Irremediably Flawed Nature of Analog Validation Methodology of Malingering Tests

Background: Analog validation of malingering tests was evoked by Smith and Burger in 1997 as a method they used to “validate” their Structured Inventory of Malingered Symptomatology (SIMS). Their procedure consists in comparing students instructed to respond honestly with those instructed to feign medical symptoms. The procedure was adopted by others, notably by Holly Miller for the development of her Miller Forensic Assessment of Symptoms Test (M-FAST). Since both the SIMS and M- FAST consist of legitimate medical symptoms incorrectly scored as indicators of malingering, the analog validation could also be used on other known lists of legitimate medical symptoms, such as the Beck Depression Inventory-II (BDI-2).

Method: 20 adults (mean age 47.9 years, SD=16.5) were instructed to respond twice to the BDI-2, at first by responding honestly and then while feigning or simulating “very severe depression.”

Results: The mean score was 6.5 (SD=7.6) for the honest responses and 52.2 (SD=6.2) for feigned or simulated depression. There was no overlap in the distribution of these two sets of scores. In our sample, any cutoff from 30 to 40 points would result in statistics of 100% sensitivity, 100% specificity, and 100% efficiency. The cutoff of 14 or more points (Beck’s lower end of the category of mild depression) would result in 100% sensitivity, 85% specificity, and 92.5% efficiency.

Discussion and Conclusion: Our easily replicable study demonstrates methodological shortcomings of analog validations. Malingering tests validated in such a fatally flawed manner, in particular the SIMS and the M-FAST, may adequately differentiate reporters from non-reporters of medical symptoms, but not legitimate patients from malingerers.

Keywords: malingering, test validation, BDI-2, SIMS, M-FAST.