Malingering Traumatic Brain Injury: Current Issues and Caveats in Assessment and Classification
An estimated 2 million individuals seek medical attention every year as the result of a closed head injury (Kraus & Sorenson, 1994). Because accidents (e.g., falls, motor vehicle accidents) account for approximately 50% of all head traumas, it is not surprising that many patients present not only for evaluation and treatment but also to a personal injury attorney for possible assistance in securing financial compensation. Given today’s litigious society, opportunity, motive, and lack of consequences for frivolous lawsuits provide an impetus for malingering. The lure of millions of dollars awarded by the courts for lost cognitive abilities may lead litigants to “enhance” deficits related to their injuries. Of course, for genuine impairments, large awards are not unreasonable. For example, West and Knowles (1991) reported that for midcareer males without a college education who are unable to return to work, loss of earnings alone typically exceeds half a million dollars. As a result of these various factors, and coupled with the observation that brain injuries are a nonobvious cause of disability (Gouvier, Steiner, Jackson, Schlater, & Rain, 1991), closed head injury is the most common neuropsychological syndrome feigned (Haines & Norris, 1995).