Empirically Guided Case Conceptualization of Posttraumatic Stress Disorder with the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) in a Forensic Disability Evaluation

The following article discusses how the Restructured Form of the Minnesota Multiphasic Personality Inventory (MMPI -2-RF; Ben-Porath & Tellegen, 2008) can be used in case conceptualizations for Posttraumatic Stress Disorder (PTSD), particularly in compensation seeking settings. We review contemporary conceptualizations of PTSD, particularly emphasizing the role that affect and personality in regards to etiology of the disorder, as well as different manifestations of the disorder. We then review the case of an individual seeking compensation for trauma related disability performed by the third author. Particular emphasis is placed on examining how interpretation of the MMPI-2-RFprofile is guided by empirical findings

Trial 1 versus Trial 2 of the Test of Memory Malingering: Evaluating Accuracy Without a “Gold Standard”

This study examines the accuracy of the Test of Memory Malingering (TOMM), a frequently administered measure for evaluating effort during neurocognitive testing. In the last few years, several authors have suggested that the initial recognition trial of the TOMM (Trial 1) might be a more useful index for detecting feigned or exaggerated impairment than Trial 2, which is the source for inference recommended by the original instruction manual (Tombaugh, 1996). We used latent class modeling (LCM) implemented in a Bayesian framework to evaluate archival Trial 1 and Trial 2 data collected from 1198 adults who had undergone outpatient forensic evaluations. All subjects were tested with two other performance validity tests (the Word Memory Test and the Computerized Assessment of Response Bias), and for 70% of the subjects, data from the California Verbal Learning Test–Second Edition Forced Choice trial were also available. Our results suggest that not even a perfect score on Trial 1 or Trial 2 justifies saying that an evaluee is definitely responding genuinely, although such scores imply a lower-than-base-rate probability of feigning. If one uses a Trial 2 cut-off higher than the manual’s recommendation, Trial 2 does better than Trial 1 at identifying individuals who are almost certainly feigning while maintaining a negligible false positive rate. Using scores from both trials, one can identify a group of definitely feigning and very likely feigning subjects who comprise about two-thirds of all feigners; only 1 percent of the members of this group would not be feigning

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Examining the Potential for Gender Bias in the Prediction of Symptom Validity Test Failure by MMPI-2 Symptom Validity Scale Scores

Using a sample of individuals undergoing medico-legal evaluations (690 men, 519 women), the present study extended past research on potential gender biases for scores of the Symptom Validity (FBS) scale of the Minnesota Multiphasic Personality Inventory-

Associations Between Symptom Validity Test Failure and Scores on the MMPI-2-RF Validity and Substantive Scales

This study examined the association between Symptom Validity Test (SVT) failure and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF; Ben-Porath Tellegen, 2008), in the Forensic Disability Claimant samples described in the MMPI-2-RF Technical Manual (Tellegen Ben-Porath, 2008a, 2008b). SVTs used included the Word Memory Test (Green, 2003), the Computerized Assessment of Response Bias (Allen, Conder, Green, Cox, 1997), the Medical Symptom Validity Test (Green, 2004), and the Test of Memory Malingering (Tombaugh, 1996). SVT failure was associated with significant elevations throughout the MMPI-2-RF overreporting validity scales and substantive scales. Pairwise contrasts between groups failing 0 and 3 SVTs revealed predominantly large effect sizes for the overreporting validity scales (d = 0.78-1.11), and many of the substantive scales, including the Cognitive Complaints (COG) scale. Results of this study demonstrate an association between SVT performance and elevated scores on the MMPI-2-RF. These results suggest that exaggeration of cognitive symptoms as demonstrated by SVT failure is also associated with overreported emotional, somatic, and neurocognitive complaints on the MMPI-2-RF

Incremental Validity of the MMPI-2-RF Over-reporting Scales and RBS in Assessing the Veracity of Memory Complaints

The Response Bias Scale (RBS) has been found to be a better predictor of over-reported memory complaints than Minnesota Multiphasic Personality Inventory-2 (MMPI-2) F, Back Infrequency (Fb), Infrequency-Psychopathology (Fp), and FBS scales. The MMPI-2-Restructured Form (RF) validity scales were designed to meet or exceed the sensitivity of their MMPI-2 counterparts to symptom over-reporting. This study examined the incremental validity of MMPI-2-RF validity scales and RBS in assessing memory complaints. The MMPI-2-RF over-reporting validity scales were more strongly associated with mean Memory Complaints Inventory scores than their MMPI-2 counterparts (d = 0.22 to 0.49). RBS showed the strongest relationship with memory complaints. Regression analyses demonstrated the incremental validity of the MMPI-2-RF Infrequent Responses, Infrequent Psychopathology Responses, Infrequent Somatic Responses, and FBS-r scales relative to MMPI-2 F, Fp, and FBS in predicting memory complaints. This is consistent with the development objectives of the MMPI-2-RF validity scales as more efficient and sensitive measures of symptom over-reporting

Differentiating PTSD symptomatology with the MMPI-S_RF (Restructured Dorm) in a forensic disability sample

The current study was designed to explore models of assessing various forms of Post-Traumatic Stress Disorder (PTSD) symptomatology that incorporate both broad and more narrowly focused affective markers. We used broader markers of demoralization, negative activation, positive activation, and aberrant experiences to predict global PTSD scores, whereas more narrowly focused markers of positive and negative affect were used to differentiate between PTSD symptom clusters. A disability sample consisting of 347 individuals undergoing medico-legal psychological evaluations was used for this study. All participants completed symptom measures of PTSD and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) (from which MMPI-2-RF scores were derived). The results indicated that demoralization was the best individual predictor of PTSD globally, and that more narrowly focused MMPI-2-RF Specific Problems scales provided a differential prediction of PTSD symptom clusters. Theoretical and practical implications of these findings are discussed within contemporary frameworks of internalizing personality and psychopathology

Inconsistent Responding on the MMPI-2-RF and Uncooperative Attitude: Evidence From Cognitive Performance Validity Measures

It is generally well understood that possible reasons for inconsistent responding on the Minnesota Multiphasic Personality Inventory–2 Restructured Form (MMPI-2-RF), as measured by the Variable Response Inconsistency (VRIN-r) and True Response Inconsistency (TRIN-r) scales, include reading or language limitations, cognitive impairment, and intentional random responding; however, the interpretive recommendations for the test suggest that higher scores on these scales can also result from an uncooperative test-taking approach. This study utilized a sample of 3,457 predominately non–head injury disability claimants to examine the association between inconsistent responding on the MMPI-2-RF and performance on cognitive tests as well performance validity tests (PVTs), an independent indicator of uncooperative test-taking attitude. Analysis of variance found that both VRIN-r and TRIN-r were associated with statistically lower cognitive test scores. These analyses also supported that TRIN-r was associated with poor performance on collaterally administered PVTs in a subsample of individuals with average reading levels. Illustrating the practical effects of these results, in follow-up relative risk ratio analyses, individuals with elevations on TRIN-r were at up to five times greater risk of PVT failure than those without elevations. Overall, the results of this study provide some support for the interpretation that inconsistent responding on the MMPI-2-RF is associated not only with cognitive/reading problems or limitations but also an uncooperative test-taking approach, particularly for elevated TRIN-r scores

Further Validation of the MMPI-2 and MMPI-2-RF Response Bias Scale: Findings from Disability and Criminal Forensic Settings

The present study extends the validation of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) Response Bias Scale (RBS; R. O. Gervais, Y. S. Ben-Porath, D. B. Wygant, & P. Green, 2007) in separate forensic samples composed of disability claimants and criminal defendants. Using cognitive symptom validity tests as response bias indicators, the RBS exhibited large effect sizes (Cohen's ds = 1.24 and 1.48) in detecting cognitive response bias in the disability and criminal forensic samples, respectively. The scale also added incremental prediction to the traditional MMPI-2 and the MMPI-2-RF overreporting validity scales in the disability sample and exhibited excellent specificity with acceptable sensitivity at cutoffs ranging from 90T to 120T. The results of this study indicate that the RBS can add uniquely to the existing MMPI-2 and MMPI-2-RF validity scales in detecting symptom exaggeration associated with cognitive response bias