Holly A. Miller, Ph.D.
College of Criminal Justice
Sam Houston State University
 Malingering

Theory and assessment
 Miller


Development of the M-FAST
Utility of the M-FAST





Forensic Assessment of Symptoms Test
Brief overview of studies
Administration and scoring of the M-FAST
Practice administration
Interpretation
Questions
 The

DSM-IV-TR defines malingering as:
Intentional production of false or grossly
exaggerated physical or psychological symptoms,
motivated by external incentives (APA, 2000)
 Why
might someone malinger?
 Prevalence of malingering


Around 8% of general evaluations
Around 20% of forensic evaluations

Miller, 2000; Rogers & Cruise, 2000; Rogers, Salekin,
Sewell, & Goldstein, 1996
 When
to assess for malingering
 Rogers suggests under these circumstances




Atypical presentation of symptoms
Unusually high number of unusual or obvious
symptoms
Nonselective endorsement of symptoms
Discrepancies between reported and documented
history of mental illness
 Why

DSM criteria





not just use clinical judgment?
Marked discrepancy between reported impairment and
objective findings
Lack of cooperation during evaluation or treatment
Medico-legal context presentation
Presence of APD
What research reports on accuracy of clinical
judgment


Utilizing DSM criteria results in high false-positive rates
Studies strongly support that objective assessment
instruments are significantly more accurate than clinical
judgment (Miller, 2005; Rogers 1984; Ziskin, 1984)
 Miller,
H. A. (2005). The Miller-Forensic
Assessment of Symptoms Test (M-FAST): Test
generalizability and utility across race,
literacy, and clinical opinion. Criminal Justice
& Behavior, 32 (6), 591-611.

Study 1 – initial M-FAST items (79 items)



280 forensic patients; 5 psychiatrists; 8 psychologists
M-FAST; SIRS; Mtest; MMPI-2
Study 2 – final M-FAST (25 items)


50 forensic patients; 5 psychiatrists; 8 psychologists
M-FAST; SIRS; Mtest; MMPI-2
 Study
1 Clinical opinion v. M-FAST results
 Psychiatrist Opinion
ROC Curve
1.00


AUC = .72 (SE = .05)
CI = .62 - .81
19 FP; 17 FN
. 75
. 50
Se n sitivity

. 25
0.00
0.00
. 25
. 50
. 75
1.00
. 75
1.00
1 - S pec ifi ci ty
 Psychologist
Opinion
D iagonal s egments ar e pr oduc ed by ti es .
ROC Curve
1.00

 M-FAST


. 75
. 50
Se n sitivity

AUC = .80 (SE = .04)
CI = .72 - .88
15 FP; 11 FN
. 25
0.00
0.00
(79 items)
. 25
. 50
1 - Speci fic ity
D iagonal s egm ent s ar e pr oduc ed by t ies .
ROC Curve
AUC = .89 (SE = .02)
CI = .85 - .93
1.00
. 75
. 50
Se n sitivity

. 25
0.00
0.00
. 25
. 50
1 - Speci fic ity
D iagonal s egm ent s ar e pr oduc ed by t ies .
. 75
1.00
 Study
2 Clinical opinion v. M-FAST results
 Psychiatrists
R O C - P s y c h ia tris ts



AUC = .65 (SE = .09)
CI = .47 - .83
7 FP; 7 FN
 Psychologists



AUC = .73 (SE = .08)
CI = .57 - .89
9 FP; 4 FN
 M-FAST



(final version)
AUC = .95 (SE = .03)
CI = .88 – 1.00
6 FP; 1 FN
1 .0 0
.7 5
.5 0
.2 5
0 .0 0
0 .0 0
.2 5
.5 0
.7 5
1 .0 0
R O C - P s y c h o lo g is ts
1 .0 0
.7 5
.5 0
.2 5
0 .0 0
0 .0 0
.2 5
.5 0
.7 5
1 .0 0
R O C – M -F A S T
1 .0
0
.7 5
.5 0
.2 5
0 .0
0
0 .0
0
.2 5
.5 0
.7 5
1 .0
0
 How

Previous research has indicated important areas
of assessment:



Certain response styles
Certain interview strategies
Several instruments include assessment of
response styles or were specifically designed to
assess malingering




to catch a malingerer
MMPI-2
PAI
SIRS
However, there remains a need for a brief screen
for malingered mental illness
 M-FAST
items were developed to
operationalize the response styles and
interview strategies that have been validated
for identifying individuals who are malingering





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Reported vs Observed symptoms (RO)
Extreme Symptomatology (ES)
Rare Combinations (RC)
Unusual Hallucinations (UH)
Unusual Symptom Course (USC)
Negative Image (NI)
Suggestibility (S)
 M-FAST
is a structured interview of 25 items
representing the “proven” detection strategies
 Administration is approximately 5-10 minutes
 Scoring is approximately 10 minutes
 Does not require the ability to read (examinee)
 Has been translated into Korean and Spanish
 M-FAST was developed using both knowngroup and simulation studies
 Materials
include manual and 8-page
interview booklet
 Validated on people 18 yrs and older
 Validated with different ethnic/race groups
 Validated across gender
 Validated with varied populations



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In prison
On probation
In forensic hospital
In civil hospital
Outpatient disability assessment
 Appropriate




Malingered psychopathology (not neuro)
Examinee must be able to understand items
Adults 18 yrs or older
Screening instrument and was not developed to
be the sole determinate of malingered mental
illness
 Professional

populations and limitations
requirements
Mental health clinician with formal training in
diagnostic interviewing and assessment
 M-FAST
should be preceded by a clinical
interview

To gather both symptom information and
observable behavior (RO assessment help)
 Read
aloud instructions for administration to
client
 Suggestibility item

1st response dictates how you ask last part of item
 Read
items and possible responses of each item
 May repeat once – but offer no explanation
 With
partner, practice administration
 Partner role play a malingerer

Want to appear mentally ill, without elevating
M-FAST score
 Then
reverse roles
 Scoring
instructions provided on last page of
interview booklet
 Score individual items
 Score scales
 If more than 2 items missing, not considered
valid administration
 Malingering
is distinct from most forms of
psychopathology; however the presence of
malingering does not rule out a psychiatric
disorder
 Significant consequences for malingering
diagnosis
 Choosing of a cut score for M-FAST


More acceptable to have false positives than
false negatives
Cut score of 6 utilized

Three levels

Total scale



Scales

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Provides an estimate of the likelihood that the examinee is
malingering
Interpretive statement: The examinee’s total score on the MFAST was significantly elevated, indicating that this
individual may be malingering mental illness.
Provides information on how the individual is malingering
Can make interpretive statements about scale elevations,
but utilize total score for overall assessment
Each scale has own “cut score”
Suggestibility item (scale)
Manual provides interpretative statement examples
Items
 Next

step
Further malingering assessment is warranted if
client elevated M-FAST
 Competency



to stand trial – forensic inpatients
Jackson, R., Rogers, R., Sewell, K. W. (2005). Forensic
applications of the M-FAST: Screening for feigned disorders
in competency to stand trial evaluations. Law and Human
Behavior, 29(2), 199-210.
Vitacco, M. J., Rogers, R., Gabel, J., Munizza, J. (2007).
An evaluation of malingering screens with competency to
stand trial patients: A known-groups comparison. Law and
Human Behavior, 31(3), 249-260.
Miller, H. A. (2004). Examining the use of the M-FAST with
criminal defendants incompetent to stand trial.
International Journal of Offender Therapy and
Comparative Criminology, 48(3), 268-280.
 Validity
Studies
Vitacco, M. J., Jackson, R. L., Rogers, R., Neumann, C. S., Miller,
H. A. Gabel, J. (2008). Detection strategies for malingering with
the M-FAST: A confirmatory factor analysis of its underlying
dimensions. Assessment, 15(1), 97-103.
 Miller, H. A. (2005). The Miller Forensic Assessment of Symptoms
Test (M-FAST): Test generalizability and utility across race,
literacy, and clinical opinion. Criminal Justice and Behavior, 32(6),
591-611.
 Veazey, C. H., Hays, J. R., Wagner, A. L., & Miller, H. A. (2005).
Validity of the Miller Forensic Assessment of Symptoms Test in
psychiatric inpatients. Psychological Reports, 96(3), 771-774.
 Guy, L. S., & Miller, H. A. (2004). Screening for malingered
psychopathology in a correctional setting: Utility of the Miller
Forensic Assessment of Symptoms Test (M-FAST). Criminal Justice
and Behavior, 31(6), 695-716.

 Civil

forensic settings
Alwes, Y. R., Clark, J. A., Berry, T. R., Granacher,
R. P. (2008). Screening for feigning in a civil
forensic setting. Journal of Clinical and
Experimental Neuropsychology, 30(2), 1-8.
 Diagnostic-specific
malingering assessment
Messer, J. M., & Fremouw, W. J. (2007). Detecting malingered
posttraumatic stress disorder using Morel Emotional Numbing TestRevised and the Miller Forensic Assessment of Symptoms Test (MFAST). Journal of Forensic Psychology Practice, 7(3), 33-57.
 Guriel-Tennant, J., & Fremouw, W. J. (2006). Impact of trauma
history and coaching on malingering of posttraumatic stress
disorder using the PAI, TSI, and M-FAST. Journal of Forensic
Psychiatry & Psychology, 17(4), 577-592.
 Guy, L. S., Kwartner, P. P., & Miller, H. A. (2006). Investigating the
M-FAST: Psychometric properties and utility to detect diagnostic
specific malingering. Behavioral Sciences & the Law, 24(5), 687702.
 Guriel, J., Yanez, T., Fremouw, W. J., Shreve-Neiger, A., Ware, L.,
Filcheck, H., & Farr, C. (2004). Impact on coaching on malingered
posttraumatic stress symptoms on the M-FAST and TSI. Journal of
Forensic Psychology Practice, 4(2), 37-56.

Holly A. Miller, Ph.D.
Assistant Dean of Undergraduate Programs
Associate Professor
College of Criminal Justice
Sam Houston State University
Huntsville, Texas 77341-2296
936-294-1686; hmiller@shsu.edu