Susceptibility of common self-report measures of dissociation to malingering.
Gilbertson, Alan D., et.al.
Dissociation: Progress in the Dissociative Disorders, Vol 5(4), Dec, 1992. pp. 216-220.

Abstract:
Examined the extent to which common self-report measures of dissociation may be consciously distorted and the relationships between the Perceptual Alterations Scale, the Dissociative Experiences Scale, and the Questionnaire of Experiences of Dissociation. 320 nursing students were randomly assigned to 1 of 4 groups and instructed to respond to the aforementioned questionnaires honestly, ‘faking good,’ ‘faking bad,’ or ‘trying to appear as if you had multiple personality disorder.’ Scores on these instruments correlated very highly within all groups. Also indicated is a high level of susceptibility on each instrument for Ss to consciously exaggerate the degree of dissociative symptomatology being measured.

On the misdiagnosis of multiple personality disorder.
Chu, James A.
Dissociation: Progress in the Dissociative Disorders, Vol 4(4), Dec, 1991. pp. 200-204.

Abstract:
Asserts that with an increased awareness of multiple personality disorder (MPD) has come an increased incidence of the misdiagnosis of MPD (i.e., false positive diagnosis of MPD) that has been seen in 3 forms: other dissociative disorders, nondissociative disorders, and malingering or factitious disorders misdiagnosed as MPD. Case examples are presented to illustrate the misdiagnosis dilemma. The accurate differential diagnosis of MPD can be challenging. The clinical implications of an accurate diagnosis are addressed.

Factitious or malingered multiple personality disorder: Eleven cases.
Coons, Philip M. and Milstein, Victor
Dissociation: Progress in the Dissociative Disorders, Vol 7(2), Jun, 1994. pp. 81-85.

Abstract:
Of 112 consecutive admissions to a dissociative disorders clinic, 11 Ss with symptoms characteristic of multiple personality disorder (MPD) ultimately were discovered to have factitious disorder or were malingering. They were compared with 50 MPD Ss previously reported (P. M. Coons et al; see record 1989-08574-001). There were few differences in demographic variables, presenting symptoms, or characteristics of alter personalities between the groups. There was a striking difference, however, between genuine MPD and simulators for the presence of symptoms characteristic of either malingering or factitious disorder. The use of collateral interviews and probing for symptoms common to factitious disorder and malingering are invaluable aids in the differential diagnosis of genuine from simulated MPD.

Simulated amnesia and the pseudo-memory phenomena.
Cercy, Steven P., et.al.
Clinical assessment of malingering and deception., 2nd ed. Rogers, Richard, (Ed); pp. 85-107;

Abstract:
Reviews some of the nonneurological aberrations of memory and suggests a conceptual framework for appreciating these presentations / describe some methods that may be useful in the identification of pseudo-amnesia and pseudo-remembering / begin with a brief overview of the phenomenology of ‘organic’ memory disorders / under the rubric of ‘nonneurological’ amnesia, [the authors] examine (1) the traditional yet controversial diagnosis of dissociative amnesia and (2) the clinical presentation of feigned amnesia / review and critically evaluate the empirical literature on the differentiation of organic memory disorders from dissociative amnesia and feigned amnesia / turn our attention from false forgetting to false remembering / the characteristics of individuals and situations that promote confabulation and the creation of false memories are reviewed detection of feigned amnesia [problems in measuring feigned memory impairment, electrophysiological approaches, specific measures of malingered amnesia, traditional psychometric approaches, investigational techniques]

Trauma-induced dissociative amnesia in World War I combat soldiers.
van der Hart, Onno., et.al.
Australian and New Zealand Journal of Psychiatry, Vol 33(1), Feb, 1999. pp. 37-46.

Abstract:
This study relates trauma-induced dissociative amnesia reported in WWI studies of war trauma to contemporary findings of dissociative amnesia in victims of childhood sexual abuse. Key diagnostic studies of post-traumatic amnesia in WWI combatants are surveyed. These cover phenomenology and the psychological dynamics of dissociation vis-à-vis repression. Descriptive evidence is cited for war trauma-induced dissociative amnesia. The authors conclude that posttraumatic amnesia extends beyond the experience of sexual and combat trauma and is a protean symptom, which reflects responses to the gamut of traumatic events.

The diagnosis of Ganser syndrome in the practice of forensic psychology.
Drob, Sanford L., et.al.
American Journal of Forensic Psychology, Vol 18(3), 2000. pp. 37-62.

Abstract:
Ganser syndrome, which is briefly described as a dissociative disorder Not Otherwise Specified in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), is a poorly understood and often overlooked clinical phenomenon. The authors review the literature on Ganser syndrome, offer proposed screening criteria, and propose a model for distinguishing Ganser syndrome from malingering. The ‘SHAM LIDO’ model urges clinicians to pay close attention to Subtle symptoms, History of dissociation, Abuse in childhood, Motivation to malinger, Lying and manipulation, Injury to the brain, Diagnostic testing, and longitudinal Observations, in the assessment of forensic cases that present with approximate answers, pseudo-dementia, and absurd psychiatric symptoms. A case example involving a 39 yr old man illustrating the application of this model is provided.

Factitious and malingered dissociative identity disorder: Clinical features observed in 18 cases.
Thomas, Ann.
Journal of Trauma & Dissociation, Vol 2(4), 2001. pp. 59-77.

Abstract:
Compared the clinical features of 18 Ss given a diagnosis of factitious or malingered dissociative identity disorder with those of 18 matched Ss who were given a diagnosis of genuine dissociative identity disorder, taken from a sample of 129 2nd opinion consultations. Clinical features suggesting a factitious diagnosis or malingering included having a score above 60 on the Dissociative Experiences Scale (DES), reporting dissociative symptoms inconsistent with the reporting on the DES, being able to tell a chronological life story and to sequence temporal events, using the 1st person over a range of affect, being able to express strong negative affect, bringing ‘proof’ of a dissociative diagnosis to the consultation, having told persons other than close confidants about the alleged abuse or alleged dissociative diagnosis, reporting alleged abuse that was inconsistent with the medical or psychiatric history or volunteering allegations of cult or ritualized abuse, telling of alleged abuse without accompanying shame, guilt, or suffering, having been involved in community self-help groups, not having symptoms of co-morbid posttraumatic stress disorder (PTSD), and having obvious secondary gain in having a dissociative diagnosis.

Symptom validity testing of a feigned dissociative amnesia: A simulation study.
Merckelbach, Harald., et.al.
Psychology, Crime & Law, Vol 8(4), Dec, 2002. pp. 311-318.

Abstract:
It has been argued that Symptom Validity Testing (SVT) has limited sensitivity in correctly identifying feigned autobiographical memory loss (e.g., dissociative amnesia) because malingerers would easily understand that below change performance on the SVT implies feigned memory loss. The current study tested this assumption in a sample of undergraduate students (N=20; aged 19-24 yrs) who committed a mock crime and then were instructed to feign complete amnesia for this event. Next, they had to answer 15 forced-choice questions that always contained the correct answer and an equally plausible alternative. Results show that a nontrivial minority of participants (40%) performed below chance. As well, understanding the SVT rationale appeared not to be related to random behavior. Taken together, the results indicate that SVT procedures might be helpful in identifying feigned dissociative amnesia.

Discriminating dissociative identity disorder from schizophrenia and feigned dissociation on psychological tests and structured interview.
Welburn, Ken R., et.al.
Journal of Trauma & Dissociation, Vol 4(2), 2003. pp. 109-130.

Abstract:
Evaluate the relative efficacy of a number of psychological tests and interviews in discriminating dissociative identity disorder (DID) from feigned dissociation and schizophrenia. Three measures of dissociation (SCID-D, DBS, SDQ-5) two personality measures (MMPI-2, Millon-III) and a brief measure of hypnotic susceptibility (Spiegel & Spiegel’s Eye-Roll Sign) were assessed for their ability to differentiate these diagnostic groups. Results indicate that the SCID-D was clearly the most efficacious instrument in discriminating DID from schizophrenia and from feigned dissociation. The DES-Taxon and the SDQ-5 were adequate in screening pathological dissociation from schizophrenia but were less discriminative of feigned dissociation. The commonly used personality inventories were unable to detect feigned dissociation and the DID group tended to have higher elevations on scales measuring psychotic symptoms than did the schizophrenic group. The Eye-Roll Sign discriminated feigned dissociation from those with dissociative disorders. Structured interviews such as the SCID-D, although resource consuming, are essential in comprehensive assessment of dissociative disorders. Comprehensive assessment of psychotic disorders should include some measure of dissociation.

Peritraumatic Dissociation as a Predictor of Post-traumatic Stress Disorder: A Critical Review.
Candel, Ingrid., et.al.
Comprehensive Psychiatry, Vol 45(1), Jan-Feb, 2004. pp. 44-50.

Abstract:
In psychiatric literature, dissociative reactions at the time of a traumatic event (i.e., peritraumatic dissociation) are considered to be risk factors for the development of post-traumatic stress disorder (PTSD). In this article, we critically review research concerned with the link between peritraumatic dissociation and PTSD. Our main point is that studies in this area heavily rely on retrospective reports of dissociative reactions during the trauma. We argue that this methodology has important limitations since people in general and PTSD patients in particular find it difficult to give accurate descriptions of past emotional states. Restrictive factors that play a role in this context have to do with forgetting, attribution, and malingering.

Assessment of genuine and simulated dissociative identity disorder on the structured interview of reported symptoms.
Brand, Bethany L., et.al.
Journal of Trauma & Dissociation, Vol 7(1), 2006. pp. 63-85.

Abstract:
Little is known about how to detect malingered dissociative identity disorder (DID). This study presents preliminary data from an ongoing study about the performance of DID patients on the Structured Interview of Reported Symptoms (SIRS, Rogers, Bagby, & Dickens, 1992), considered to be a ‘gold standard’ structured interview in forensic psychology to detect feigning of psychological symptoms. Test responses from 20 dissociative identity disorder (DID) patients are compared to those of 43 well informed and motivated DID simulators. Both the simulators and DID patients endorsed such a high number of symptoms that their average overall scores would typically be interpreted as indicative of feigning. The simulators’ mean scores were significantly higher than those of the DID patients on only four out of 13 scales. These results provide preliminary evidence that well informed and motivated simulators are able to fairly successfully simulate DID patients and avoid detection on the SIRS. Furthermore, many DID patients may be at risk for being inaccurately labeled as feigning on the SIRS.

Detecting malingered posttraumatic stress disorder using the Morel Emotional Numbing Test-Revised (MENT-R) and the Miller Forensic Assessment of Symptoms Test (M-FAST).
Messer, Julia M., et.al.
Journal of Forensic Psychology Practice, Vol 7(3), 2007. pp. 33-57.

Abstract:
The present study investigated the utility of two assessment measures in detecting malingered posttraumatic stress disorder (PTSD): The Morel Emotional Numbing Test-Revised (MENT-R) and the Miller Forensic Assessment of Symptoms Test (M-FAST). The Detailed Assessment of Posttraumatic Stress (DAPS) was used as the criterion variable for the following groups: clinical PTSD, subclinical PTSD, honest responders, and coached malingerers. Total scores on the MENT-R distinguished among the four groups of participants. The three groups responding honestly averaged fewer than 3.5 errors, while malingerers missed over 5 times that number. Scores on the M-FAST were also higher for the group of participants malingering. Although the MENT-R and M-FAST correctly identified 63 and 78% of coached malingerers, respectively, the combined use of both measures resulted in the correct classification of over 90% of the participants instructed to malinger PTSD.

Distinguishing between neuropsychological malingering and exaggerated psychiatric symptoms in a neuropsychological setting.
Ruocco, Anthony C., et.al.
The Clinical Neuropsychologist, Vol 22(3), May, 2008. pp. 547-564.

Abstract:
It is unclear whether symptom validity test (SVT) failure in neuropsychological and psychiatric domains overlaps. Records of 105 patients referred for neuropsychological evaluation, who completed the Test of Memory Malingering (TOMM), Reliable Digit Span (RDS), and Millon Clinical Multiaxial Inventory-III (MCMI-III), were examined. TOMM and RDS scores were uncorrelated with MCMI-III symptom validity indices and factor analysis revealed two distinct factors for neuropsychological and psychiatric SVTs. Only 3.5% of the sample failed SVTs in both domains, 22.6% solely failed the neuropsychological SVT, and 6.1% solely failed the psychiatric SVT. The results support a dissociation between neuropsychological malingering and exaggeration of psychiatric symptoms in a neuropsychological setting.

Do motivations for malingering matter? Symptoms of malingered PTSD as a function of motivation and trauma type.
Peace, Kristine A., et.al.
Psychological Injury and Law, Vol 4(1), Mar, 2011. pp. 44-55.

Abstract:
Psychological disorders associated with traumatic events, such as post-traumatic stress disorder (PTSD), may be prone to malingering due to the subjective nature of trauma symptomology. In general, symptoms tend to be inflated when an external reward (i.e., compensation) is associated with the claim. The present study was designed to test whether malingered claims of PTSD symptoms differed as a function of the type of trauma being malingered (accident, disaster, sexual assault) and the motivation for malingering (compensation, attention, revenge, no motivation). Participants were randomly assigned into conditions, given malingering instructions, and then asked to complete three measures of trauma symptoms (Impact of Event Scale—Revised; Post-Traumatic Stress Disorder Checklist; Trauma Symptom Inventory). Results indicated that participants in the sexual assault condition produced higher symptom reports on nearly all scales. Revenge and compensation motivations yielded elevated symptom scores. Further, individuals rated high in fantasy proneness and dissociation produced elevated scores on atypical responding and most clinical scales. More research is needed to examine the extent to which different motivations and trauma types influence symptom reporting.

Recalled peritraumatic reactions, self-reported PTSD, and the impact of malingering and fantasy proneness in victims of interpersonal violence who have applied for state compensation.
Kunst, Maarten., et.al.
Journal of Interpersonal Violence, Vol 26(11), Jul, 2011. pp. 2186-2210.

Abstract:
The present study explores the associations between three types of peritraumatic reactions (dissociation, distress, and tonic immobility) and posttraumatic stress disorder (PTSD) symptoms in a sample of 125 victims of interpersonal violence who had applied for compensation with the Dutch Victim Compensation Fund (DCVF). In addition, the confounding roles of malingering and fantasy proneness are examined. Results indicate that tonic immobility did not predict PTSD symptom levels when adjusting for other forms of peritraumatic reactions, whereas peritraumatic dissociation and distress did. However, after the effects of malingering and fantasy proneness had been controlled for, malingering is the only factor associated with increased PTSD symptomatology. Implications for policy practice as well as study strengths and limitations are discussed.

Personality Assessment Inventory profile and predictors of elevations among dissociative disorder patients.
Stadnik, Ryan D., et.al.
Journal of Trauma & Dissociation, Vol 14(5), Oct, 2013. pp. 546-561.

Abstract:
Assessing patients with dissociative disorders (DD) using personality tests is difficult. On the Minnesota Multiphasic Personality Inventory–2 (J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 1989), DD patients often obtain elevations on multiple clinical scales as well as on validity scales that were thought to indicate exaggeration yet have been shown to be elevated among traumatized individuals, including those with DD. No research has been conducted to determine how DD patients score on the Personality Assessment Inventory (PAI; L. C. Morey, 1991), which includes the symptom exaggeration scale Negative Impression (NIM) and the malingering scales Malingering Index (MAL) and Rogers Discriminant Function (RDF). The goals of this study were to document the PAI profile of dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS) patients and to determine how the validity and Schizophrenia scales are related to other PAI scales as well as dissociation. A total of 42 inpatients with DID or DDNOS were assessed on the PAI as well as the Dissociative Experiences Scale–II. The DID/DDNOS patients were elevated on many PAI scales, including NIM and, to a lesser extent, MAL, but not RDF. Dissociation scores significantly and uniquely predicted NIM scores above and beyond Depression and Borderline Features. In addition, after we controlled for MAL and RDF, dissociation was positively associated with NIM. In contrast, after we controlled for the other 2 scales, dissociation was not related to MAL and was negatively related to RDF, indicating that RDF and, to a lesser extent, MAL are better correlates of feigning in DD patients than NIM.

Utility of the SIRS-2 in distinguishing genuine from simulated dissociative identity disorder.
Brand, Bethany L., et.al.
Psychological Trauma: Theory, Research, Practice, and Policy, Vol 6(4), Jul, 2014. pp. 308-317.

Abstract:
Individuals with trauma histories often elevate on validity scales and forensic interviews intended to detect symptom exaggeration or ‘faking bad.’ A widely used forensic interview designed to detect feigned psychiatric illness, the Structured Interview of Reported Symptoms (SIRS; Rogers, Bagby, & Dickens, 1992), overclassifies individuals with complex trauma, including patients with dissociative identity disorder (DID), as feigners (Brand, McNary, Loewenstein, Kolos, & Barr, 2006; Rogers, Payne, Correa, Gillard, & Ross, 2009). However, a new Trauma Index shows promise of being useful in accurately distinguishing feigned versus genuine individuals with severe trauma (Rogers et al., 2009). No studies have examined the performance of the new edition of the SIRS, the SIRS-2 (Rogers, Sewell, & Gillard, 2010), with severely traumatized or dissociative individuals. This study sought to determine the utility of the SIRS, the SIRS-2, and the Trauma Index in distinguishing genuine DID from simulated DID. A sample of 49 DID patients was compared to 77 well-coached DID simulators. The SIRS classification rules combined with the Trauma Index, as well as the Trauma Index alone, provided the best balance of sensitivity and specificity, with similar overall diagnostic power. The SIRS-2, either alone or combined with the Trauma Index, was not as sensitive as the SIRS or Trauma Index alone. However, the SIRS-2 demonstrated excellent specificity.

Distinguishing simulated from genuine dissociative identity disorder on the MMPI-2.
Brand, Bethany L., et.al.
Psychological Trauma: Theory, Research, Practice, and Policy, Vol 7(1), Jan, 2015. pp. 93-101.

Abstract:
Due to high elevations on validity and clinical scales on personality and forensic measures, it is challenging to determine if individuals presenting with symptoms of dissociative identity disorder (DID) are genuine or not. Little research has focused on malingering DID, or on the broader issue of the profiles these patients obtain on the Minnesota Multiphasic Personality Inventory (MMPI-2), despite increasing awareness of dissociation. This study sought to characterize the MMPI-2 profiles of DID patients and to determine the utility of the MMPI-2 in distinguishing DID patients from uncoached and coached DID simulators. The analyses revealed that Infrequency, Back Infrequency, and Infrequency-Psychopathology (Fp) distinguished simulators from genuine DID patients. Fp was best able to discriminate simulated DID. Utility statistics and classification functions are provided for classifying individual profiles as indicative of genuine or simulated DID. Despite exposure to information about DID, the simulators were not able to accurately feign DID, which is inconsistent with the iatrogenic/sociocultural model of DID. Given that dissociation was strongly associated with elevations in validity, as well as clinical scales, including Scale 8 (i.e., Schizophrenia), considerable caution should be used in interpreting validity scales as indicative of feigning, and Scale 8 as indicative of schizophrenia, among highly dissociative individuals.

The overlap between dissociative symptoms and symptom over-reporting.Open Access
Merckelbach, Harald., et.al.
The European Journal of Psychiatry, Vol 29(3), Jul-Sep, 2015. pp. 165-172.

Abstract:
Background and Objectives: The potential link between dissociative symptoms and symptom over-reporting has been given little attention. In two student samples (N’s = 139 and 113) and a clinical sample (N = 21), we examined whether self-reported dissociative symptoms are related to symptom over-reporting. Methods: We relied on different measures of dissociation and over-reporting. In the clinical sample, we looked at whether the well-established link between dissociative symptoms and sleep disturbances would survive if we corrected for symptom over-reporting. Results: Dissociativity correlated with symptom over-reporting in the student samples, but not in the clinical sample. Correcting for over-reporting tendencies did not fundamentally alter the relationships between dissociative symptoms and sleep disturbances in the clinical sample. Conclusions: Our results suggest that the overlap between symptom over-reporting and dissociativity is much more a problem in nonclinical than in clinical samples.

Is it trauma- or fantasy-based? Comparing dissociative identity disorder, post-traumatic stress disorder, simulators, and controls.
Vissia, E. M., et.al.
Acta Psychiatrica Scandinavica, Vol 134(2), Aug, 2016. pp. 111-128.

Abstract:
Objective: The Trauma Model of dissociative identity disorder (DID) posits that DID is etiologically related to chronic neglect and physical and/or sexual abuse in childhood. In contrast, the Fantasy Model posits that DID can be simulated and is mediated by high suggestibility, fantasy proneness, and sociocultural influences. To date, these two models have not been jointly tested in individuals with DID in an empirical manner. Method: This study included matched groups [patients (n = 33) and controls (n = 32)] that were compared on psychological Trauma and Fantasy measures: diagnosed genuine DID (DID-G, n = 17), DID-simulating healthy controls (DID-S, n = 16), individuals with posttraumatic stress disorder (PTSD, n = 16), and healthy controls (HC, n = 16). Additionally, personality-state-dependent measures were obtained for DID-G and DID-S; both neutral personality states (NPS) and trauma-related personality states (TPS) were tested. Conclusion: For Trauma measures, the DID-G group had the highest scores, with TPS higher than NPS, followed by the PTSD, DID-S, and HC groups. The DID-G group was not more fantasy-prone or suggestible and did not generate more false memories. Malingering measures were inconclusive. Evidence consistently supported the Trauma Model of DID and challenges the core hypothesis of the Fantasy Model.

Assessment of complex dissociative disorder patients and simulated dissociation in forensic contexts.
Brand, Bethany L., et.al.
International Journal of Law and Psychiatry, Vol 49(Part B), Nov-Dec, 2016. pp. 197-204.

Abstract:
Few assessors receive training in assessing dissociation and complex dissociative disorders (DDs). Potential differential diagnoses include anxiety, mood, psychotic, substance use, and personality disorders, as well as exaggeration and malingering. Individuals with DDs typically elevate on many clinical and validity scales on psychological tests, yet research indicates that they can be distinguished from DD simulators. Becoming informed about the testing profiles of DD individuals and DD simulators can improve the accuracy of differential diagnoses in forensic settings. In this paper, we first review the testing profiles of individuals with complex DDs and contrast them with DD simulators on assessment measures used in forensic contexts, including the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Personality Assessment Inventory (PAI), and the Structured Inventory of Reported Symptoms (SIRS), as well as dissociation-specific measures such as the Dissociative Experiences Scale (DES) and Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R). We then provide recommendations for assessing complex trauma and dissociation through the aforementioned assessments.

Symptom overreporting and dissociative experiences: A qualitative review.
Merckelbach, H., et.al.
Consciousness and Cognition: An International Journal, Vol 49, Mar, 2017. pp. 132-144.

Abstract:
We discuss a phenomenon that has received little attention to date in research on dissociative phenomena, namely that self-reports of these phenomena overlap with the tendency to overendorse eccentric items. We review the literature documenting the dissociation-overreporting link and then briefly discuss various interpretations of this link: (1) overreporting is an artifact of measuring dissociative symptoms; (2) dissociative psychopathology engenders overreporting of eccentric symptoms through fantasy proneness or impairments in internal monitoring; (3) an overreporting response style as is evident in malingerers, for example, promotes reports of dissociative symptoms. These three interpretations are not mutually exclusive. Also, the dissociation-overreporting link may have different origins among different samples. Because overreporting may introduce noise in datasets, we need more research specifically aimed at disentangling the dissociation-overreporting link. We suggest various avenues to accomplish this goal.

Artifizielle Störungen.
Translated Title: Factitious disorders.
Kapfhammer, H.-P., et.al.
Der Nervenarzt, Vol 88(5), May, 2017. pp. 549-570.

Abstract (English):
Patients with factitious disorders intentionally fabricate, exaggerate or feign physical and/or psychiatric symptoms for various open and covert psychological reasons. There are many issues regarding the diagnostic state and classification of factitious disorders. Both the categorical differentiation of and clinical continuum ranging from somatoform/dissociative disorders to malingering are being controversially debated. Epidemiological studies on the frequency of factitious disorder meet basic methodological difficulties. Reported rates of prevalence and incidence in the professional literature most probably have to be considered underestimations. Illness deception and self-harm as core features of the abnormal illness behaviour in factitious disorder may refer to various highly adverse and traumatic experiences during early development in a subgroup of patients. Chronic courses of illness prevail; however, there are also episodic variants.

Assisting the courts in understanding and connecting with experiences of disconnection: Addressing trauma-related dissociation as a forensic psychologist, Part I.
Brand, Bethany L., et.al.
Psychological Injury and Law, Vol 10(4), Dec, 2017. pp. 283-297.

Abstract:
Although trauma-related dissociation (TRD) is a common reaction to trauma often associated with significant impairment and prognoses that necessitate extended treatment, few assessors are knowledgeable about dissociation, its assessment, and methods for presenting information about it to courts in a way that is evidence-based yet understandable. This paper is the first part of a two-part series that aims to expand forensic assessors’ knowledge about TRD and enhance their ability to assess and present information about dissociation. This article provides overviews of research about dissociation and offers suggestions on how expert witnesses can assist counsel and courts in understanding dissociative reactions and their importance in personal injury cases. Specifically, we define dissociation; discuss the links between trauma, dissociation, and posttraumatic stress disorder; briefly review neurobiological findings related to dissociation; describe dissociative-related impairment and treatment; review challenges that can interfere with accepting and understanding dissociative symptoms; and suggest methods for helping counsel and courts accurately understand and consider TRD in assessing cases and deciding their outcomes.

Assessing trauma-related dissociation in forensic contexts: Addressing trauma-related dissociation as a forensic psychologist, Part II.Brand, Bethany L., et.al.
Psychological Injury and Law, Vol 10(4), Dec, 2017. pp. 298-312.

Abstract:
Chronic dissociative reactions and dissociative disorders can occur following traumatic events and are associated with suffering and impaired functioning. Therefore, trauma-related dissociation could be part of the claims made in civil actions or contribute to mitigation or an insanity defense in criminal actions. Dissociative reactions to trauma, including dissociative disorders, are more common than most mental health professionals realize. Unfortunately, few professionals have training in the assessment of dissociation, and forensic experts may be unaware of research indicating that standard interpretations of well-regarded assessment instruments can result in inaccurate determinations of symptom exaggeration in cases with dissociation. This paper is the second paper of a two-part series that aims to expand assessors’ knowledge about trauma-related dissociation (TRD) and enhance their ability to assess and present information about dissociation. In this article, we focus on the forensic assessment of TRD and discuss: dissociative symptoms; complex trauma; trauma-related disorders; an approach to assessment of TRD; trauma-related reactions that can impede the detection of TRD; and differential diagnosis of genuine versus feigned dissociation. In addition, we review research related to the validity and appropriate interpretation of the following measures in use with persons with TRD: Dissociative Experiences Scale, Multiscale Dissociation Inventory, Somatoform Dissociation Questionnaire, Trauma Symptom Inventory-2, Multidimensional Inventory of Dissociation, Structured Clinical Interview for Dissociative Disorders-Revised, Minnesota Multiphasic Personality Inventory-2, Personality Assessment Inventory, Structured Interview of Reported Symptoms, Test of Memory Malingering, and the Gudjonsson Suggestibility Scale.

Can the Trauma Symptom Inventory-2 distinguish coached simulators from dissociative disorder patients?
Palermo, Cori A., et.al.
Psychological Trauma: Theory, Research, Practice, and Policy, Vol 11(5), Jul, 2019. pp. 477-485.

Abstract (English):
Objective: The first objective was to understand how individuals with complex dissociative disorders (CDD) score on the Trauma Symptom Inventory-2 (TSI-2). These individuals have high elevations on many psychological measures’ validity and clinical scales because of the severe traumatic reactions they experience; thus, creating a challenge for clinicians who seek to determine whether these individuals are exaggerating reported symptoms. The second objective was to compare coached CDD simulators to CDD profiles on the TSI-2s clinical and validity scales. The third objective was to examine the utility rates of the TSI-2s Atypical Response Scale (ATR) in distinguishing feigned CDD from clinical CDD. Method: This study compared 39 CDD inpatients to 51 coached CDD simulators on the TSI-2. A profile analysis compared the CDD group and coached simulators on the TSI-2 scales, and post hoc 1-way analysis of covariances (ANCOVAS) examined significant differences between the groups. Results: The CDD patients elevated on most of the TSI-2 clinical scales and factors. There were significant differences between CDD patients’ and CDD simulators’ TSI-2 profiles, with simulators failing to endorse some of the co-occurring symptoms common in CDD. The ATR correctly classified only 60–73% of participants and its specificity scores were low. Conclusions: It is important to understand how CDD individuals score on the TSI-2 so that their results can be recognized and meaningfully interpreted. The TSI-2 may not be a useful measure for distinguishing feigned CDD from CDD. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

Impact Statement:
Clinical Impact Statement: Individuals with complex dissociative disorders (CDD) display high elevations on many psychological measures’ validity and clinical scales because of their severe trauma histories, yet CDD are often not recognized by mental health professionals. Clinicians are challenged to determine whether reported symptoms are exaggerated with these cases. The Atypical Response Scale (ATR) of the Trauma Symptom Inventory-2 (TSI-2) was specifically developed to recognize atypical response patterns among traumatized individuals. This is the first study to examine the profiles of CDD patients on the TSI-2 as well as the first study to compare CDD patients to coached simulators on the TSI-2. We found that there were significant differences between the TSI-2 profiles. The ATR only correctly classified 60–73% of participants. The TSI-2 ATR scale may not be useful to distinguish feigning CDD.

Detecting clinical and simulated dissociative identity disorder with the Test of Memory Malingering.
Brand, Bethany L., et.al.
Psychological Trauma: Theory, Research, Practice, and Policy, Vol 11(5), Jul, 2019. pp. 513-520.

Abstract (English):
Objective: Few studies have assessed malingering in individuals with complex trauma and dissociation. This is concerning because these individuals’ severe and ranging symptoms are associated with elevations on some, but not all, validity scales that detect symptom exaggeration. Dissociative individuals may experience dissociative amnesia, yet no study to date has examined how to distinguish clinical from malingered amnesia with dissociative samples. The current study examined whether the Test of Memory Malingering (TOMM) can accurately distinguish patients with clinically diagnosed dissociative identity disorder (DID) and simulators coached to imitate DID. Method: Utility statistics classify individuals’ TOMM scores as suggestive of clinical or simulated DID. TOMM scores from 31 patients diagnosed with DID via structured interviews were compared to those of 74 coached DID simulators. Results: Discriminant analyses found scores from TOMM Trials 1 and 2 and total TOMM scores accurately classified clinical or simulated DID group status. In addition, TOMM Trial 1 demonstrated high specificity (87%) and positive predictive power (94%), as well as moderate sensitivity (78%), negative predictive power (63%), and overall diagnostic power (81%). Despite exposure to DID-specific information, simulators were not able to accurately feign the DID group’s TOMM scores, which is inconsistent with the iatrogenic/sociocultural model of DID. Conclusion: The TOMM shows promise as useful in clinical and forensic contexts to detect memory malingering among DID simulators without sacrificing specificity. Accurate distinction between genuine and feigned complex trauma-related symptoms, including dissociative memory, is integral to the accurate diagnosis of traumatized populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

Impact Statement:
Clinical Impact Statement: This study examines whether the Test of Memory Malingering (TOMM) can identify individuals with clinical dissociative identity disorder (DID) from students coached on malingering DID. Amnesia is a hallmark symptom of DID. Analyses found TOMM scores accurately identified clinical and malingering DID participants and that simulators were not able to malinger DID. This study is the first to validate the TOMM among individuals with complex trauma and dissociation, a short measure appropriate for clinical and forensic settings. This is crucial given the severe symptomatology and high costs associated with untreated DID, which can be attenuated through accurate diagnosis and treatment.

The cry for help in psychological injury and law: Concepts and review.
Young, Gerald., et.al.
Psychological Injury and Law, Sep 13, 2019.

Abstract:
The cry for help is one of the explanations of results indicating negative impression management on symptom validity tests (SVTs) and respondent validity scales of personality and related inventories used in the area of psychological/psychiatric injury and law. One common interpretation of scale/test findings like these is that respondents are exaggerating, and their symptoms are due to feigning or even malingering. However, research shows that patients with scale/test results on these measures and inventories that indicate symptom over-reporting might be expressing genuine extreme psychopathology or emotional distress. A related possibility is that the respondents are catastrophizing, thinking the worst, desperate and pleading for understanding and help. That is, they might be ‘crying out for help.’ The cry for help motivation in the context of psychiatric forensic disability and related psychiatric/psychological evaluations is poorly defined in the literature, leading to contradictory research results and interpretations. Also, certain conditions and disorders that are relevant to forensic disability evaluations and related contexts might, in and of themselves, include a cry for help, complicating the forensic conclusion (e.g., dissociation, somatic symptom disorder). The present paper addresses definitional issues related to the cry for help, including its conscious/unconscious status, reviews the literature on it, suggests ways of measuring it (and the prevalence of malingering), indicates the ethical scope of when it should be used, and offers research strategies to improve the reliability and validity of its use in the forensic disability and related evaluation context.

Types of malingering in ptsd: Evidence from a psychological injury paradigm.
Fox, Katherine A., et.al.
Psychological Injury and Law, Dec 20, 2019.

Abstract:
The extent to which persons may feign or malinger psychological symptoms is an important concern for civil litigation, specifically in the context of personal injury. The consequences inherent in personal injury cases involving psychological distress require an understanding of how malingering presents in medico-legal contexts, and how it can be assessed using available measures. Symptom validity tests (SVTs) and performance validity tests (PVTs) have been developed to assist in the detection of feigned psychological illness and neurocognitive impairment. While demonstrated divergence between symptom-based and performance-based outcomes have been demonstrated in civil litigants with posttraumatic symptoms after the experience of a physical injury, limited research has evaluated how these measures operate in the context of psychological injury alone. The present study evaluated the relationships among symptom-based and performance-based measures of malingering under a simulated personal injury paradigm in which psychological but not physical injury was sustained. A total of 411 undergraduate participants completed four measures of malingered symptomatology, including both symptom validity and performance validity indicators. Participants were instructed to respond to measures as if they were experiencing common emotional, behavioral, and cognitive symptoms of PTSD following a motor vehicle accident. Using a multi-trait multi-method matrix, weaker correlations were found between PVT and SVTs (ranging from .15 to .28), but moderate significant correlations were found across symptom validity measures (.51 to .65), thus demonstrating an expected dissociation between methods of malingering assessment. Additional analyses support the stability of these findings, when accounting for past exposure to motor vehicle accidents, and replicated the need for a multiple failure approach. Findings are consistent with expectations of convergent and discriminant validity and support the conceptualization of malingered PTSD as a non-unitary construct that is composed of multiple domains or ‘types,’ as reflected by a lack of convergence between SVT and PVT methods. In practice, evaluators of psychological injury are encouraged to utilize more than one measure of malingering, including both PVT and SVT approaches, when PTSD is alleged.

Stress- and trauma-related blockade of episodic-autobiographical memory processing.
Staniloiu, Angelica., et.al.
Neuropsychologia, Vol 139, Mar 2, 2020. ArtID: 107364

Abstract:
Memory disorders without a direct neural substrate still belong to the riddles in neuroscience. Although they were for a while dissociated from research and clinical arenas, risking becoming forgotten diseases, they sparked novel interests, paralleling the refinements in functional neuroimaging and neuropsychology. Although Endel Tulving has not fully embarked himself on exploring this field, he had published at least one article on functional amnesia (Schacter et al., 1982) and ignited a seminal article on amnesia with mixed etiology (Craver et al., 2014). Most importantly, the research of Endel Tulving has provided the researchers and clinicians in the field of dissociative or functional amnesia with the best framework for superiorly understanding these disorders through the lens of his evolving concept of episodic memory and five long term memory systems classification, which he developed and advanced. Herein we use the classification of long-term memory systems of Endel Tulving as well as his concepts and views on autonoetic consciousness, relationships between memory systems and relationship between episodic memory and emotion to describe six cases of dissociative amnesia that put a challenge for researchers and clinicians due to their atypicality. We then discuss their possible triggering and maintaining mechanisms, pointing to their clinical heterogeneity and multifaceted causally explanatory frameworks.

The dissociative subtype of posttraumatic stress disorder: Forensic considerations and recent controversies.
Ellickson-Larew, Stephanie., et.al.
Psychological Injury and Law, Jul 3, 2020.

Abstract:
This article provides an overview of the evidence concerning the dissociative subtype of posttraumatic stress disorder (PTSD) and its relevance in forensic contexts. We discuss best practices for the assessment of the subtype in forensic settings, including consideration of malingering, and the impact of the subtype on witness presentation and potential award determinations. We review recent debate concerning the definition of the subtype and how multivariate analyses can be used to inform the understanding of the relationship between PTSD and dissociation. Altering the definition of the subtype (or of the core PTSD criteria), such as by including additional types of dissociative symptoms, would likely hold major implications for diagnostic prevalence and comorbidity and could substantially affect forensic cases involving the dissociative subtype of PTSD. We suggest that for DSM-6, it would be best to use structural evidence to decide how best to revise the subtype and accurately capture its relationship with the core PTSD symptoms. It is important for forensic experts to be well-versed in the state of the science concerning this condition so as to reliably and validly assess clients and inform triers of fact of the strengths and weaknesses of this body of work.