MALINGERING AND DEFENSIVENESS IN THE NEUROPSYCHOLOGICAL ASSESSMENT OF MILD TRAUMATIC BRAIN INJURY

A balanced approach to the detection of malingering and defensiveness in the neuropsychological assessment of mild traumatic brain injury (MTBI) is suggested, while genuine neurobehavioral and psychopathological sequelae are documented. The absence of neuroradiological evidence and heavy reliance on patient report and neuropsychological test data make malingering and defensiveness issues that are critical in forensic contexts and for the credibility of neuropsychology. Deficiencies in interview data collection and the relative strengths and weaknesses of the MMPI (Minnesota Multiphasic Personality Inventory) are reviewed. The potential independence of malingering and defensiveness and of MMPI and neuropsychological data are noted. The equivocal research on malingering is reviewed, with particular emphasis on assessment of memory deficits as one of the most common complaints in MTBI. Arguably, malingering is more similar to than different from other diagnoses, but it has not been so treated in clinical practice. The need for developing sophisticated malingering probes is acknowledged, but the quest for a single malingering test is criticized and preference given to approaches that rely on evaluating data patterns indicating malingering.