Test of Memory Malingering (TOMM) Scores are not Affected by Chronic Pain or Depression in Patients with Fibromyalgia

Abstract

Neuropsychologists routinely give effort tests, such as the Test of Memory Malingering (TOMM). When a person fails one of these tests, the clinician must try to determine whether the poor performance was due to suboptimal effort or to chronic pain, depression, or other problems. Participants were 54 community-dwelling patients who met American College of Rheumatology criteria for fibromyalgia (FM). In addition to the TOMM, they completed the Beck Depression Inventory–Second Edition, Multidimensional Pain Inventory–Version 1, Oswestry Disability Index–2.0, British Columbia Cognitive Complaints Inventory, and the Fibromyalgia Impact Questionnaire. The majority endorsed at least mild levels of depressive symptoms (72%), and 22% endorsed “severe” levels of depression. The average scores on the TOMM were 48.8 (SD = 1.9, range = 40–50) for Trial 1, 49.8 (SD = 0.5, range = 48–50) for Trial 2, and 49.6 (SD = 0.9, range = 45–50) for Retention. Despite relatively high levels of self-reported depression, chronic pain, and disability, not a single patient failed the TOMM. In this study, the TOMM was not affected by chronic pain, depression, or both.

Keywords:

• Chronic pain
• Depression
• Effort
• Malingering
• Test of Memory Malingering

Notes

¹The issue of false positives is complex. Researchers sometimes have simply assumed that any person scoring below the cutoff who is not involved in litigation is a “false positive.” Alternatively, of course, the person simply might not be trying his best for reasons other than litigation, such as not caring about the evaluation, being generally uncooperative, or having a strong desire to be seen as sick or disabled. Under any of those circumstances, the person would not actually be a false positive.

A substantial minority (22%) scored in the “severe” range on the Beck Depression Inventory–II (i.e., 29 or higher). TOMM = Test of Memory Malingering.

*MPI = Multidimensional Pain Inventory. Approximately 20% of the sample reported their pain to be 5–6 on a 6-point Likert scale, with 0 = no pain and 6 = very intense pain.

¹The university students were instructed to fake memory problems. While taking the test, some were given feedback following each item as to whether it was correct or incorrect, and others received no feedback.

²The university students were given a week to prepare, using any materials they wanted, to malinger believable problems relating to a head injury sustained in a motor vehicle accident.

³Symptom-coached students were told to fake cognitive impairment and they were given information describing typical symptoms and problems in people with traumatic brain injuries. Test-coached students were given instructions describing effective test-taking strategies that would help them avoid detection.