Faking Mild Traumatic Brain Injury

In the October, 1996, issue of the Soft-Tissue Review, we reported on a study¹ that found that college students could not convincingly mimic the symptom profile for whiplash injuries. A new study² examined the ability of another group of college students to malinger either multiple sclerosis (MS) or mild traumatic brain injury (MTBI).

The authors effectively summarize the problem of malingering in their introduction:

"In recent years, researchers have been examining the ability of neuropsychologists to detect malingering. The detection of malingering is of obvious importance in the context of the limited resources available for those in need of medical and rehabilitative services. Its significance also is evident in the growing number of legal claims that follow injuries in the workplace, moving vehicle accidents, and other compensable circumstances. Clinicians are increasingly being called upon to make judgments regarding the effort and performance of litigating clients." 2

In this current study, 69 college students were divided into three groups: a group that was to malinger MS; a group that was to fake MTBI; and a control group that was asked to simply take the tests without faking any condition.

The malingering students were in turn divided into two more groups: one set of students were given an informational packet about their "condition," and another group given no information. All of the subjects were given five minutes to plan their strategy for faking their condition.

All of the students were then run through a battery of neuropsychological tests used to measure MS and MTBI in legitimate patients.

Upon studying the resulting data, the researchers reported some interesting findings:

There was no significant difference between the students who were informed or uninformed about the condition they were to fake. Being informed about the condition did not assist them in malingering.
There was no significant difference between the MS and MTBI group of students—they all faked their conditions in the same manner, with no distinction for condition. For instance, both MS and MTBI have particular patterns of neuropsychological findings: "On measures of conceptual reasoning, the literature predicts significant MS population deficits but little or no deficits in the mild TBI population...On measures of span memory/attention, the literature predicts difficulties in the mild TBI groups yet no impairments observed in the MS groups..." None of these distinctions or patterns were found in the students asked to malinger these conditions.
The students consistently exaggerated the possible dysfunction and number of symptoms, as compared to what a group of physicians considered appropriate for the particular condition.

Wallis BJ, Bogduk N. Faking a profile: can na�ve subjects simulate whiplash responses? Pain 1996;66:223-227.
Klimczak NJ, Donovick PJ, Burright R. The malingering of multiple sclerosis and mild traumatic brain injury. Brain Injury 1997;11(5):343-352.

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