Malingering and Executive Dysfunction in Trauma Patients: Diagnostic Challenges with the M-FAST

Many people who have been exposed to trauma apply to psychiatry and forensic medicine outpatient clinics for treatment and forensic reports. These people may exaggerate their psychiatric symptoms consciously or unconsciously for various reasons. It is imperative for clinicians to comprehend this condition in the context of treatment regulation and forensic processes. This study aimed to evaluate the relationship between the Miller Forensic Assessment of Symptoms Test (M-FAST) score and clinical, sociodemographic variables and Stroop test and Block Design Test (BDT).

The present study was conducted on a sample of patients over the age of 18 who had applied to the forensic medicine and psychiatry outpatient clinics for trauma-related reasons and had accepted to participate in the study. The patients were asked to complete Symptom Checklist-90 (SCL-90). M-FAST, The Stroop Test, and BDT were administered. The Stroop test and BDT were administered to assess the correlation between cognitive abilities and the M-FAST score. Those with an M-FAST score of seven or higher were considered possible malingerers. Clinician who examined the patient decided whether they were a malingerer, without knowing their M-FAST score.

All clinical and sociodemographic variables were divided into two groups (present or absent) and compared according to M-FAST scores. Prevalence of possible malingerer was determined to be 33%. Possible malingerer were more likely to be male, have psychiatric comorbidities, and show poorer executive and visuospatial functioning. M-FAST scores positively correlated with psychopathology and Stroop interference, and negatively with BDT performance. Regression and ROC analyses supported the M-FAST's fair diagnostic accuracy (AUC=0.79).

Unlike prior studies, our research emphasizes how cognitive functioning impacts malingering assessment in trauma-affected, treatment-seeking. To the best of our knowledge, this is the first study to utilize M-FAST in patients seeking treatment for reasons other than forensic reasons.