Inappropriate Use of the Modified Somatic Perception Questionnaire (MSPQ) to Diagnose Malingering

Background: The Modified Somatic Perception Questionnaire (MSPQ) is frequently used by psychologists contracted by car insurance companies as a measure of malingering medical symptoms. The MSPQ has not been validated on patients injured in car accidents: the use of MSPQ on that patient group deserves methodological scrutiny.

Method: The overlap of individual MSPQ items with symptoms typically reported by patients injured in motor vehicle accidents (MVAs) was examined, including also the post-concussive and whiplash symptoms and signs of autonomic dysregulation as often noted with unrelenting pain, pain related insomnia, and sudden spikes of stabbing back or neck pain.

Results: About two-thirds of MSPQ items (8 of the 13 scored items, i.e., 61.3%) show a definite overlap with medical symptoms legitimately experienced by post-MVA patients. Three of these, the dizziness, blurring of vision, and nausea, are listed in the widely used Rivermead Post-Concussion Symptoms scale where they are scored correctly as indicators of the post-concussion syndrome, not as signs of malingering. Three other items, “Muscles in neck aching,” “Legs feeling weak,” and “Muscles twitching or jumping”, can be considered as associated with whiplash injury to cervical spine or also with sprain or strain of other tissues, and the associated fatigue. Furthermore, symptoms of “Feeling hot all over” and Sweating all over” are familiar to persons who experienced sudden episodes of excruciating back pain.

Discussion: Symptoms similar to post-MVA patients are also experienced by patients with industrial injuries such as on construction sites, and also in war veterans who sustained concussive and whiplash injuries in their exposure to violent blasts. These patients are particularly vulnerable to being falsely diagnosed as malingerers (or expressed in other words, as magnifying or exaggerating their symptoms).

Conclusions: Using the MSPQ as a test of malingering on such (or on similar) clinical groups constitutes malpractice.

Keywords: malingering, pain, MSPQ, post-concussion syndrome, whiplash syndrome.