Department of Psychology.
Department of Nursing.
Psychol Trauma. 2019 Jul;11(5):513-520. doi: 10.1037/tra0000405. Epub 2018 Sep 13.
Few studies have assessed malingering in individuals with complex trauma and dissociation. This is concerning because these individuals' severe and ranging symptoms are associated with elevations on some, but not all, validity scales that detect symptom exaggeration. Dissociative individuals may experience dissociative amnesia, yet no study to date has examined how to distinguish clinical from malingered amnesia with dissociative samples. The current study examined whether the Test of Memory Malingering (TOMM) can accurately distinguish patients with clinically diagnosed dissociative identity disorder (DID) and simulators coached to imitate DID.
Utility statistics classify individuals' TOMM scores as suggestive of clinical or simulated DID. TOMM scores from 31 patients diagnosed with DID via structured interviews were compared to those of 74 coached DID simulators.
Discriminant analyses found scores from TOMM Trials 1 and 2 and total TOMM scores accurately classified clinical or simulated DID group status. In addition, TOMM Trial 1 demonstrated high specificity (87%) and positive predictive power (94%), as well as moderate sensitivity (78%), negative predictive power (63%), and overall diagnostic power (81%). Despite exposure to DID-specific information, simulators were not able to accurately feign the DID group's TOMM scores, which is inconsistent with the iatrogenic/sociocultural model of DID.
The TOMM shows promise as useful in clinical and forensic contexts to detect memory malingering among DID simulators without sacrificing specificity. Accurate distinction between genuine and feigned complex trauma-related symptoms, including dissociative memory, is integral to the accurate diagnosis of traumatized populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
很少有研究评估过复杂创伤和分离患者的伪装。这令人担忧，因为这些个体严重而广泛的症状与一些但不是所有检测症状夸大的效度量表的升高有关。分离个体可能会经历分离性遗忘，但迄今为止尚无研究探讨如何在分离样本中区分临床性和伪装性遗忘。本研究检验了记忆欺骗测验（TOMM）是否可以准确区分经临床诊断的分离性身份障碍（DID）患者和接受指导模仿 DID 的模拟者。
效用统计将个体的 TOMM 分数归类为提示临床或模拟 DID。通过结构化访谈诊断为 DID 的 31 名患者的 TOMM 分数与 74 名接受指导的 DID 模拟者的分数进行了比较。
判别分析发现，TOMM 试验 1 和 2的分数以及总 TOMM 分数准确地分类了临床或模拟 DID 组的状态。此外，TOMM 试验 1 表现出高特异性（87%）和阳性预测值（94%），以及中等敏感性（78%）、阴性预测值（63%）和整体诊断能力（81%）。尽管接触了 DID 特异性信息，但模拟者无法准确地模仿 DID 组的 TOMM 分数，这与 DID 的医源性/社会文化模型不一致。
TOMM 有望在临床和法医环境中有用，可在不牺牲特异性的情况下检测 DID 模拟者的记忆欺骗。准确区分真实和伪装的与复杂创伤相关的症状，包括分离性记忆，是准确诊断创伤人群的关键。
