Holly A. Miller, Ph.D.

College of Criminal Justice

Sam Houston State University
 Malingering
Theory and assessment
Miller Forensic Assessment of Symptoms Test
Development of the M-FAST
Utility of the M-FAST
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 not just use clinical judgment?
DSM criteria
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 1.0 0
ROC Curve

AUC = .72 (SE = .05) .75

.50

CI = .62 - .81 .25

Sensitivity
19 FP; 17 FN
0.0 0
0.0 0 .25 .50 .75 1.0 0

1 - Sp e cificity

Psychologist Opinion
D iago nal seg ments are pro duc ed by ti es.

ROC Curve
1.0 0

AUC = .80 (SE = .04) .75

CI = .72 - .88
.50

.25
Sensitivity

15 FP; 11 FN 0.0 0
0.0 0 .25 .50 .75 1.0 0

M-FAST (79 items)

1 - S pe cificity
D iag ona l se gme nts a re p rodu ced by tie s.

ROC Curve

AUC = .89 (SE = .02)

1.0 0

.75

CI = .85 - .93 .50

.25
Sensitivity

0.0 0
0.0 0 .25 .50 .75 1.0 0

1 - S pe cificity
D iag ona l se gme nts a re pro duc ed b y ties .
 Study 2 Clinical opinion v. M-FAST results
Psychiatrists ROC - Psychiatrists

AUC = .65 (SE = .09)

1.00

.75

CI = .47 - .83 .50

7 FP; 7 FN .25

Psychologists
0.00
0.00 .25 .50 .75 1.00

ROC - Psychologists

AUC = .73 (SE = .08)

1.00

CI = .57 - .89
.75

.50

9 FP; 4 FN .25

M-FAST (final version) 0.00

0.00 .25 .50 .75 1.00

AUC = .95 (SE = .03)

ROC M-FAST

1.0
0

CI = .88 1.00
.75

.50

6 FP; 1 FN .25

0.0
0 0.0 .25 .50 .75 1.0
0 0
 How to catch a malingerer
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
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
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 known-
group 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
In prison
On probation
In forensic hospital
In civil hospital
Outpatient disability assessment
 Appropriate populations and limitations
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 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
Provides an estimate of the likelihood that the examinee is
malingering
Interpretive statement: The examinees total score on the M-
FAST was significantly elevated, indicating that this
individual may be malingering mental illness.
Scales
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 Test-
Revised and the Miller Forensic Assessment of Symptoms Test (M-
FAST). 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), 687-
702.
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