Eduardo Osuna , Milagros López-Martínez , Ramón Arce , María José Vázquez prison inmates of response Analysis patterns on the MMPI-2 inpsychiatric ORIGINAL ARTICLE Clinical and Health Psychology International Journalof

Download (0)

Full text

(1)

International Journal

of Clinical and Health Psychology

www.elsevier.es/ijchp

ORIGINAL ARTICLE

Analysis of response patterns on the MMPI-2 in psychiatric prison inmates

Eduardo Osuna

a,∗

, Milagros López-Martínez

b

, Ramón Arce

c

, María José Vázquez

d

aUniversidaddeMurcia,Spain

bUniversidadCatólica‘‘SanAntonio’’deMurcia,Spain

cUniversidadedeSantiagodeCompostela,Spain

dUniversidadedeVigo,Spain

Received2June2014;accepted15September2014 Availableonline11October2014

KEYWORDS MMPI-2;

Malingering;

Underreporting;

Psychiatricprison inmates;

Expostfactostudy

Abstract Inordertoassessmentalhealthstatus,andtheclassificationofboththeoverre- portingandunderreportingscalesandindexes,102psychiatricprisoninmatesdeemedmentally incompetent tostandtrialcompleted theSpanish adaptationofthe MMPI-2understandard instructions(honestresponding).Theresultsshowedpatternsofconsistent,non-random,nor extremelyacquiescentresponses.Moreover,no-outlierresponsesweredetected.Inlinewith thepsychiatricdiagnosis,allthepsychiatricprisoninmateswereclassifiedbythebasicclinical scalesasclinicalcasesofthepsychotic dyadi.e.,schizophreniaandparanoidideation.The overreportingscalesandindexes(i.e.,F,K,Fb,F-K,Fp,DsandFBS)classifiedtheparticipants as malingerers, whereasthe L,Wsd,and Odunderreporting scalesas goodfeigners. These scalesassessingimpressionmanagementi.e.,consciouslyfakinggoodbiasedresponses,didnot classifyoverreporters.Thus,theyarerobustindicatorsofhonestrespondingamongpsychiatric prisoninmates.Theimplicationsoftheseresultsforthepracticeofforensicpsychologyare discussed.

©2014AsociaciónEspa˜noladePsicologíaConductual.PublishedbyElsevierEspaña,S.L.U.

PALABRASCLAVE MMPI-2;

simulación;

disimulación;

EstudiodelestiloderespuestaenelMMPI-2depenadospsiquiátricos

Resumen Seharealizadounestudioexpostfactoenunapoblaciónde102penadospsiquiátri- cosquerespondieronbajoinstruccionesestándaralaadaptaciónespa˜noladelMMPI-2,conel objetivo deconocerelestadomentalinformadoenelMMPI-2,asícomo elcomportamiento de los indicadores de simulación y de disimulación. En los protocolos de respuesta no se

Correspondingauthor.DepartamentodeMedicinaLegalyForense,FacultaddeMedicina,CampusUniversitariodeEspinardo,E30100 Murcia,Spain.

E-mailaddress:eosuna@um.es(E.Osuna).

http://dx.doi.org/10.1016/j.ijchp.2014.09.002

1697-2600/©2014AsociaciónEspa˜noladePsicologíaConductual.PublishedbyElsevierEspaña,S.L.U.Open access under CC BY-NC-ND license.

Open access under CC BY-NC-ND license.

(2)

penadosno imputables;

estudioexpostfacto

observaroncasosdeoutliers,patronesderespuestastotalmenteazarososoextremadamente aquiescentes,altiempoqueeranconsistentes.Todoslospenadospsiquiátricosfueronclasifica- dos,enconsonanciaconeldiagnósticopsiquiátrico,enlasescalasclínicasbásicascomocasos clínicosenladíadapsicótica(i.e.,esquizofreniaeideaciónparanoide).Lasescalaseíndices desimulaciónutilizados(i.e.,F,K,Fb,F-K,Fp,DsyFBS)losclasificaroncomosimuladores,en tantolasescalasdemedidadeladisimulaciónL,WsdyOdlosclasificaroncomodisimuladores.

Estasescalas,queformanpartedelmanejodelaimpresión,estoes,delamanipulaciónfavor- ableyconscientedelaimagen,noinformandecasosenpoblacionesdesimuladores.Así,éstas escalasseríanindicadoresrobustosdenosimulación.Finalmente,sediscutenlasimplicaciones deestosresultadosparalaprácticaforense.

©2014AsociaciónEspa˜noladePsicologíaConductual.Publicado porElsevierEspaña,S.L.U.

One of the most crucial and complex tasks for foren- sicpsychology andpsychiatryis toestablish psychological causalrelationsbetweenpeopleandtheiractions.Thenor- mativeprinciple of culpabilityimpliesindividuals deemed mentallyincompetent cannot beheld criminallyresponsi- blenorliabletopunishmenti.e.,theylackguiltandcannot actcriminally.Inclinicalterms,individualswhocannotbe heldcriminallyresponsibleonthegroundsofmentalincom- petencearereadilydiagnosed,buttranslatingthisdiagnosis tothefieldofforensicsisunsustainablegiventhatmalinger- ingisnotsuspectedinclinical contexts,andthus remains undiagnosed(Rogers,2008).Incontrast,inforensicsettings adifferentialdiagnosis ofmalingeringis acrucialrequire- mentthat shouldbebased,not onclinical impressionsor judgements,butontheexigenciesofareliabletechnique groundedonreplicableempiricalfindings,andaknownerror rateendinginatail(i.e.,itisinadmissibleforanhonestsub- jecttobeidentifiedasamalingerer)(AmericanPsychiatric

&Association,2013;Graham,2011;Greene,2011).

Asthegoalofforensicevaluationistwofoldi.e.,toassess mentalhealth, andtoestablish adifferentialdiagnosis of malingering,amultimethod approachis required combin- ing clinical interviews and psychometric instruments, of whichtheMMPIisthemostextensivelyused(Graham,2011;

Greene,2011;McDermott,2012;Rogers,Sewell,Martin,&

Vitacco,2003).Thus,theaimofthisfieldstudywastoassess self-reportedmentalhealth ontheMMPI-2,aswell asthe responsepatternsoftheover-andunder-reportingmarkers, underhonestresponseevaluationconditionsi.e.,standard instructionsinasampleofpsychiatricprisoninmates.

Method

Participants

The sample consisted of a 102 Spanish psychiatric prison inmates,93 men(91.2%), and9women (8.8%);age range 22to77years(M=39.28,SEM=1.04).Allsubjectsfreely volunteeredtoparticipateandgavetheirinformedconsent.

Thoughnormallypeoplewith psychiatricdisorderscanbe subject to evaluation (Greene, 2011), 58 were excluded due to a lack of cognitive competence or willingness to beevaluated. The main psychiatric diagnosis (51.0%) was schizophrenia and other psychotic disorders; followed by

personalitydisorders(24.5%),anddisordersrelatedtoillicit substance abuse(16.7%).In theremaining 7.8%,themain diagnosiswasdepressivedisorderorinfancy,childhood,and adolescentdisorders.

This sample was contrasted with a second sample of 100 second degree prisoninmates, convicted for offences againstpeople,consistingof90malesand10womenaged 20to73years(M=41.09,SEM=1.08).

Experimentaldesign

Aquasi-experimentalexpostfactostudywasdesignedwith fielddatafrompsychiatricprisoninmates,non-psychiatric prisoninmates,thenormativepopulation,andtheclinical population. Thus, the mental health of psychiatricprison inmates wasmeasured on the MMPI-2, theconsistency of responses and the validity of the protocols of psychiatric prison inmateswere evaluated, taking as contrastive cri- terion normative and clinical populations,and astandard prisonsample.Thedesignsensitivityanalysis,showedthat forthecomparisonofthemeansofasampleof102partici- pantswithagivenvalue,theprobabilityofdetecting(1-␤) significant differences(␣ <.05)for amedium effectsize, was99%;and100%for thecomparisonofproportionswith agivenvalue(.05and.02),and99%fortheanalysisofthe associationbetweenvariables.

Instruments

The psychometric instrument employed in this study was the adapted Spanish version of the MMPI-2 (Hathaway &

McKinley,1999).Inordertomeasurethementalhealth of participants,thestandardclinicalscaleswereused,buton ethicalandlegalgrounds,theMasculinity-Femininityscales wereexcluded.Toanalysedistortionsintheresponses,the standard validity scales, the Cannot Say (?), K, F, and L scales,andtheadditionalvaliditymarkerswereusedsince theyaremoreusefulthantheoriginalonesforthedesignof forensicpractice(Fari˜na,Arce,Vilari˜no,&Novo,2014),in relationtooverreportingandunderreporting(Baer&Miller, 2002; Rogers et al., 2003): the Back Infrequency Scales (Fb), Gough Dissimulation (Ds) (Gough, 1954), which was preferred to the revised version (Ds-r) since the Ds out- performs the Ds-r in the consistency of cut scores, and

Open access under CC BY-NC-ND license.

(3)

minimizes therisk offalse-positives (Rogersetal., 2003), Faking-Bad(FBS)(Lees-Haley,English,&Glenn,1991),Infre- quency Psychopathology (Fp) (Arbisi & Ben-Porath, 1995) for assessingoverreporting; andthe Superlativescales(S) (Butcher & Han, 1995), Wiggins’ Social Desirability (Wsd) (Wiggins,1959),Edwards’SocialDesirability(So)(Edwards, 1957),andOtherDeceptionscale (Od)(Nichols& Greene, 1991),fortheanalysisofunderreporting.Furthermore,the scalesandindexesforthemeasurementoftheconsistency ofresponses,theTRINandVRINscales,andthe|F-Fb|index wereused.

Procedure

Access to the clinical histories, and prison reports and recordswasgrantedincompliancewithprevailing ethical andlegalstandards.Allevaluationswereundertakenindi- viduallyandin privatebystaff trainedin forensicclinical evaluation, underarelaxed friendly atmospherethat had beenestablishedpreviouslyinoneormoresessions,accord- ingtothesubject’sabilitytopayattention,concentration, memory,and thefatigueobserved in taskcompletion. No caseexceeded50minutesofcontinuousevaluation.Inline withtheguidelinesproposedbyGraham(2011)forevaluat- ingin clinical-forensicsettings,theevaluator ensuredthe responsesreflectedthetrue conditionofthesubject, and responded to any doubts or questions. Participants were informed of the objective of the study, the importance in collaborating with honest responses was underscored, andtheywereassuredtheirdatawouldremainanonymous and confidential. Finally,participants were debriefed and interviewedtoascertainthedegreeofmotivationandimpli- cationinthetaskthroughtherecallandcomprehensionof instructions, and by ensuringparticipants had understood and performed the task correctly (Palmer, Borrás, Pérez- Pareja, Sesé,& Vilari˜no,2013; Rogers, 2008).The results confirmedthecorrectexecution:concordancewiththeclin- icaldiagnosisregisteredinmedicalrecords,therewereno cases of unwillingness to cooperate with the evaluation, outliers, or patterns of completely random or extremely acquiescentresponses.

Thesameprocedureandstepswereappliedtothesam- ple of second degree prisoninmates. The evaluation was undertakenaspartoftheclassificationprocessduringthe prisonadmissionstage.

Results

Threesteps (Arce, Fari˜na, Carballal,& Novo,2006,2009) relate the research model and knowledge transfer to forensicsettingsintheanalysisofMMPIprotocols.Thefirst stepisrelatedtothetotalinvalidationoftheprotocoli.e., unwillingnesstocooperateintheevaluation,outliers,and patterns of completely random or extremely acquiescent responses. Thus, the results of contingencies on the No- ResponsesScale(?)showedthatallofthepsychiatricprison inmatesunderassessmentcollaboratedwiththeevaluation (r<10; Graham, 2011). Moreover, there were no cases of totally random patterns of responses in VRIN (r≥18), extremelyacquiescentinTRIN(r≥18)oroutliersinK(r>26) (Greene, 2008). Nevertheless, a 52% rate of extremely

elevatedscores(T70+5SD,i.e.,T≥120)wereobservedinF, and25%inFb,whichcouldberelatedtoarandomresponse profilethoughitisalsoadistinctivesignofseverelydisorga- nizedor acutepsychoticpatients(Graham,2011; Greene, 2011), which is precisely the psychiatric diagnosis of the subjectsinthisstudy.Likewise,extremelyhighscores(|F- Fb|≥19;Greene,2008)wereobservedintheF-Fbindexi.e., theyarenotrepresentativeoftheclinicalpopulation (p<

.001)in45.1%ofpsychiatricprisoninmates.Thecrosscheck of each contingency in which |F-Fb| was ≥19, confirmed it wasalways a product of F>Fb, that is, the prevalence of positive psychotic symptomatology (F) over depressive symptomatology(Fb)(Greene,2011).Thepsychiatricdiag- nosisofthesesubjectsconfirmedthispredominance.Thus, theresultsoftheFandFbscales,andtheF-Fbindexconcur withthediagnosisforthispopulation.Havingverifiedcollab- orationi.e.,thatnocasewastrulyanoutlierornorandomly respondedprotocols,wemayconclude thattheresponses obtainedwerecharacteristic/representativeofthesetypes ofpopulationssotheymaybeincludedforanalysis.

The second step in evaluating the consistency of the responses was in terms of acquiescent responses, indis- criminatetrueorfalseresponses(TRIN),randomresponses (VRIN),andchange(orstability)inresponsestyle(F-Fb).The results(seeTable1)revealthat theTRINandVRINmeans arewithintheregionofnormality,andaresignificantlydis- tantfromthecriterionofinconsistency,withalargeeffect size.Moreover,thestudyofcases(seeTable2)showedall meansfellwithintheregionofnormalityinVRIN,whereas theprevalenceforTRINwasasexpected.

As for changes in response style, the F-Fb index, the proportionofcasesobserved (.86)wassignificantlyhigher (seeTable2) thanexpected (.02)withalarge effectsize (OR>4.25).Incomparisontonon-psychiatricprisoninmates, asignificantlyhigherprevalenceinthechangeinresponse style,␹2(1,N=202)=138.11,p<.001,␾=.84,wasobserved in psychiatric prison inmates. In short, the response of psychiatric prison inmates was characterized by a non- acquiescentand non-random pattern of responses, and a changeinresponsestylethroughouttheevaluation.

Thethirdstep,involvedtheanalysisofprotocolvalidity, whichwasonlyperformedonpopulationsthatexcludedsys- tematicallyinconsistentresponsesorprotocolswithtotally randompatternsof responses (rVRIN<18),extremely acqui- escentresponses(rTRIN<18),andoutliers(rK≤25).Asthese conditionsweremet,wecontinuedtoproceedaccordingly.

The resultswere subdivided, according tothe availability inthecommercialversionoftheMMPI-2,intooriginalvalid- itymarkers(available),andadditionalmarkers(unavailable, professionalshavenodirectaccess).Theresultsoftheorig- inal validity markers (see Table 1) show that the means forthe LandK scalesfell withintheregionof normality, whereasthemeansfortheFandFbscalesfelloutsideand weresignificantlydistant,withalargeandmoderateeffect size,respectively,fromnormalitytowardsoverreporting(an alternativehypothesiswouldbesufferingfromsevereinjury, whichwasthecase).Finally,theF-Kindexrevealedasig- nificantbiasinresponsestowardsoverreportingamongthe populationofpsychiatricprisoninmates,withalargeeffect size.

Theadditionalmarkersweresubdividedintooverreport- ingmarkers:theFp,Ds,andFBSscales;andunderreporting

(4)

Table1 Measures,confidenceintervalforthemean,regionofnormality,andcomparisonofmeasures.

Index M(95%CI) RfN t d test-value

Consistencyofitemendorsement

VRIN 7.75(7.00---8.46) 0<r<13 -14.23*** -1.40 13a

TRIN 9.52(9.15---9.89) 6<r<13 -18.52*** -1.82 13a

|F-Fb| 22.69(20.04---25.34) 0<r<8 9.38*** 0.93 8b

Standardvalidityscalesandindexes

L 7.77(7.30---8.24) 1<r<9 -5.16*** -0.51 9b

K+ 12.90(11.98---13.82) 7<r<24 -23.31*** -2.31 24b

K++ 12.40*** 1.23 7b

F 46.30(44.97---47.63) 0<r<19 40.02*** 3.96 19b

Fb 23.62(21.33---25.91) 0<r<17 5.65*** 0.56 17b

F-K+ 33.40(31.34---35.46) -23>r<10 53.42*** 5.29 -23b

F-K++ 22.16*** 2.20 10b

Additionalvalidityscales

Fp 20.49(19.47---21.51) 0<r<5 29.85*** 2.95 5b

Ds 38.66(19.47---21.51) 2<r<30 8.13*** 0.80 30b

FBS 27.11(26.01---28.21) 8<r<31 -7.01*** -0.69 31b

S 20.99(19.15---22.83) 10<r<44 -24.61*** -2.44 44b

Wsd 14.59(13.59---15.59) 6<r<19 -8.60*** -0.85 19b

So 12.62(11.44---13.80) 7<r<36 -39.10*** -3.87 36c

Od 14.90(13.94---15.86) 5<r<22 -14.46*** -1.43 22b

Note.df(100);M=mean;95%CI=95%confidenceinterval;RfN=Regionfornormalityi.e.,90%ofthedistribution(two-tailed:5%lower and5%upper);criteriafortheRfNtakenfromclinicalsettingofCaldwellandGreene(Greene,2008,2011),andforTRINandVRIN,as bothareuniversalforthenormativepopulation(Butcheretal.,1989,2001);d=Cohen’sd.

*p<.05;**p<.001.

atest-valuefromMMPI-2Manual(Butcheretal.,1989,2001);

b test-value=95thpercentileforclinicalsetting(Greene,2008);

c test-value=95thpercentileforclinicalsetting(Greene,2011);+test-valueforunderreporting;++test-valueforoverreporting.

Table2 Classificationratesoftheitemendorsementconsistencyindexes.

Psychiatricprisoninmates Non-psychiatricprisoninmates

Index CutScore f(p) Z OR f(p) Z OR

TRIN ≥r13a 4(.039)+ 1.36 --- 0(0)+ --- ---

VRIN ≥r13a 0(0) --- --- 1(.01) --- ---

|F-Fb| ≥r10b 88(.863) 60.21*** 43.15 3(.03) 0.71 ---

Note.

aFromButcheretal.(1989,2001);

b 98thpercentileforclinicalsettings(Greene,2008);---indicatethattheORswerenotcalculatedastheprevalenceofobservedcases wasnotstatisticallysignificant;+TRINrawscores≤5werealsoindicativeofinconsistency(indiscriminatetendencytofalseresponse), registeringthesamerateofcasesaswasexpected(.02)forpsychiatricprisoninmates,andnonefornon-psychiatricprisoninmates;

*** p<.001;f(p)=frequency(proportion);Z=Z-test;OR=oddsratio.

markers:theS,Wsd, So,andOdscales(seeTable1).The meanfortheFpandDsscaleswassignificantlyhigherthan thecut-off pointfor suspectedoverreporting withalarge effectsize,whereasthe meanfor the FBSfell withinthe regionof normality. Finally, the population of psychiatric prisoninmatesscored withintheregionofnormalityinall ofthescalesevaluatingunderreporting.

Intermsofclassification,alloftheoverreportingmark- ers(seeTable3)showedasignificantrateofclassification ofpsychiatricprisoninmatesasoverreporting responders, rangingfrom6.8%ofK,to100%ofF,whereasnon-psychiatric inmatesonly scoredhigh onthe DsScale.Accumulatively,

atleasttwomarkers(seeTable4)werefoundtobeindica- tive of,reachinga maximumof 6markers (mode =5)for psychiatricprisoninmates,whilstfornon-psychiatricprison inmates,twooverreportingmarkerswerefoundinonesub- ject,onlyonein11subjects,andnonein88(mode).

Theassessment ofunderreportingonthe additional(S, Wsd,So,andOd)scalesshowedthemeanforthepopulation ofpsychiatricprisoninmateswaswithintheregionofnor- mality(seeTable1).Strikingly(suspectedmalingeringbeing thehypothesis),theassessmentofcasesontheunderreport- ing scales(see Table5) showedthat L,Wsd and Odwere significant,andhighly(largeseffectsizesinLandWsd,and

(5)

Table3 Classificationrateofoverreportingmarkersinpsychiatricandnon-psychiatricprisoninmates.

Psychiatricprisoninmates Non-psychiatricprisoninmates

Index CutScorea f(p) Z OR f(p) Z OR

F ≥r25 102(1) 70.00*** 50.00 2(.020) 0 ---

K ≤r5 7(.068) 3.43*** 3.40 2(.020) 0 ---

Fb ≥r21 60(.588) 40.57*** 29.40 2(.020) 0 ---

F-K ≥r17 94(.920) 64.29*** 46.00 0(0) 0 ---

Fp ≥r7 97(.951) 66.50*** 47.55 3(.030) 0.71 ---

Ds ≥r35 73(.716) 52.93*** 35.80 10(.100) 5.71*** 5.00

FBS ≥r34 10(.098) 5.57*** 4.90 0(0) --- ---

Note.

a 98thpercentileforclinicalsettingfromCaldwell(Greene,2008);test-valueforZ-testandOrs=.02(T70).

*** p<.001.

Table4 Accumulativeanalysis ofthe numberofoverre- portingmarkerspersample.

No.ofindexes f % cumulative%

Psychiatricprisoninmates

2 6 5.9 5.9

3 13 12.7 18.6

4 30 29.4 48.0

5 46 45.1 93.1

6 7 6.9 100

Non-psychiatricprisoninmates

0 88 88 88

1 11 11 99

2 1 1 100

moderateinOd)sensitivetoit.Asimilareffectwasobserved inthepopulationofnon-psychiatricprisoninmates(thesus- pectedhypothesislinkedtoobtainingprisonbenefits)with asignificantprevalencerateinL,Wsd,andOd,andalarge effectsizes, andasmalleffectsizes inK.Accumulatively, thedata(seeTable6)revealedevidenceofunderreporting in 78.4%psychiatricprisoninmates: in 48% withoneindi- cator,in 16.7%two markers,and in 13.7%threemarkers.

Table6 Accumulativeanalysisofthenumberofunderre- portingmarkersperpopulation.

No.ofindexes f % cumulative%

Psychiatricprisoninmates

0 22 21.6 21.6

1 49 48.0 69.6

2 17 16.7 86.3

3 14 13.7 100

Non-psychiatricprisoninmates

0 17 17 17

1 24 24 41

2 19 19 60

3 32 32 92

4 5 5 97

5 3 3 100

Comparatively,asimilarnumberofunderreportingmarkers wasobservedinpsychiatricprisoninmates(notsuspected) asinnon-psychiatric(suspected),␹2(1,N=202)=8.68,ns,

␾=.058.

The comparison between the means for the popu- lation of psychiatric prison inmates (see Table 7) and

Table5 Classificationrateofunderreportingmarkersinpsychiatricandnon-psychiatricprisoninmates.

Psychiatricprisoninmates Non-psychiatricprisoninmates

Index Cutscore f(p) Z OR f(p) Z OR

L ≥r7a 73(.716) 30.27*** 14.32 70(.700) 29.55*** 14.0

K ≥r22a 3(.029) --- --- 10(.100) 2.27* 2.00

F-K ≤r-.21a 0(0) --- --- 1(.010) --- ---

S ≥r39a 3(.029) --- --- 7(.070) 0.90 ---

Wsd ≥r18a 77(.755) 32.04*** 15.10 55(.550) 22.73*** 11.00

So ≥r36b 0(0) --- --- 0(0) --- ---

Od ≥r19a 22(.318) 12.18*** 6.16 51(.510) 20.91*** 10.20

Note.

a FromButcheretal.(1989,2001);

b FromGreeneforclinicalsetting(2011);thetestvalue(H0)forZ,asunderreportingwasnotsuspected,was.05,tailedinthedirection ofthetargetoftheindicator;---valuewasnotcomputedbecausethenumberofcasesobservedwas≤.05(H0).

*p<.05;**p<.01;***p<.001.

(6)

Table7 One-samplet-test.

Scale t M SD d

Hypochondriasis 13.88*** 83.31 9.69 1.37

Depression 0.29 70.27 9.69 0.03

Hysteria 6.73*** 76.67 10.01 0.66

Psychopathicdeviate -4.28*** 66.23 8.91 -0.42

Paranoia 13.98*** 88.82 13.59 1.38

Psychasthenia 4.45*** 74.02 9.12 0.44

Schizophrenia 25.24*** 96.56 10.63 2.50

Hypomania -2.64** 66.67 12.73 0.27

Socialintroversion -8.50*** 59.68 12.27 0.84 Note.df(101);test-value:T=70.

**p<.01;***p<.001.

Table8 Comparisonoftheprevalenceofclinicalcasesin psychiatricprisoninmateswiththeprobabilityexpectedfor thenormativepopulation.

Scale Po Z OR

Hypochondriasis .922 64.9*** 46.1

Depression .578 41.6*** 28.9

Hysteria .804 56.4*** 40.2

Psychopathicdeviate .304 20.4*** 15.2

Paranoia .902 63.5*** 45.1

Psychasthenia .735 51.4*** 36.8

Schizophrenia .1 70.5*** 50.0

Hypomania .402 27.5*** 20.1

Socialintroversion .284 19.0*** 14.2

Note.N=102.Po=Proportionofpathologyobservedinthepsy- chiatricprisoninmates;test-value=.02(T70).

*** p<.001.

the standard clinical scales with the decision criterion for clinical cases (test-value = T70), informed of the diagnosticimpression ofclinicalcases(T>70)inhypochon- driasis (excessively worried about health), conversion hysteria(somatization),paranoia,psychasthenia(obsessive- compulsive disorder, and generalized anxiety and stress), schizophrenia, and depression (T = 70). In contrast, the population of non-psychiatric inmates suffered from psy- chopathic deviation (i.e., antisocial), hypomania (bipolar disorder,manic),andsocialintroversion(introversion,gen- eral subjective distress and negative affect). Strikingly, this population did not suffer from antisocial personal- itydisorder, thus chronicity ofdelinquency wasnottobe expected.

The prevalence of diagnostic impression of disorders (see Table 8) was significantly high with a more than large effect sizes (OR>20, that is, >1.5SD) on all the scales, particularly in the psychotic dyad, paranoia and schizophrenia,thatthelawofprecedencerelatestomen- talincompetence,with90.2%,and100%classificationrates, respectively.

Discussion

Fromtheresults ofthis studywe maydraw thefollowing conclusions.

Total invalidity of the protocol. No cases of out- liers, totally random patterns of responses or extremely acquiescent responses were found in the responses of non-psychiatric prison inmates. Moreover, psychiatric prison inmates who are in sufficient cognitive conditions to be evaluated at the time of the evaluation, can be evaluatedwiththisinstrument(Greene,2011).

Analysisoftheconsistencyofresponses.Theprotocolsof thisstudywereconsistent.Theresultsoftheresponsesof psychiatricprisoninmatesshowednosystematictendency of responses in atrue or falsedirection (TRIN). Likewise, psychiatricprisoninmatesdidnotexhibitapatternofran- domresponses(VRIN).Inshort,theresponsesofpsychiatric prison inmates were consistent. Similarly, the responses of people instructed to malinger (Arce, Pampillón, &

Fari˜na,2002;Arceetal.,2006,2009)werealsoconsistent.

However,theexplanationforbothisgroundedondifferent assumptions: the honest responses of psychiatric prison inmates and clinical populations, and the adoption of a response strategy sensitive tothe content of malingering items(Greene,2011),thatis,theyevaluateifthecontent is favourable or unfavourable for the malingering of a psychopathologicalprofile.

Analysisofchangeinresponsestyle.Inpsychiatricprison inmates, a significant andeven acute change in response stylewasobservedontheF-Fbindex(Fwaslocatedinthe first 370 items, and Fb from 370 onwards), suggesting it wasanindicatorofinconsistency.However,thisassumption istheoreticallyflawedandcannotbesubstantiatedbythe datagiventhatFandFbmeasuredifferentconstructs,thus onecannotdeterminefromthediscrepanciesbetweenboth whichindividualshavechangedtheirresponsestyle.Avery elevated score onFis indicateof very severepsychologi- calsymptoms,thatis,positives(i.e.,hallucinationsand/or delusions)thatareinfrequentintheclinicalpopulation,but notsointheprisonclinical recordsreviewedin thisstudy (the antecedents, psychiatric diagnosis, and legal rulings validatethepresenceofthesesymptoms),inthatveryhigh scoresontheFbwererelatedtodepressivethoughts,sui- cidalideation,andotherrelatedsymptoms(Greene,2011).

Inshort,thechangeinresponsestyleismoreapparentthan realgiventhatthescalesinvolveddonotmeasurethesame construct.Moreover,empiricalfindingsrevealthatthisindex requires thecombination of VRIN inordertobeeffective for detecting random responses. Nevertheless, VRIN vali- datedallof theprotocolsofthepopulation ofpsychiatric prisoninmates.Inanycase,incrementalvalidityofthiscom- bination isminimum(Greene,2011).Bearingin mindthat a change in response style does not imply inconsistency, whichmaybeobservedinpopulationsofpsychiatricprison inmates,butnotinmalingerers,norinthegeneralclinical population(Butcheretal.,1989,2001;Greene,2008),the corroborationofthischangeisapositiveindicatorofhonest responses.

Measuresofoverreporting.Thescalesandindexesmea- suringoverreporting (i.e.,F,K,Fb,F-K,Fp, Ds,andFBS), classified, in comparisontothe clinical population, a sig- nificantly high number of psychiatric prison inmates as overreporters.Moreover,thisclassificationhadanaccumu- lative effect (mode = 5). Thus, the means for the prison inmatepopulationwereintheregionofoverreporting,with theexception ofthe FBSandKscalesthatfell withinthe

(7)

region of normality. In terms of suggested overreporting strategies,theFfamily(i.e.,F,Fb,F-K,andFp),withthe underlyingassumptionthatmalingeringisrelatedtounusual symptoms,inparticularpsychoticones,wasextremelysen- sitive in this population with overreporting classification ratesrangingfrom58%fortheFb,morethan90%fortheFp andF-K,toa100%oftheF.Inparticular,theFpsuggested thepresenceofastrategyformalingeringofraresymptoms i.e.,infrequentlyinformedsymptoms(e.g.,<.05)inclini- calpopulation;andtheF,Fb, andF-Kscalesof quasi-rare symptomsi.e.,infrequentlyinformedsymptomsinthenor- mativepopulation.However,thesesymptomsthatappearin thediagnosisandmedicalrecordswere,inthiscase,mark- ers of genuine severe mentallydisordered cases, and not malingering.TheDsScale,withameanintheregionofover- reporting,andsignificantlyhighoverreportingclassification ratesuggestedtheuseofamalingeringstrategy‘‘erroneous stereotypes’’i.e.,endorsingsymptomsnotendorsedbythe normal clinical population. Finally, the means for the K Scales(lowscoresindicatedexaggerationofproblems),and theFBS(relatedtothemalingeringofpersonalinjury)were within normality, with significant overreporting classifica- tionrates,butwithasmallereffectsizesthanpreviousones.

Succinctly,toagreaterorlesserextent,allofthemeasures ofoverreportingexhibitedsignificantratesclassifyingpsy- chiatricprisoninmatesasoverreportersinhonestresponse conditionsi.e.,theywouldbefalsepositives(identifyinga genuinepatientasamalingerer).Asthiseffectisaccumula- tive,thesescalesandindexesforevaluatingoverreporting arenotvalidforthispurposeinthecontextofpsychiatric prisoninmates.

Measuresofunderreporting.Themeansforunderreport- ing among psychiatric prison inmates were in the region of normality, which was surprising since it is the oppo- site to malingering (hypothesis to be contrasted in this case in forensic practice), and severe psychopathological injury,theL,Wsd,andOdscalessignificantlyclassifiedmore underreporters than was initially expected. These three measurement scales were part of the ‘‘Impression Man- agement’’ factor of Paulhus (1984) model that embraces the conscious and favourable manipulation of self-image, versusthe unconsciousSelf-DeceptiveEnhancement (K,F- K, So, and S scales). Conscious underreporting markers werenotobservedamongoverreportersasintentionalityis requiredforthedistortionofresponse,whichiscontradic- torytooverreporting(Arceetal.,2002,2006,2009).Thus, thedetectionofconsciousunderreportingmarkers,witha prevalenceofaround80%,wouldbeinlinewiththeforensic techniqueoftheGlobalEvaluationSystem(Arce&Fari˜na, 2005), apositive nooverreportingcriterion validating the protocolobtained.

The standard and additional validity markers. The commercialversionoftheMMPI-2onlyincludesthestandard validity scales and indexes (i.e., L, F, K, F-K, and Fb), thus the analysisof overreporting wouldrest on F,K,Fb, andF-K,andunderreportingonL,K,andF-K.Nonetheless andunder thesecircumstances, the hypothesis of overre- porting was stronglysuggested (100% of cases in F; more than90%ofF-K,andnearly60%inK),whereasfor under- reporting this only occurred in L, given that K and F-K werenotsensitivetounderreport.Thisannulstheefficacy of the resulting forensic technique sinceit maintains the

hypothesis ofoverreporting, and underminesthe value of the underreporting markers as a positive criterion: only L was sensitive to underreporting, leading to a lack of intermeasure consistency (K and F-K were not sensitive).

Notwithstanding, taking all of the original and additional markersas a whole,the populationsof psychiatric prison inmates, andnon-psychiatric prison inmatesin the prison admissionstagewerevastlydifferentintermsoftheover- reportingmarkersi.e.,stronglypresentinthepopulationof psychiatricprisoninmates(mode=5),andstronglyabsentin seconddegreeprisoninmatesintheprisonadmissionstage (mode = 0). From all of these, a forensic technique for discriminating between both populations, that eliminates the probability of false positives (classification of honest responsesasoverreporting)inlinewithforensicstandards, couldbedriven.

Diagnostic impression. The most prevalent diagnostic impression (p = 1) of a mental condition among psychi- atric prison inmates on the standard clinical scales was schizophrenia followed by paranoia, which was concord- ant (convergent validity) with the diagnosis, psychiatric records,andcourtrulingsonmentallyincompetenceowing toschizophreniaorparanoiddelusiondisorder.Profilescor- respondingtoa‘‘psychoticV’’configurationwereobserved, thatis,extremelyhigh scores(T>80)in schizophreniaand paranoia,andlowscoresinpsychasthenia,characteristicof individualswithdisordered thinking, delusions, and hallu- cinations,apsychopathology thatlegallydefines aperson as mentally incompetent (Arce et al., 2002). Thus, the main diagnostic impression of an incapacitating psychotic disorder on the MMPI-2 was validated. It is worth noting the‘‘psychosomatic v’’configuration(higherhypochondri- asisand hysteria than depression) implied the population ofpsychiatricprisoninmatesconvertedpsychologicalprob- lemsintophysicalsymptoms,chronicpsychopathology,and resistancetotreatment(e.g., minimizingproblems, resis- tancetochange).Duetotheminimizationofsymptoms,this configurationwasassociated tohigh scores ontheunder- reporting scales, and in particular the L scale (Greene, 2011).

Psychiatricprisoninmatesandantisocialbehaviour.Psy- chopathy(Psychopathic DeviationScale), understood asa permanentpatternof antisocialbehaviour, wasnot adis- tinctivecharacteristicofthe psychiatricprisonpopulation incomparisontootherclinicalpopulations.Thus,therela- tionshipbetweenantisocialanddelinquentbehaviour,and psychiatricprisoninmateswasweak.

This study is subject to several limitations. First, the results of this study are not generalizable to other populations of psychiatric prison inmates as cognoscitive incompetent from giving informedconsent or being eval- uatedweregroundsforexclusionfromthisstudy.Second, thepsychometric instrument hasnodiagnostic value, but providesdiagnostic impressionsof mental health, and for establishing a differentialdiagnosis of overreporting. The forensicpsychologistmustcorroboratetheseimpressionsof mentalhealthwiththeclinicalinterview,behaviouralobser- vation, and other tests (Vilari˜no, Arce, & Fari˜na, 2013).

Third,theresults andinferencesare notgeneralizable to instrumentsother thantheMMPI-2. Fourth, thestatistical significanceandpowerdonotimplyanyintrinsicvalidityin judicialcontext.

(8)

Funding

This research was funded by the Project with refer- enceEDU2011-24561(Dirección GeneraldeInvestigación y GestióndelPlanNacionaldeI+D+i;SpanishMinistryofSci- enceandInnovation).

References

AmericanPsychiatricAssociation.(2013).Diagnosticandstatistical manualofmentaldisorders(5thed.).Washington:DC:Author.

Arbisi, P., & Ben-Porath, Y. (1995). An MMPI-2 infrequent responsescaleforusewithpsychopathologicalpopulations:The Infrequency-PsychopathologyScale F(p).Psychological Assess- ment,7,424---431.

Arce,R.,&Fari˜na,F.(2005).Peritaciónpsicológicadelacredibili- daddeltestimonio,lahuellapsíquicaylasimulación:ElSistema deEvaluaciónGlobal(SEG).PapelesdelPsicólogo,26,59---77.

Arce,R.,Fari˜na,F.,Carballal,A.,&Novo,M.(2006).Evaluación delda˜nomoralenaccidentesdetráfico:Desarrolloyvalidación deunprotocoloparaladeteccióndelasimulación.Psicothema, 18,278---283.

Arce,R.,Fari˜na,F.,Carballal,A.,& Novo,M.(2009).Creacióny validacióndeunprotocolodeevaluaciónforensedelassecuelas psicológicasdelaviolenciadegénero.Psicothema,21,241---247.

Arce,R.,Pampillón,M.C.,&Fari˜na,F.(2002).Desarrolloyeval- uacióndeunprocedimientoempíricoparaladeteccióndela simulacióndeenajenaciónmentalenelcontextolegal.Anuario dePsicología,33,385---408.

Baer,R.A.,&Miller,J.(2002).Underreportingofpsychopathology ontheMMPI-2: Ameta-analytic review. Psychological Assess- ment,14,16---26.

Butcher,J.N.,Dahlstrom,W.G.,Graham,J.R.,Tellegen,A.M.,

&Kaemmer,B.(1989).MMPI-2:Manualforadministrationand scoring.Minneapolis,MN:UniversityofMinnesotaPress.

Butcher, J. N., Graham, J. R., Ben-Porath, Y. S., Tellegen, A., Dahlstrom,W.G.,&Kaemmer,B.(2001).MinnesotaMultipha- sicPersonalityInventory----2:Manualforadministration,scoring and interpretation(Rev.ed.). Minneapolis,MN: Universityof MinnesotaPress.

Butcher,J.,&Han,K.(1995).DevelopmentofanMMPI-2scaleto assessthepresentationofselfinasuperlativemanner:TheS scale.InJ.N.Butcher,&C.D.Spielberger(Eds.),Advancesin personalityassessment(Vol.10(pp.25---50).Hillsdale:NJ:LEA.

Edwards,A. (1957).Thesocialdesirabilityinpersonalityassess- mentandresearch.NewYork:Dryden.

Fari˜na,F.,Arce,R.,Vilari˜no,M.,&Novo,M.(2014).Assessmentof thestandardforensicprocedurefortheevaluationofpsycho- logicalinjuryinintimate-partnerviolence.SpanishJournal of Psychology,17,E32.

Gough,H.G.(1954).Somecommonmisperceptionsaboutneuroti- cism.JournalofConsultingPsychology,18,287---292.

Graham, J. R. (2011). MMPI-2: Assessing personality and psy- chopathology(5thed.).NewYork:OxfordUniversityPress.

Greene, R.L. (2008). Malingering and defensiveness on the MMPI-2. In R. Rogers (Ed.), Clinical assessment of malin- gering and deception (3th ed., pp. 159-181). New York:

Guilford.

Greene,R.L.(2011).TheMMPI-2/MMPI-2-RF:Aninterpretiveman- ual(3thed.).Boston:MA:Allyn&Bacon.

Hathaway,S.R.,&McKinley,J.C.(1999).InventarioMultifásicode PersonalidaddeMinnesota-2.Madrid:TEA:Manual.

Lees-Haley,P.R.,English,L.T.,&Glenn,W.J.(1991).AFakeBad ScaleontheMMPI-2forpersonalinjuryclaimants.Psychological Reports,68,203---210.

McDermott, B. E. (2012). Psychological testing and the assess- mentofmalingering.PsychiatricClinicsofNorthAmerica,35, 855---876.

Nichols,D.S.,&Greene,F.L.(1991,March).Newmeasuresfordis- simulationontheMMPI/MMPI-2.Paperpresentedatthe26th AnnualSymposium onRecentDevelopments intheUseofthe MMPI,St.PetersburgBeach,FL.

Palmer, A., Borrás, C., Pérez-Pareja, J., Sesé, A., & Vilari˜no, M. (2013). Are patients with chronic pain and fibromyalgia correctly classified by MMPI-2 validity scales and indexes?

European Journalof PsychologyAppliedto LegalContext,5, 123---129.

Paulhus,D.L.(1984).Two-componentmodelsofsociallydesirable responding.Journalof Personalityand SocialPsychology, 46, 598---609.

Rogers,R.(2008).Currentstatusofclinicalmethods.InR.Rogers (Ed.),Clinicalassessmentof malingeringanddeception(3th, pp.391---410).NewYork:Guilford.

Rogers,R.,Sewell,K.W.,Martin,M.A.,&Vitacco,M.J.(2003).

Detectionoffeignedmentaldisorders:Ameta-analysisofthe MMPI-2andmalingering.Assessment,10,160---177.

Vilari˜no,M., Arce,F.,&Fari˜na,F.(2013).Forensic-clinical inter- view:Reliabilityandvalidityfortheevaluationofpsychological injury.EuropeanJournalofPsychologyAppliedtoLegalContext, 5,1---21.

Wiggins,J.S.(1959).InterrelationshipsamongMMPImeasuresof dissimulationunderstandardandsocialdesirabilityinstructions.

JournalofConsultingPsychology,23,419---427.

Figure

Updating...

References

Related subjects :