Utility of the Mild Brain Injury Atypical Symptoms Scale to detect symptom exaggeration: An analogue simulation study

Abstract

Brief self-report symptom checklists are often used to screen for postconcussional disorder (PCD) and posttraumatic stress disorder (PTSD) and are highly susceptible to symptom exaggeration. This study examined the utility of the five-item Mild Brain Injury Atypical Symptoms Scale (mBIAS) designed for use with the Neurobehavioral Symptom Inventory (NSI) and the PTSD Checklist–Civilian (PCL–C). Participants were 85 Australian undergraduate students who completed a battery of self-report measures under one of three experimental conditions: control (i.e., honest responding, n = 24), feign PCD (n = 29), and feign PTSD (n = 32). Measures were the mBIAS, NSI, PCL–C, Minnesota Multiphasic Personality Inventory–2, Restructured Form (MMPI–2–RF), and the Structured Inventory of Malingered Symptomatology (SIMS). Participants instructed to feign PTSD and PCD had significantly higher scores on the mBIAS, NSI, PCL–C, and MMPI–2–RF than did controls. Few differences were found between the feign PCD and feign PTSD groups, with the exception of scores on the NSI (feign PCD > feign PTSD) and PCL–C (feign PTSD > feign PCD). Optimal cutoff scores on the mBIAS of ≥8 and ≥6 were found to reflect “probable exaggeration” (sensitivity = .34; specificity = 1.0; positive predictive power, PPP = 1.0; negative predictive power, NPP = .74) and “possible exaggeration” (sensitivity = .72; specificity = .88; PPP = .76; NPP = .85), respectively. Findings provide preliminary support for the use of the mBIAS as a tool to detect symptom exaggeration when administering the NSI and PCL–C.

Keywords:

• Minnesota Multiphasic Personality Inventory–2 Restructured Form
• Mild Brain Injury Atypical Symptoms Scale
• Symptom exaggeration
• Posttraumatic stress disorder
• Postconcussional disorder

Acknowledgments

The Human Research Ethics Committee of Queensland University of Technology (QUT-HREC No. 1100000385) approved this research. This project was granted an occupational workplace health and safety clearance. Funding for this project was provided by the School of Psychology and Counselling, Queensland University of Technology. The authors would like to thank Ivan Chang and Lauren Cunningham for their assistance with data collection and entry. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Army, or Air Force, the Department of Defense, or the U.S. Government.

Notes

¹Exclusion categories were not mutually exclusive.

²Participants were screened for these criteria prior to enrolment in the study. However, a handful of participants reported a history of mental health treatment, or having sustained a TBI, after study participation.