Detecting Malingering in Compensated Low Back Pain Patients: An Analog Study

• Main Author: Grewe, Jennifer R.
• Format: Others
• Published: DigitalCommons@USU 2010
• Subjects: cluster analysis; compensated population; low back pain; low back patients; malingering; experimental psychology; Psychology
• Online Access: https://digitalcommons.usu.edu/etd/552; https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1548&context=etd

Given the prevalence and cost of low back pain, particularly among workers' compensation patients, it is advantageous to understand how various psychological constructs may be related to prolonged disability and failure to return to work. Malingering is a psychological construct that is clearly relevant for worker compensation populations and is a construct that is well suited for experimental control within an analog study. Malingering is the intentional exaggeration of physical or psychological symptoms that are motivated by external incentives such as time away from work. The ability to detect malingering in such a population with psychological assessments is unclear. An analog study was conducted in which we instructed college students to portray themselves as injured workers who received a back injury that required them to be off work while they recovered. Students were then told that they would be seeing a psychologist who would attempt to ascertain their abilities to return to work via the MMPI-2. Students were then randomly instructed to respond to the MMPI-2 in three different ways: a control condition was instructed to respond as if they suffered a workplace back injury that resulted in significant pain; a subtle fake-bad condition who received the control instruction plus were informed they did not enjoy their work and their back injury allowed them to enjoy personal and family time more; and a fake-bad condition that received the control instruction plus were asked to deliberately portray themselves as experiencing physical symptoms severe enough to keep them off work longer. Currently, no assessment of malingering exists within a compensated low back pain population. The purpose of this study was to determine if the MMPI-2 can be used to differentially identify "patients" who are instructed to report symptoms veridically versus "patients" instructed to consciously feign and magnify symptoms in an effort to avoid returning to work. Malingering and non-malingering patients' scores on the MMPI-2 validity and clinical scales were subjected to a cluster analysis to determine if a malingering profile could be accurately identified. A 5-cluster validity solution and 4-cluster clinical (both with K correction) solution were accepted. Substantially lower scores on L and K, elevated scores on F on the 5-cluster validity solutions, distinguished the "malingering" profile. The 4-cluster clinical solution was characterized by elevated scores on the clinical scales of hypochondriasis, depression, paranoia, and schizophrenia, which distinguished the "malingering" profile. The results indicate that the MMPI-2 could be useful in detecting malingering in compensated back pain patients. Results are discussed in the context of pain studies.