The Assessment of Performance and Self-report Validity in Persons Claiming Pain-related Disability

Abstract

One third of all people will experience spinal pain in their lifetime and half of these will experience chronic pain. Pain often occurs in the context of a legally compensable event with back pain being the most common reason for filing a Workers Compensation claim in the United States. When financial incentives to appear disabled exist, malingered pain-related disability is a potential problem. Malingering may take the form of exaggerated physical, emotional, or cognitive symptoms and/or under-performance on measures of cognitive and physical capacity. Essential to the accurate detection of Malingered Pain-related Disability is the understanding that malingering is an act of will, the goal of which is to increase the appearance of disability beyond that which would naturally arise from the injury in question. This paper will review a number of Symptom Validity Tests (SVTs) that have been developed to detect malingering in patients claiming pain-related disability and will conclude with a review of studies showing the diagnostic benefit of combining SVT findings from a comprehensive malingering assessment. The utilization of a variety of tools sensitive to the multiple manifestations of malingering increases the odds of detecting invalid claims while reducing the risk of rejecting a valid claim.

Keywords:

• Chromic pain
• Malingering
• Assessment

Acknowledgment

The material in this article was originally published in German as the following: Greve, K. W., & Bianchini, K. J. (2009). Schmerz und Beschwerdenvalidierrung [Symptom validity testing in pain]. In T. Merten & D. Dettenborn (Eds.), Diagnostik der Beschwerdenvalidität (pp. 193–229. Berlin: Deutsch Psychologen Verlag GmbH. This updated article is now published for the first time in English with the kind permission of Deutscher Psychologen Verlag, Berlin.

Notes

¹ It is becoming a more common practice to refer to those measures assessing the validity of performance on ability tests as “performance validity tests” (PVT) and reserving the term “symptom validity test” for those indicators designed to assess exaggeration of subjectively reported symptoms. These latter indicators may also be referred to as “self-report validity tests.” However, for simplicity of explication and in keeping with long-standing usage, this paper will refer to any psychometric test, score, or indicator used to detect invalid performance on measures of cognitive or physical capacity or exaggeration of subjective symptoms as a “symptom validity test”.

² “Mixed-group” validation (Dawes & Meehl, 1966) has certain advantages over “criterion-groups” validation and may result in more precise estimates of classification accuracy (Frederick, 2000; Frederick & Bowden, 2009).

³ A review of this research is beyond the scope of this paper and the reader is referred to three recent publications on this topic for more information (Boone, 2007; Larrabee, 2007; Morgan & Sweet, 2009).

⁴ The forced-choice methodology has recently been applied to persons with primary pain complaints who also reported impaired somatosensory function (Greve, Bianchini, & Ameduri, 2003).

⁵ Being able to apply embedded indicators retrospectively is very helpful in research projects using archival data in which stand-alone SVTs may not have been used. See Larrabee, Millis, and Meyers (2008) for a good example of this application. Use of embedded indicators may also be helpful when examining data from a forensic evaluation when stand-alone SVTs were not used or were inadequate.

⁶ The exception is the case of a significantly below chance performance on a forced-choice SVT, a finding which is considered definitive evidence of intentional under-performance (Frederick & Speed, 2007; Reynolds, 1998) and which along with the presence of external incentive meets criteria for a diagnosis of malingering (Bianchini et al., 2005; Slick et al., 1999).