one digit of an answer is incorrect (applies
only to items for whiCh ~he correct response consists ot a~
least two digits.)
Divide t.o t a I
~umber of apprax~mata answers by 14.
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l2nstandard !dminis~ration: Start adAinistration ~ith Item
., (co incraase nlllllber of cppo r e un.LtLes to make FSHI?
~rrors.) Admi.nister at least 25 ~tems beyond the ceiling I
and ~ontinue to 1150 if feasible.
fill Errors:
item auabe r ,
All errors on items below the standard ceil~ng
Incl1lde sub-basal items if administ~red.
Fo£~ula ~ Perc~ ra~: Divide total n1lmber of PSHP
errors by t~e ceiling i~em nUllber.
Faking scores a~e derived from the i!S Associative Learning
subtest and frolll the Dot Cownting tasts by sumllling
deviations froll expected trends. The expe~ed trend for the
i~S Associative Learning ~ubtest is improvement or no change
ovar trials. Decrements from one trial to the next violate
the exp~cted trend; accordingly, the index consist~ of the
sum of decrements over trials (calculated separately for tbe
easy and hard lists.) The expected trend on both Dot
counting tests is a pos.itiV'e correlation between cou nc a nq
time and nUMber of dots. Violations of this trend consist
of taking longer. to count a set of docs than ~t tOCK to
count the n~xt smaller set. The index is calc~lated by
summing the number of seconds of such di~crepancies.
Page 129
117
APPENDIX 6
Table 15
Group !eans and Standard Deviations on Dependent Meas~r=s
------------------------------_.._-------------".------Honest Specific Global
Measure Normal Faiting Fuing
----_.......--------~---------....------------------------Finger Oscillation
Maximum Do mi.nant Mean 58.09 20 .. 35 37 .. 39s , d. 5.06 1~ .. 86 11.75
Best Effort 0011. Mean 51.91 53.96s.d. 9.00 7.87
Coeffici.ent ofVariation DOli. !ean 8 .. 78 18 .. 31 10 ..86
s.d. q.73 19.01 7.63
t!ax! IIUJIl Sandall. Mean 53.96 37.30 37.09s.d. 6.06 11.88 11 .. 3Q
Best Effort Nondom. Mean Q8.30 48 ..56s.d. 7.76 8.55
Coefficient ofVariation Nondolll. Mean 6.44 12 .. 52 11.06
s ..d. 2.90 10.62 12.90
Hand DynallollieterMaxilllum Dominan~ Mean 34.00 17.. 04 31.96
s. d.. 9.. 10 10.30 10.77
Best Effort. Oom. Mean 36.13 36 .. 52s.. d. 9.55 8.42
Coefficient ofVariation nc s Ln ane Mean 5.80 46.26 13.69
s, d. 3.37 ~ 1. 23 11. 41
Maxi mllli Nondominant. Mean 29.22 32.61 29.56s. d. 7.95 9.. 27 9.4d
Best Effort Nondom. Mean 32.56 32.70s.. d.. 9.57 8.93
Coefficient. ofVa.riat.ion Nondom. Mean 5.64 d.51.+ '1.46
s; d. 3.51 ij. 11 9.87
Page 130
, '8
Tabld 15. (Continued) c r oup Means andStandard Dev1a~ions on Dependen~ Measures
I!easuraHonestNormal
Speci ficfaKing
GlobalFakir.g
-----........--~----------------------------------------
WAlS Digi~ Span 1 Raw Kean 6.61s, d. 1.20
Trails B Time Means.d.
WAlS Digit Symbol Raw ~ean
s. d.
.AIS Arithmetic Raw Heans.d.
iAlS Arithmeeic ~FSBP Means. d.
iAlS lrithlle~ic
% Approximate Answers Means.d.
58.8711.05
71.3015.97
12. 173.83
7.2616.80
108. 0061.93
41.3913.65
10.562.89
11. 8310.27
6. /437 .. 71
5.143.94
106.1371. ijO
48.1+314. 1 1
19.&515.50
7.. 968.14
5.741. 54
iAI S Digi t Span B Raw Mean 5.13s. d. 1.22
Pifteen Item Memory Kean 1ij.83s. d. .65
VMS Assoc. LearningTotal raw score Mean 18.~8
s. d. 2.06
Easy index ~ean .22s. d. .52
aard index Mean 1. /43s. d. .73
PPVT To~al Score Mean 120.87s. d. 12.88
PPVT % FSHP Exrors Mean .10s .. d. ..,)3
4. ij81.08
14.223.85
.78
.95
1.391.37
1 15. 6121.86
• 13.05
4.22.95
13.302.80
15.35ij. 11
.651. 15
1.521. 12
101.2235.0b
• 15• 11
Page 131
119
Table 15. (continued) Group ~eans andStandard Deviations on Dependent Measures
....-_---.-.---~------------_.-_-..._-.. .. ....,.;":'..._-------------------Honest Specific Global
l!gasure Normal Faking Fil.idng~--~--~---~-----------------------------------------~~---Do~ counting Indices
Onqrouped Mean 5.26 9.. 26 8.83s.d. 1.29 3.48 7.00
Grouped Mean 2.35 6.09 4.56s.d. 1.07 3.92 2.59
ongrouped-Grouped Mean 13.83 13.48 18.83. s. d. 5. S3 11.48 19.58
iOId Recog.-Becall Mean ~.48 2.00 3.26s. d. 2. S2 3.09 2.9 i
Fingertip iritinqDOlllinant Index Mean .1.J9 .44 .29
s, d. .01 .08 • 18
Rondoll. Index Mean .48 .44 .49s. d. • 02 .07 .02
-.-._-.-.-...-.-----------.---~~----.--,-. _-....--...-_-------------
Page 132
120
A? t'ENDIX 7
Table 16
Classification of MMPI t'rofiles UsingLachu's Validity Configuration Rlll~s
Group
~MP.I Validity TypeIiones-tNorllal
SpecificFaking
GlobalFaking
......._----_.------~-------------.---------------------1 0 2 0
lA 0 a 1
3 0 1 0
5 2 1 1
6 0 1 0
7 0 2 0
8 0 1 5
9 0 0 1
9+9A 0 , J
14 21 14 12-----...--------------- ----------------------
Page 133
121
APPENDIX 8
FBEQaENCY TABLES FOR SELECTED?REtEST AND POSTTEST QUESTIONNAIRE ITEMS
Table 17
Faking Criteria Reported On Pretest Item 2And/Or Posttest Items 1, 2, and 15
(Expressed ~s Percen~age of SubjectsAcross Faking Groups Who Reported)
Symptom or ProblemPretestonly
Posttestonly Both
__~__---",,-,"'-'-~ ~~__o'~__~_~ '-" "'-__~_~~_
~OTOR DYSFUNCTIONS/DYSPRAXIA
Motor Oysfunctions - UnspecifiedSlow ~ove~cn~~ ac~ivity - generalHand/arm paralysis or par~ial
paralysis -- dominantnOlldominantboehunspecified
Hand/arm weakness -- dominantnondominan tbothullspecified
Band/arm slowness -- dominantunspecified
aand/a.rm fine motor coo.rdination/control dysfu~ction dominant
unspecifiedTremors/spasms/shaking dominant
, unspecitiedother hand/arm problems (stiff,. heavy, e cc s ) dominant
unspecifiedFine moto~ dysfunction ~ith
gross motor normalGross motor dysfunction withfine ~otor normal~oor quality ~riting, drawing
.02.00
• 15.00.00.04.02.00.00.00.00.00
.02
.02.02.02
.02
.J2
.00
.00• iJ4
.09
.70
.13
.. 00
.00
.02
.20
.02
.02
.76
.13
.24
.02
.Ob
.00
.02
.04
.04
.00
.00
.04
.00
.02
• 07.00.00.00.00.00.00.00• 00.00
• 11.00.00.02
.02
.02
.02
.00• J 2
Page 134
122
Table 17. (Continued)Faking Cri~ax~a Repor~ed On Pre~es~ Item 2
And/Or Posttest Items 1, 2, and 15(Ex~rassed As Percentage of SubjectsAcross Faking Groups who Raported)
Symptom or Problem
PHYSICAL SYMPTO~S AND PAIN
Pretes1:Only
Post~est
Onl.y Both
Headaches .06Dizziness/dizzy spells .11Fa~ntin9/blackouts .02Back or neck pain .00Nausea, vomiting, s~o~ach trouble .02Loss of con~rol of body functions .02Poor coordina~ion .02Pain/tingling in hands/arms/legs .04Physical Sy~ptOAS aDspecified/o~her .02
SENSORY-PERCEPTUAL DYSFUNCtiONS
.20
.06
.02
.00
.09
.00
.02
..04
.43
.26
.02
.00
.02
.. 02
.00
.02
.02
.00
Beaxing lossTinnitusVision problellsBand/arm numbness -- d c ai na ne
unspecifiedNumbness elsewhere/unspecified
COGNiTIVE DEFICITS
.00
.00• 04.09.00.02
.00
.04
.04
.11.54• 13
.02
.00
.09• 1 5.06.02
Confusion .00Poor comprehension/unclear thinking .00Poor on complex probless, ideas .02Poor on abstrac~ problems, ideas .04Poor reasoning, problell solving .04Concentra1:ion/attantion deficit .00Kemory prob18ms, amnesia .00Slow/hesitant responses (cognitive) .00~ath difficulty .02Reading difficulty .02"Stupid", "ignorant", etc. .00
.70
.09
.00• 00.04.52.41.20.04.00.39
.02
.04
.00
.00.00.11.37.014.00.00.JO
Page 135
123
Table 17. (Continued)Faking Criteria Reported On Pretest Item 2
And/Or Posttest Items 1, 2, and 15(Expressed As Percentage of su bjec-csAcross Paking Groups ~ho Reported)
- --.._----------------~-----------------,----------------
symptom or ProblemPre1:estOnly
E'ost1:estOnly Beth
------.....--._.--...---~----_.----------------------------~OTIVATXON/E~O~ON/SOCIAL
Depression .02Infer~ority, lacks confidence .00Insecu reianxi 011s/tanse/fear ful • 02Apathy, inactivity .00Sleep disorders, nigh1:mar~s .00Daydreaming, ~Ut of touch v/reali1:Y ~02
Visual hallucinations .00AUd~tory hallucinations .00crazy, disturbed, e"tc. .02Frustrated/embarrassed by handicaps .02lnger, bad tellper .0tJHostile, ~~cooperative, resentful .00Paranoid i di~rus-cful, antisocial .00I~~atient6 impulsive .00Shy, lonely .00Tired, easily fa-cigued .02Other social/emotional problems .00
SPEECH AND COMMUNICATION
Trouble understanding speech orverbal instructions .00
Frequently needs repea1: instruc~. .02Speech impediment .02Expressive language disorder .00
.06.04.15.0tJ.13.02.02.02• 11.00.0tJ.0tJ.06.02• 11.06,,02
.41
.00
.00• 11
.00.Oil.02.00.00.00.00.00.00.00.00.00.00.00.00.00.00
.06
.00
.00
.00
Page 136
124
Table 17. (Con~inued)
faking Criteria Reported On Pretest Item 2And/Ox ~osttest It~ms 1, 2, and 15\Exp~assed As Perceneage of Subjec~s
Across Faking Groups Who Repor~ed)
Symptom OI ProblemPretestonly
posttestOnly Boell
TES1 PERFOB!AHCE PROBLEMS AND BRAIN-BEHAVIOR SYNDROMES
Errors - unspecified .00Errors - Caraless or random .02Errors - Easy items/tests .00Errors normal people do noe make .02Errors - appro~ima~ely correct .00Do poorly, less than best on tests .00Subjective (unverifiable) syaptoms .02Symptoms depend tests given to me .06Cognitive dysfunctions belie~ed to
be con'uolled by hellispherecontralateral to sotor dysfunction .02
Perform inconsisten tly • 00Random responses on MaPI ,00No sYlll ptOIBS indicated • Ott
• 11.04.02.00.02• 13.00.00
.00
.04
.04
.Oq
.00
.00
.00
.00
.00.00.00.00
.02
.0 a
.vo
.00___"'--~"'- ~IIIICJ'-'-'~ ~ ~ ~"'-- ~ _
Page 137
115
Table 18
Frequency Tables For Selected Post~est I~ems
(Percentages Reported Across Faking Groups)
----------------------------------------------~-----------Percent Reporting
ITEM 16. TRZCKS USED TO ?)~E SYMPTOMS OR PSOBLEMS
(a» No~ trying Te~y hard(b) Approximate answers(C) Distributing errors(d) Doing as poo~ly as possibleSlow responses, movementsAvoid use of -impairedu functionSAow latara~ized dysfunctions~ry to be inconsis~ent
Imagine you really ~~ve tbe problemCon£usion/frustration/inatten~ion
DoD.'t COllcen'~rate (make real errors)Shov signs of pain, discomfort
DISGULSE5 (FRO~ ITEMS 15, 17, 18, AND 19).
~;edic"ted DisgUises
.96
.80
.85
.35• 15.11• O~.04.02• 13.09.02
Doo't score too low or completely fail .91Do poorly on SOMS tests, lilell on otbers .52Distribute errors witbin tests .80Gi7e approximate answers .67
Other DisQuise 3tateqie~
Be consistent .163e inconsistent .09Don't make ob~ious errors or be obTious .35~ake s1mpto~s "all or none" .06Go slov, hesitate .11Don't go too slow .02Be careful, cautious • J6~ake careless errors .. 06Make errors on easy items .02~ake errors on nard items .06Doo't make intentional errors .02Don't use impaired fu~ctions .15Pake only puysical (not cognitive) problems .J2Pake only cognitive (not physical) problems .02DQn'~ listen/concentrate--make real errors .09Imagine symptoms are real .06
Page 138
12&
Table 18. (Con'tin ued)Frequency Tables Por Selected Pos'ttes't Items(Percentages Reported Across Faking Groups)
_ ..._~ --... ~ .. u. __
Percent Reporting---_...-----.--.~-----....---.-.-_-~-------....--------------Act normal/natural .20Act crazy, disturbed .02Aet like trying hard* doing your bes~ .11Loo~ (ac~) sincere .02Be cooperati ve • oJ4Be uac 00 pera ti ve/hos1:i1 e • 02Ac~ confident, sure of self .04Show lack of confidence, act unsure .02HelIain cal~ • 06Ac't ~~~vous/tense/aI1%ious .04Act like trying hard to overcolle disability .02Act serious, keep a s~ra~ght face .09Look proud when giving wroag answers .02Look exam~ner i~ the eye .06Avoid eye contac~ vith examiner .02Act confused .06Speak oaly when asked to .02Aet like can~ot concentrate .02Show d~scomfor't from pain .06Act enthusiastic, interested in testing .02Act tired, fatigued, uninterested in testing .04Present self as exceptionally honest .43Present self as nor ~l except for symptoms .22Present self as religious, church-oriented .04present self as pro-law enforcement .04Present self as exceptionally fair .02Present self as happy, intelligent,well-adjusted, o'ther positive attributes .09
ITE!! 20. DID BEST OK SO!E TESTS: REASONS
Didn't know how to faka .06Didn't know how bad to fake .02Didn't know whether to fake .02Forgot to fake .. O~Did well to compensate for other bad scores .09Too easy or obvious to fake .. 26Test was irrelevant to my symptoms .11
Page 139
127
Table 18. (Continued)~4equency Tables For Selec~ed Post~est Items(Percentages Reported Across Faxing Groups)
Percent Repor~ing
~------------~------~~----------~------------------------Enjoyed test, challenge, wanted to do best .04Hard to fake tests involving face-to-facecon~ac~ with examiner (be can see fa~ing) .02
Too ellbarassing to look st-apid, etc. .04Should do well, given my background .04Did best on unimpaired side of body .06Don't knoll why .04Don't listan/concentrate--lIake real errors .09Imagine sYllp~oms are real .06
ITE~ 22. HARD TO PAKE: REASONS
Hard to be consistent on repeat items .10Hard to be inconsisten~ on repea~ items .02Too easy to fa.ke--would be obvious .50unprepared, do not know hoy to fake .13Correct answers are automatic, hard to fake .06Hard to fake tests visible to examiner ~13
Can only fake cer-eain dimensions of a '1;as~
(e.g. slowness, but not errors) safely .02Kard to fake cognitive ~ests .02Too te~pting to do your best on tests .02
ITEM 23. TRIED TO BE CONSISTENT?
Tried to be consistent .80Tried to be inconsistent .17Tried to "improve" over trials .15Tried to get worse r "fatigueR over trials .02Counted taps to stay consistent .30----------------------------------_-.----------------------
Page 140
128
REFERENCE NOTES
1. Freedland, K. E., and Craine, J. F. Techni~ues for
de~ec~ing faXing on neuIopsycholog~cal ~ests. P~per
presented at the annual meeting of the Westarn
psycnological Association, Los A~gelas, AP~ll 1981.
2. Yates, J. T. Personal communication, September
1981.
3. fleaton, B. K. Personal communica~ion, April 1981.
Page 141
129
Bibliography
Agats1:on, a,
opll tilalmol og""
Ocular mali~garing.
1944, 11, 223-231.
Archives
Alarcon, R. D. ays~eria and hys~erical personality:
How come one without the other? Psychia~ric
Quarterly, 1973, !I, 258-215.
Aaerican Psychiatric Associa~ion.
Statistic~l Manu~~ !l1, 1980.
Diagnostic
Anderson, J.
Impla.ca~ions.
R. CogniLive Psychology ~
San Francisco: Freeman, 1980.
Antllony, If. Comparison of clients'
exaggerated, and matching ~!PI ~rofiles.
Consul~ng s~ ~linical psychology,
100-103.
Anthony, M. Malingering as role ~aking.
Clinical Psychology, 1976, 11, 32-41.
standard,
Journal of
1911, 1.2,'
Journ~ of
Barnes, G. i., & Lucas, G. J. Cerebral dysfunction vs.
psycnogenesis in Hals~ead-Reitan tes~s. Journai oE
~erv2~ aqg ~ental Disease~ 197~, 122, 50-60.
Page 142
Bash, I. Y. r1ali agering:
130
A study des~gned to
difLerentiate between schizophrenic offanders and
malingerers. (DO~oral disserta~ion, New York
University, 1978) • Qissertatioa ~bstq!~
International, 1978, l2, 2973. (University
Microfilms No. 78-2~19q)
Bash, I. Y., & Alpert, M. The determination of
lDalingering.
Sciegces, 1980, l!1, 86-99.
Bender, L. B. A visual 2otor gestalt test and its
clinical use. American orthopsychiatric Assoc~ati2s
Resea;ch Monograehs, 1938, No.3.
Benton, Borsc~ach performance of suspected
malingerers. Joarnal Abnormal Soc ial--PsycholoqI, 19Q5, iQ, 94-96.
Boll, T. J. The aalstead-Beitan Neuropsychological
Battery. In S. B. Filskov s T. J. Boll (Eds.),
~~ndbook 21 ~~iAicsl Neuroesychologv.
lIiley, 1981.
New York:
Bowlus, w. E., & Currier ~ R. D. A test for hysterical
llellliQ.~a1gesia. ~ Enqla~ Journal ~ ~icine,
1963, lli, 1253-1255.
Page 143
Br ad!, J. P. ,
hysterical
techniques.
!O, 331-339.
131
Boydstun, J. A. l!alingering. In H. I. Kaplan, A. !'!.
Freedman, s B. J. Sadock (Eds.), Compr~.!ls~m
Textbook £! Psychi~try I!!. Baltimore: .illiams &
iiilkins, 1980.
& Lind, D. L. Experimental analysis of
blindness: Operant conditioning
~i.ves g! ~eneral £sych~at.£I, 1961,
Bruhn, A. R., & Reed, 11. B. Simulation of brain damage
on the Bender-Gestalt test by college s euden ts.
Journal 2! Personality Assessment, 1975, 11,
2~4- 255.
Burkhart, B. R., Christian, s, L., s Gyn~har, M. D.
IteD subtlety and faking on the ~~PI: A paradoxical
relationship.. ~~.£J!.s1 sI Personality !sse§2~1l,
1978, ~, 76-80.
Burkhar~, B. R., Gynther, M. D., & Christian, w. L.
PSyChological ~indedness, intelligence, and it=m
subtlety endorsement pat'terns on the ~MPI. ~Bsl
g£ ~linical Psychol~, 1978 c ~' 76-79.
Bu.rkhar't, B. B.., Gynther, M. D., s Fromuth,:1. E. Tile!
relative predictive validity of subtle vs. obvious
i tams 0 .. the l!MPI Depression scale. d~.£..ig.~ c f
clinical psv~hQ1Qg~, 1980, 12, 748-751.
Page 144
132
Canter, A. A background interference procedure to
~ncrease sensitivity of the Bender-Gestalt ~eSt to
organic brain disorder. Journal 2i Consu!Sing
psychology, 1966, lQ, 91-97.
Canter, A. SIP Bender test for the detection of organic
brain disorder: Modified scoring ~ethod and
repli.cation. ~rnaJ.t 2! ££llIDL1:tinq ~ Cl~ni.csl
Psychology, 1968, 11, 522-526.
Ca~ter, F. M. Simulation on th~ California
PsyChological Inven tory and the ad justillent of t.ne
simulator. Journ~l ~ consglting 2sycboleSy, 1963,
2:1, 253-256.
Carlson, N. R. Physio,l9SLI g! Be.l1avi,9r (2nd ed.).
Boston: Allyn and Bacon, 1981.
Carter, A. B. the functional overlay. tancet, 1967, 1,
1196-1200.
Chodoff, P.
Ameri£~1!
1073-1078.
rh a diag nosis
J?urnal ,g1
of hysteria:
Psychiatry,
An overview.
1974,
Christian, a. L., Burkhart, B. a., & GInther, ~. D.
Subtle-obvious ratings of MMPI items: ~ew ~~tereSt
in an aId concept. ~rnal oE £.Q.!l~lSiQg ag.sclin~cal !?sycl101ogy, 1978, !i.§, 1178- 1186.
Page 145
Cramer, 6., Gcrshberg,~. B., s Stern, M.
133
~unchau.sen
sydrome: its relaeionship ~o malinger~ng, hysteria,
and ebe pnysician-patien1: r e Lat.Lon s c Lp, :\rchi~ Qi
~lli Psychiatry, 1971, ~, 573-578.
cuze , S. G. The diagnosis of h1s~eria: What ar~ we
trying to do? American dgg&nal of Psychia~r~1 1967,
Chl1sid, J. G. Correlative Neuroana~oml~ F3uctional
Neurology (16th ed.). Los Al~os, California: lange
!edical PUblications, 1976.
Clarke, P. a., & Bilger, R. C. The ~heory of signal
de~ec~abilit1 and the aeasurement of hearing. In J.
Jexger (Ed.), Modern Develoemen~s ia AUdiologv (2nd
ed.). New York: Academic Press, 1973.
Cofer, C. N., Chance, J. E. I s Judson, A. J. A study of
malingering on the ~~PI. Journal 2! ~sycholgSYI
conn, M., Ventry, I. M., s Woods, R. Ii. Pure-tone
average and spondee threshold relationships in
simulated hearing loss. Jou:rna 1 Audit.orv---ReseaI£!!, 1972, 11, 234-239.
Page 146
13'4
Cot~le, i. C., & Powell, J. O. The effec~ of ra~dom
answers to the ~MPI. ~E~~ionA1 ~ f~Icno12S!~
MeasoremellS, 1951, 1.1, 22q-227.
Cronbach, L. J. !2~entials g£ pSI~holog~£~ !~ir.g
(Jrd ed.). New York: aarper & Row, 1970.
Dahlstrom, W. G., & Welsh, G. S. An~ Handbo~: !
Guide 12 ~ ~ CliRical practice ~ ~a££~.
~~nneapol~s: University of ~innasota Press, 1960.
Dahls~rom, w. G., Welsh, G. S.,
~~PI aangbook, !olume 1:
(Rev. ed.). Minneapolis:
Press, 1972.
& Dahlstrom, L. E. !n
Clinical Interpretation
Uni~ersity of ainnesota
Dahls~rom, W. G., Welsh, G. S., & Dahls~rom, L. E. !n
~MPI Handbook, Volqme ~: Research Applica~ions (Rev.
ed.). Minneapolis: Universiey of Minneso~a press,
1975~
Davis, D., & Weiss, J. a. ~alingering and associated
syndromes. In S. AIieti s E. B. Brady (Eds.),
Ameri~ ~~ £! psychiatrv (2nd ad.). Ne~
York: Basic Books, 1974.
Page 147
135
Deikman, E. Ose of cortical function testing in a
personal injury ~rial. In i. L. Smith & M. J.
Phillipus (Eds.), ~~g2sICQolgg~~al I~i~g in
Orga~ Brain QIsfunction. Springfield, Illi~ois:
Charles C. Thomas, 1969.
DeJong, R. N. Ia! Neurologic ~~amina~ion (4tb ed.) New
York: Harper & Row, 1979.
Dies, R. R. Detection of simula~ed ~HPI records using
the desirability (Dy) scales. Journal 2! Clinical
Psycholag!, 1968, 1!, 335-337.
Dunn, L. ~. Expanded ~~Du41 !££ 1A2 ~eabodI fiE~ure
Vocab91§rI *es~. Circle Pines, !innesota: American
Guidance Service, 1965.
Edwards, A. L. On Gu~tman scale analysis. Educatignal
and pSIcnological Me~sBrement, 1948, ~, 313-318.
Cons1:ruct';on.
1956.
Edwards, A. t; ~chni9ues
New York:
2i ~ttit~de SAd Scale
Appleton Centu~1 Crofts,
Egan, J. P. ~ignal Detec~ion ~~ ~ RQf ~~.
New York: Acade~ic Press, 1975.
Eggars, H. Estimation of uncorrected visual acuity in
malinyerers. ~rchiv~ of Oph~halmology, 19~5, 11,
23-27.
Page 148
•136
Eissler, K. R. Malingering. In G. B. jJ ilbur s s ,
Muensterbegger (Eds.), f2!choanalys~s ~as CUlsy~.
Nell Ior k: International ani versi ties Press, 1951.
En gelberg,
193- 196.
~. The validity
~ournal of AUdito~y
of the Doerfler-Stewart
Research, 1970, lQ,
Engen, T. Psychophysics: Discrimina~ion and detection.
In J. W. ~ling & t. A. Riggs (Eds.), ~oodworth §
sch1osberg's ~xperiment~l psychg10gy (Jrd ed.). Nell
York: Bolt, Rinehart and iins'ton, 1972.
Exner, J. E. On the detection of willful falsifications
in ~he !MPI. Journal ~ Consulting Ps¥chq12gI,
1963, 11, 91-94.
Feitisod, I!., Hoy't, s, F., Wilson, i. B., s spire, J. I?
Visually evoked response: Use in neurologic
evaluation of pos't-traulla tic subjecti va visual
COlll plain 'ts. Archives 2I. Ophthalmology, 1976, 2!,
231-240.
Feldman, I!. J., & Graley, J. The effac'1:s ot an
experi~ental set to simulate abnormality on group
Rorschach parfo~ma~ce. ~sa1 2! ProJ~£~
Iech~ig~~, 195~, ~, 326-334.
Page 149
137
Pilskov, S. B., s Leli, D. A. Assessmen t of the
individual in neuropsychological practic~. In S. B.
FilsKov & T. J. Boll (Eds.), na~dboo5 2~ £11~~
!eu&oeslch~q~l. New York: iiley, 1981.
Finn, J. D. ! ~e£era~ ~odel !Q£ ~~tivariata ~I§is.
New York: Holt, Rinehar~, & ~inston, 1974.
Pinn, J. D., & Mattson,
Educatignal Researca.
Resollrces, 1978.
I. ~ulti~riaSi Anal~21§ ia
Chicago: National Educational
Gendreau, P., Irvine, M., s Knight, s, Evaluating
response set st yles on the MM PI with prisoners:
Faking good adjust~ent and maladjustment. £anadian
Joqrnal gl ~ehavior~l Scien£g, 1913, 2, 183-19~.
Golds'tein, G. Methodological and theoretical issues in
neuropsychological assessment. ~ournsl 21
Behaviora1 l§sessmen!, 1979, 1, 23-~O.
Goldstein, B. Malingering key for mental tests.
PsycBoloqical ]s1l~1!~, 1945, ~, 104-118.
Goodenou gh, I.
];,guca tj,.Q!lll
179- 190.
!I. A teC.hnique for scale anaLys i,s ,
m Psycho logica 1 ~ea suremen t, 1940~,
Page 150
138
Gordon, ~. E., & Gross, R. H. A cr~~i~ue of me~hcds fo~
operationalizing tne concep~ of fakeabili~y.
Educ§tion~ s~ P~ychologica1 ~sureme~t i97S, 12,
771-782.
Gough, Ei. G. Si~ulated patterns on ~he ~MPI. Journal
~1 Abnormal ~ Social Psychology, 19~7, il,
215- 225.
Gough, B. G. The F ~inas K dissimulation index for the
~!PI. Jou;~!l 2l ~onsultiag psvchology, 1950, l!,
LJ08-~13.
Gough, B. G. c c s acn lIisconceptions about neuroticism.
Journal g! ~onsBltiaq Psychology, 1954, ~, 287-292.
Green, B. F. Attitude measurement. In G. ti~dzey
(Ed.), ~andb?g! gf ~ocial psvchology. Cambridge,
~assachuset~s: Addison-Wesley, 1956.
Green, D. !., & Swats, J. A. ~~~~J ~£tion Theory
~ psycbopby§ics. New York: Wiley, 1966.
Gr ossb€rg, J. M., s Grant, B. F. Clinical
psychophysics: Applications of ra~io scaling a~d
signal detection methods to researcb on pain, fear,
drugs, and &edical decision ma~~ng. £~ICholog~cal
Bulletin, 1978, 1154- 1176.
Page 151
139
Grosz, EI. J., & Zimmerman, J. Experimental analysis of
hysterical blindness: A follo~-up report and new
experimental data. A!chiv~ £1 ~~neral fsych~£Z,
1965, lJ, 255-260.
Grove, T. G. Performance of naive and role-playing
pseudo-malingerers on an unco ad a e.i one d EDB
audiometric test. JOUInal 2! Auditory Research,
1966, 2, 337- J 50.
Grow, a., ['!cVaugh, i., s Eno,
~[,!PI. Journal 21 Clinical
910-917.
T. D. Faking and the
Psychology, 1980, ~,
Gynther, M.D., Burkhart, 8. a., & Bovaniez, C. Do face
valid items hav~ more predictive validity than
subtle items? ~he case of the ~MPI ~ scala.
Journal 2! Cgnsq+ting ~ Clinical Psycholo9I, 1979,
!!1, 295-300.
Harper, J. W. An inves~igation of th~ faking scales of
th~ aMPI and eheir use in differential diagnosJ.s.
Disse£ta!~ ~~~ International, 1976,
37,(5-B),2506.
Harris, D. A. A rapid and simple techni~ue fa! tna
detection of nonorganic hearing loss. !~1!~ of
Otolaryngology, 1958, ~§, 758-760.
Page 152
11.40
aa~ris, D. A. Detecting non-valid h~a~ing tes~s in
industry. ~2urnal g1 Q££yEati~ ~~!~, 1Y79,
11, 814-820.
aeaton, B. K., & Crowley, T. J. Effects of psychia'tI:ic
disorders and their somatic t~eatments on
neuropsycnological test results. In S. B. Filskov &
T. J. Boll (Eds.), lialH!~ gi cbinical
NeuropsychologI. New York: ~iley, 1981.
Heaton, a. K., SlIith, H. a., Jr., Le.hllan, a. A., s Tfogt,
A. T. prospects for faking believable deficits on
neuropsychological te~ing. Journal g! Consulting
~ ~.ipical Psychology, 1978, ii, 892-900.
Heaton, s, K., s Heaton,
patient. In s. B..
ijandbo~k g£ ClinicAl
ililey, 1981.
B. K. Testing the impaired
F ilskov s T. J. Boll (Eds.),
Neuropsychologv. New York:
Henry, A. P. A method of classifying non-scale ~esponse
patterns in a Guttman scale. Public Qeinion
Quarteily, 1952, l§, 94-106.
Hoffman, a.
sUffering.
279-288.
The medico-legal sig~~ica~ce of pa~~ and
South I~xas 1~ Journal, 1975, 12,
Page 153
i ~ ,
Hopkinson, N. T. Functional hearing loss. In J. Jerger
(Ed.), M9d~r~ ~eloBm~ in !udiology (2nd ed.).
New York: Academic Press, 1973.
Hull, C. fl., s Nie, N. H.
~cGraw-flill, 1981.
New YorJC:
Hl1l1t, H. P. The effect of deliberate deception on
!!innesota t!u~tiphasi.c Personalit:y Inven'tory
performance. Journal ~ consulting ?sychologz,
Hunt, a , A. ~he detection of malingering: A fur~her
study. !!Jli.!~ S.!~~ ~l Medical BUlletin, 191+6,
flunt, a, A., s Older, H. J. Detection of malingering
through psychometric tests. United States Naval-==-=---
~edi£al BUllitin, 1943, iJ, 1318-1323.
Istre, c. O. , s Burto n, a, Automatic audiomet:ry for
detecting lalingering.
1969, .2.Q, 326- 332.
!Ichives 2i otolaryngologI,
Jackson, D. N. , & !!essick, S. Acquiescence and
desirability as r9sponse determinants on t:he MMPI.
~at:i0IJ.s.l sllS I?svqpological MeaSll rem.ar. t, 1961, ll,
771-790.
Page 154
Jerger, J. f & Herer, G.
142
Unexpected dividend l~ ae~esy
audiolll~try.
Oisorde~, 1961, ~§, 390-391.
Kacj(ar, S. K. Bekesy a~diometry in simulated hearing
loss.
1971,1§, SOti-510.
Kazdin, A. E.
New York: Barper & Rov, 1980.
Kerr, L., & Tmomas, J. P. The effects of reordering the
response categories on the area under the ROC.
Behalfior Resea.rch ~ethods 5!.sS. l!1strulBentation, 1977,
Keschner, M. Simulation (malingering) in relation to
inju~ies to tme brain and spinal cord and the
coverings. In S. Brock (Ed.), Injuries 2! ~ ~ain
and ~aal ~g~S ~ Their Covering2'
Baltimore: Williams & iil~ins, 1949.
(3r d ed , ) •
Kinstler, D. B. Functional mearing loss. In L.
travis (Ed.),
Audiolog!. ~nglewood Cliffs, New Jersey: Prentlce-
fIall, 19 7 1•
Kolb, B., & lihisha'i , I. Q.
~euroesycqglog~. San Francisco: Freeman, 1980.
Page 155
144 3
Krame~, K. K., La Piana, F. G., & Appleton, B. Ocular
malingering and hys~eria: diagnosis and managem~nt.
~urTey 2! Oph~halmoloSI, 1979, l~, 89-96.
£~~£Al ~ss~ssmens and
Los Angeles: Western
Lac.bar, D. L. ~ ~Jj.fl:
Automated Interpretation4
Psychological Services, 1974.
Lanyon, R. I. simulation of normal and psychopathic
~~PI personali~y patterns. Journa~ 2! Consul~ing
psycholQ9I, 1967 r 11, 9~-91.
Larson, A. ~ental and nervous injury in workmen's
compensation. Vanderbil~ ~ Review, 1970, ll,
1243-1263.
Lezak, ~. D. ~~gpsycbological Assessment.
OX.ford University Press, 1976.
New York:
Lincoff, B. A., & Ennis, J. Differential diagnosis of
hysteria and malingering. ~merican Journal 2!
Oph~l1al.!lologI, 1956, li, 415.
Lof~us, 3., & Monahan, J. Trial by da~a: Psychological
resaarch as legal eTidence. Ame£ican ~~~g~~,
1980, ~, 270-283..
Long, G. M., & iaag, ~. L. Limitations on ~he practical
appl~cabili~y of ~ and ~ measures. ~~n
~.Q£.2, 1981, 11, 285-290.
Page 156
,
1~~
Mack, J. L. The use of neuropsychological testimony in
civil court proceedings. In G. Cooke (Ed.), ~
~ gf ~ porer.~ic psycbol09i~~. S~rin9field,
l:l~inois: C.harles C. Thomas, 1980.
Martin~ P. N., & Monro, D. A. Au~hors' comments on
effects of sophistication on Type V Bekesy patterns
in simula~ed nearing loss. Journal g£ ?eee£h aag
Bearing Disorgers, 1976, il, 283.
~at~hews, C. G., Shaw, o. J., & Klove, B. Psychological
tes~ perforaances in neu~ologic and
"pseudoneurologic" sUbjee-ts. Cortex, 1966, 1,
244- 253.
~c~ahon, E. A., & Satz, P. Clinical neuropsychology:
Soae forensic app~ications. In S. B. Filskov & T.
J. Boll (Eds.) , tiandb0.2~ 2! Clinical
NeuroQsIcho129I. ~ew York: iiley, 1980.
Menninger, K. 1. Psychology of a certain type of
malingering. Archives 2i Negrology ~ P5Ichia~r!,
1935, 33, 507-515.
Miller~ B. W. A review of practical ~es~s for ocular
malingering and hY5ter~a. aU,vay 21 0eh~~s~mQl2SY,
1973, 11, 2~1-2~6.
Page 157
145
~iller, G. A., Galantec, E., & Pribram, K. H. ~L2 a~d
~ S~ruc~ura g! Behavior. New York: Holt, 1960.
Miller, H., & Cartlidge, N. Simulation and malingering
af~er injuries to tbe br ain an d s pinal cord.
Lancet, ~arch 11, 1972, 580-585.
!onIO, D. A., & Mar~in, F. N. Effects of sophistication
on four tests foc nonorganic nearing loss. Journal---91. seeeih W Hecarin,g Disor:der~, 1977, li, 528-534.
!orgenlander, B. t. Tes~s for aalingering. !2! ~~S
J09.rB~ 2! [!egiciue, 19701' illf .103.
Nie* R. a., Bull, C. H., Jenkins, J. G., Steinbrenner,
K. , s Bent lf B. for the--SocialScienqgs (2nd ed.).
1915.
New York: ~cGraw-Hill,
Nunnally, J. C. psychometric Theorv (2nd ed.). New
York: ~cGraw-Hill, 1978.
Osborne, D. A. A ~oderator variable approacn to MMPI
validity. Jou~nal ~ Clini~ psychol~, 1970, ~,
4 86-~ 90.
ossipov, v. P. 11 alingering: The simulation of
psyc nos i s ,
~, 39-~2.
Page 158
Pang-C Iling,
repo rt.
322-327.
146
G. The rone-In-Noise test: A preliminary
Journal gi Audit.0ll Research, 1970, .1Q,
Pankratz, L., Fausti, S. A., & Peed, s. A forced-cho~ce
technique to evaluate deafness in the hysterical or
malingering pa tien 1;. ~Enal g! Con~.lling ~
Cl£n~cal gsychology, 1975, !], ~21-~22.
Parsons, o. A., & Prigatano, G. P. ~ethodological
considerations in. cl.inical neuropsychological
researc4. ~ourna~ g! Consulting and ~~n~£al
Psycholggz, 1978, !i, 608-619.
Paulson, !. J., & Lin, T. T. Predicting WAIS I.Q. from
Shipley-aartford scores. ~ournal g£ Clinical
psycbologl, 1970, 1~, ~53-ij61.
Peck, J. E., & Ross, M. A comparison of the ascending
and the descending sodes for administering the Pure
Tone stenger test. Journab 2! Auditory R~sea££h,
1970, lQ, 218-220.
Perley,~. J., s Gaze, S. 8. Hysteria: The st.abi':~t.y
and usefulness of clinical criteria. ~ ~g1and
~~ 21 gedic~Dg, 1962, 12&, ~21-~25.
Page 159
147
Perlin, M. L. The legal s~atus of ~he psycnologis~ in
the courtroom. ~m£..S 1.ai! ~2, 1979, ~,
19t4-200.
statistical
?sycho!etrika,
Proc~or, c. B. A probabilistic fo~mulation and
analysis of Guttma~ scal~ng.
1970, 12, 73-78.
Proctor, C. B. Reliability of a Guttman scale score.
American ~~§tical ~ssoc~a~ieA ?roceed~nqs g! ~
~ocial Sta~ist~cs Section, 1971, 348-49.
Quam, K. Ocular malingering.
Journal, 1974, 1!, 73-76.
American Q£lh22!i£
Raskin, ~., Talbott, J. A., & Myerson, Ao T.
of conversion reactions: Predictive
pS1chiatri~ criteria. Journal g! ~
~edical Associa~ion, 1966, 121, 102-106.
Diagnosis
value of
American
Reitan, R. 11.. Manual for administration of
neuropsychological test batteries for adults and
children. unpUblished manuscript, Neuro~sycnology
Laboratory, University of Washington (undated).
Rei tan, R. Me , s Davison,
1!~g~Wgll: ~u.rren~
Nell Yock: iiley, 1974..
(Eds.. ) .
Page 160
Rey, A. L' exa ae n ps ycho Lo q.Lqu e
l'encephalopathie traQmati~ue.
I?sychologie, 19~1, l§, 286-340.
dans las
!!£.!!m~
H8
cas
de
Rey, A. Sollicication de La memoire de fixa~ion par des
~ots et des objets presentes simultanement.
Arch.\vis ~ Psychologie, 1959, 11, 126-139.
Rey, 1. &'examen £linique ~ esychologie.
Presses Uniyersitaires de France, 196~.
i?aJ: is:
Ritson, B., & Focrest, A. The simulation ofpsycnosis:
1 contemporary presentation. British Journal 2!
~edical Psychology, 1970, !J, 31-37.
Ross, s , D. Neuroses following trauma and their
relation to compensation. In S. Arieti (Ed.),
American gandboo~ ~ Psychiatry, Vol. 3. New York:
Basic Books, 1966.
Philadelphia: Saunders,
Scheie, B. G. , s Albert,
cDhthalmology (9th ed.).
1917.
D. rex~book g£
Shapiro, D. L. "Faking bad" in the criminal justice
sys~eme l2~~ ~ gorgasiq PSYChology, 1979, 1,
13-16.
Page 161
149
Shaw, D. J., & Ma~~news, C. G. D~fferen~~al ~MPI
performance of braiA-damaged versus pseado
neurologic groups. Journal 2i Clinical ~sychology,
1965, 11, ~05-~08.
Shaw, R. S. Pathologic malingering:
disabled extremity. ~ England
~edicj.ae, 1964, ill, 22-26.
The pai:lful
~Brna! g£
Shepher, D. C. Non-organic
consistency of behavioral
Jou;nal 2! ~eeech ~ Rearing
1ij9- 163.
Slovic, P., Fischhof,f, B.,
Behavioral decision theory.
pSI;hologI, 1977, ~, 1-39.
hearing loss and ~he
auditory responses.
Researcb, 1965, '8,
& Lich~ens~ein, S~
Annual R~vi~~ ~
Small, L. ~opsychodiagsg§i§ ia Psychotherapy (Rev.
ed.). New York: Brunner/Mazel, 1980.
Staats, A. W. ~2~ial Behaviorism.
Dorsey Press, 1975.
Bomewood, Illinois:
Stern, D. B. Handedness and the laeeral dis~~ibution of
conversion reactions. Journal of Nervous and ~ental--- ---Qisorde£~, 1977, 1.§!, 122-128.
Page 162
150
Stoui:faI:, S. A., sc r qaeea , E. F., Hays, D. G., s Henry,
A. F. A tacnniqae for improving cu~ulative sca13s.
Public Opinion Quar~erlv, 1952, !i, 273-291.
Swe~s, J. A. The relative operating characteristic in
psychology. Scienc~, 1973, ill, 990-1000.
Swats, J. A., &. Green, n, M. Applications of signal
detection ~heoIY. In H. L. I? i c k , Jr. , H. w.
Leibowitz, J. E. Singer, A. Steinschneider, & H. i.
S~evenson ~ds.),
Practice. Hev York: Plena., 1978.
Szasz I T. S. !alingering: nOiagnosis" or social
conde.nation? Archives sf NegrologY aad psychiatry,
1957, ill, ~3 2-1443.
Szasz, T. S. Garden City, Na~
York: Donb~eday, 1970.
Tanner, w. P., Jr., &. Sv~ts, J. A. A decision-Making
t~eory of visual detection.
1954, 31, ~01-409.
PsyC401ogical Revi~,
TheodoI: , L. B., & Mandelcorn, ~. s. Hysterical
blindness: A case repor1:. and study us~ng a modern
psychophysical technigue. Journal
gsychologz, 1973, ~, 552-553.
Page 163
151
Torgerson" \1. S. lli~ ~ Me'ttods £! Scaling. New
York: Wiley" 1962.
Tovey, E. B. Court tes1:.imony by a ~syc.hologis't on the
question of brain damage. In W. L. Smith & M. J.
Pbilippus (Eds.), ~euroP~ychological Test~ng ia
Qrganic Brain Dysfqnc~~on. Springfield, Illinois:
Charlas C. Thomas, 1969.
Ullmann, L. P. , S Krasner, L. ! ~~I~a2lo~£Al !~roach
ss Abnorm4.l BehC\vi,g£ (2nd ed.). Englewood Cliifs,
New Jersey: Prentice-Hall, 1975.
Ut'tal, i. R.
'diley, 1978.
~ ~~ychobiolggz gI Mind. New York:
Ventry, I. e, , s ChaiJelin, J. B. (Eds.).
~ultidiscipline study of functional hearing loss
(monograph). JOU:~ 21 AYditorv Resea.rch, 1965, ,2,
179-272.
Ventry, I. M. Comment on ar~icl= by Mar'tin and Mcnro.
4.ournal 2! ~~~ ~AS Heariag Disorders, 1976, il,
282-283.
iales, B., s Seeman, W. A new ae e hcd for detecting the
fake good respocse set on the ~~PI. ~~a~l Q1
£JJ:ll4:£Al l?syc lt 2.19gy , 1968, ~~, 211-216.
Page 164
152
Wasniths, C. E.
suffering.
7-16.
~edical evalua~ion of mental pai~ a~d
~.smdnd:L1s£~l!ili1~ ~ll~, 1957, &,
iatson, C. G. Intratest scatter in hospitalized brain-
damaged and SChizophrenic patients. Journal 21
consultiag pSIcho12SI, 1965, 12, 596.
iechsler, Q. ~anual ~ ~ ~~c~sl~~ ~1! !]tell!~~
Scal~. New York: Psychological corporation, 1955.
lli l1!!C}sureIl2! ill Appraisal 2! Adult
(~th ed.• ). Baltimore: Williams &
iechsler, D.
r nt ellJ:ge nce
Irl ilk ins I 1958.
ieiner, D. N. Sub~le and obvious keys for the ~innesota
Mult.iphasic Personality In'len~o:r:y. JournC}l 2£
~onsulsing f2ychologz, 1948, 11, 16~-170.
iei:ltraub, M.
diagnosis.
L. Hyste:r:ia: A clinical guide
£!]A £linicsl sImeosls, 1977, 12(6).
to
ieisxrantz, L., Warrington, E. K., Sande:r:s,
~arshall, J. Visual capacity in the
field following a rest:r:icted occipital
~.a, 1974, 21., 708-728.
M. D., s
nemiancl?~c
abla ti on.
Jlientilorth-Roh:r:, L, s t'1aclntosll,
with ~~IS int:r:asubtest scatter
R. Psychodia~nc3is
of sccce s ,
Page 165
153
ietzel, J. o. Malingering tests. Ameri~ ~~~1 g1
Qphtl1a.lmologv, 1943, ~, 577-586.
Wiggins, J. S. Interrelationships among ~MPI m~asures
of dissimulation under standard and social
desirability instruc~ions. Journal 2i CaU2ulcinQ
PsychologZ, 1959, ~, 419-427.
wiggins, J. S. Personali!l s~ ~~gicti2L: ~acipl~s
2i Rerson~l~t! ~~~~. Reading, Massachusetts:
Addison-iesley, 1973.
ioolsey, R. M. Hysteria: 1875 to 1975. Diseases of ~
Ne.rvoQS System, 1976, n, 379-386.
Woolsey, R. a., & Goldner, J.
ramifications of hysteria.
Ravi~!, 1976, 1l, 299-330.
A. The medical-lagal
California ~~~~
Ziskin, J. Coping !!!A gsychi~!i£~ f~cnologica~
Testimony (3rd ad , ) Venice, California.: Law a a d
Psychology Press, 1981.
Zuckerman, J. ~~g~2~ ~2inatian 2! ~ ]Y2 (2nd
e d.. ). Philadelphia: Lipincott, 1964.
