A narrative review of differential diagnoses in the forensic determination of malingering based on discrepancies and scores on performance and symptom validity tests.

Résumé

The forensic determination of malingering is primarily guided by performance validity tests (PVTs), symptom validity tests (SVTs), and discrepancies in the examinee's presentation. A determination of malingering may occur when PVT or SVT scores fall within the invalid range. Additionally, such determinations may arise from discrepancies between (neuro) psychological test results and established information about the examinee, or from discrepancies within the examinee's presentation. Current diagnostic frameworks incorporate differential diagnosis considerations intended to preclude a malingering determination despite the presence of discrepancies or invalid PVT and SVT scores. However, these differential diagnosis considerations are largely conceptual and remain insufficiently supported by empirical evidence. Drawing on prior literature, this narrative review examines research concerning 21 additional factors which are currently absent from existing malingering criteria, but which may compromise diagnostic accuracy. These factors include distraction, abuse history, ethnocultural and linguistic diversity, substance use, various comorbidities, fatigue, stress, and various interpersonal and situational factors. To reduce the risk of false-positive malingering determinations, recommendations for modifications to forensic assessment practices and directions for future research are proposed.