Traumatic Brain Injury and Malingering: A Systematic Review

Objective: The relevance of detecting feigning on neuropsychological evaluations of traumatic brain injury (TBI) patients has been increasing as studies alert to the tendency to overreport symptoms of TBI for attaining different kinds of compensation. Considering this, the main goal of this study was to explore which instruments and tasks have been used to evaluate feigning of TBI-related neuropsychological deficits malingering and whether these instruments effectively detect instructed feigning of this symptomatology when compared to bona fide TBI patients. Method: A systematic review supported by the Preferred Reporting Items for Systematic review and Meta-Analysis for Protocols and Cochrane guidelines was performed. Thirty-one studies focused on examining the differences between instructed malingerers and TBI patients were included. Results: The results show that the tasks used to assess malingering are diverse and not only specifically designed for this purpose. The most frequently used instrument was the Test of Memory Malingering and other instruments or tasks that involve some aspect of memory functioning. Additionally, it was also found a significant difference between the performance of the instructed malingerers and TBI patients across all the included studies, with a general tendency of malingerers to perform worse and report more symptoms than patients. Conclusion: This review highlights the effectiveness of Symptom and Performance Validity Tests in evaluating the overall credibility of reported TBI-related symptomatology, which is increased by combining two or more instruments or tasks.