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Article| January 01 2012
Malingering and Other Validity Considerations: With an Emphasis on Document Review
Chris Stewart Patterson, MD;
Chris Stewart Patterson, MD
Robert J. Barth, PhD;
Robert J. Barth, PhD
Christopher R. Brigham, MD;
Christopher R. Brigham, MD
James B. Talmage, MD;
James B. Talmage, MD
Steven Leclair, PhD;
Steven Leclair, PhD
Michael Coupland, CPsych
Guides Newsletter (2012) 17 (1): 1–12.
https://doi.org/10.1001/amaguidesnewsletters.2012.JanFeb01
Chris Stewart Patterson, Robert J. Barth, Christopher R. Brigham, James B. Talmage, Steven Leclair, Michael Coupland; Malingering and Other Validity Considerations: With an Emphasis on Document Review. Guides Newsletter 1 January 2012; 17 (1): 1–12. doi: https://doi.org/10.1001/amaguidesnewsletters.2012.JanFeb01
Many of the methods used to assess impairment rely on the completeness, accuracy, and reliability of patients' self-presentations, and evaluators should be able to identify behavioral factors such as illness behavior and malingering; the latter is not ratable, but its presence complicates appropriate case management. This article focuses on the clinical data and the analysis that can be helpful in identifying malingering, as well as validity problems during document and medical file reviews. According to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, examiners always should be aware of the possibility of malingering during impairment evaluations, and the possibility of avoiding responsibility and/or obtaining monetary awards increases the likelihood of exaggeration and/or malingering. Current methods for assessing malingering in general assess the probability of malingering based on comparisons to research statistics and free the evaluator from any reliance on expert opinion. Correlating multiple clinical sources is useful in assessing the validity of a clinical presentation and includes the individual's pre-existing status; information about the injury; the history of the presenting illness, past medical and social histories, physical examination, questionnaires and scales, functional capacity evaluations, and video surveillance. Coherence analysis is a method of clinical data review that uses multiple themes to determine if data provide an integrated presentation. Evaluators should highlight issues of discontinuity, inconsistencies, incongruencies, noncompliance, or poor effort.
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