Skip to main content

Advertisement

Log in

Cutoff Scores for the Morel Emotional Numbing Test for PTSD: Considerations for Use in VA Mental Health Examinations

  • Published:
Psychological Injury and Law Aims and scope Submit manuscript

Abstract

The use of cutoff scores on symptom validity measures has been applied to determine the authenticity of posttraumatic stress disorder (PTSD) in U.S. Department of Veterans Affairs compensation and pension examinations. This approach is controversial due to variations in the interpretation and application of cutoff scores from symptom validity testing. In response to the proposal that the cutoff score on the Morel Emotional Numbing Test for Posttraumatic Stress Disorder (MENT) be increased, the diagnostic accuracy of the standard cutting score for identifying simulated symptoms of PTSD was compared to the proposed alternate cutoff score. The results of decision matrix tables (true positive, true negative, false positive, and false negative) comparing the sensitivity and specificity and deriving confidence intervals for the standard cutoff score and proposed alternate cutoff score are presented. In addition, analyses using binomial probability theory to determine whether the outcome of increasing the cutoff score on the MENT meets reasonable standards for types I and II errors are presented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Association, A. P. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Arbisi, P. A., Murdoch, M., Fortier, L., & McNulty, J. (2004). MMPI-2 validity and award of service connection for PTSD during the VA compensation and pension evaluation. Psychological Services, 1(1), 56–67.

    Article  Google Scholar 

  • Bianchini, K. J., Greve, K. W., & Love, J. M. (2003). Definite malingered neurocognitive dysfunction in moderate/severe traumatic brain injury. The Clinical Neuropsychologist, 17(4), 574–580.

    Article  PubMed  Google Scholar 

  • Bush, S. S., Ruff, R. M., Troster, A. I., Barth, J. T., Koffler, S. P., Pliskin, N. H., ... Silver, C. H. (2005). Symptom validity assessment: Practice issues and medical necessity. National Academy of Neuropsychology Policy and Planning Committee. Archives of Clinical Neuropsychology, 20(4), 419–426.

  • Fox, D. D. (2011). Symptom validity test failure indicates invalidity of neuropsychological tests. The Clinical Neuropsychologist, 25(3), 488–495.

    Article  PubMed  Google Scholar 

  • Green, P. (2001). Why clinicians often disagree about the validity of test results. Neuro Rehabilitation, 16, 231–236.

    PubMed  Google Scholar 

  • Green, P. (2007). Spoiled for choice: Making comparisons between forced choice effort tests. In K. Boone (Ed.), Assessment of feigned cognitive impairment: A neuropsychological perspective (pp. 50–77). New York: The Guilford Press.

    Google Scholar 

  • Greve, K. W., Bianchini, K. J., & Ameduri, C. J. (2003). The use of a forced choice test of tactile discrimination in the evaluation of functional sensory loss: A report of 3 cases. Archives of Physical Medicine and Rehabilitation, 84(8), 1233–1236.

    Article  PubMed  Google Scholar 

  • Heilbronner, R. L., Sweet, J. J., Morgan, J. E., Larrabee, G. J., Millis, S. R., & Conference Participants. (2009). American Academy of Clinical Neuropsychology consensus conference statement on the neuropsychological assessment of effort, response bias, and malingering. The Clinical Neuropsychologist, 23, 1093–1129.

    Article  PubMed  Google Scholar 

  • Howe, L. L. (2012). Distinguishing genuine from malingered posttraumatic stress disorder in head injury litigation. In C. R. Reynolds (Ed.), Detection of malingering during head injury litigation (pp. 301–330). New York: Springer.

  • Iverson, G. L. (2003). Detecting malingering in civil forensic evaluations. In A. M. Horton Jr. & L. C. Hartlage (Eds.), Handbook of forensic neuropsychology (pp. 137–177). New York: Springer.

    Google Scholar 

  • Iverson, G. L. (2006). Ethical issues associated with the assessment of exaggeration, poor effort, and malingering. Applied Neuropsychology, 13(2), 77–90.

    Article  PubMed  Google Scholar 

  • Larrabee, G. J. (2012). Performance validity and symptom validity in neuropsychological assessment. Journal of the International Neuropsychological Society, 18, 1–7.

    Google Scholar 

  • Messick, S. (1989). Validity. In R. L. Linn (Ed.), Educational measurement (3rd ed., pp. 13–103). New York: Macmillan.

    Google Scholar 

  • Morel, K. R. (1995). Use of the binomial theorem in detecting fictitious posttraumatic stress disorder. Anxiety Disorders Practice Journal, 2(1), 55–62.

    Google Scholar 

  • Morel, K. R. (1998). Development and preliminary validation of a forced-choice test of response bias for posttraumatic stress disorder. Journal of Personality Assessment, 70(2), 299–314.

    Article  PubMed  Google Scholar 

  • Morel, K. R. (2008). Development of a validity scale for posttraumatic stress disorder: Evidence from simulated malingerers and actual disability claimants. The Journal of Forensic Psychiatry and Psychology, 19(1), 52–63.

    Article  Google Scholar 

  • Morel, K. R. (2012). Manual for the Morel Emotional Numbing Test for Posttraumatic Stress Disorder: Psychometric Properties. (3rd ed. rev.). Las Vegas, NV: Author.

  • Morel, K. R., & Shepherd, B. E. (2008). Developing a symptom validity test for posttraumatic stress disorder: Application of the binomial distribution. Journal of Anxiety Disorders, 22(8), 1297–1302.

    Article  PubMed  Google Scholar 

  • Orme, D. R. (2012). Diagnosing PTSD: Lessons from neuropsychology. Military Psychology, 24(4), 397–413.

    Article  Google Scholar 

  • Resnick, P. J., & Knoll, J. (2005). Faking it: How to detect malingered psychosis. Journal of Family Practice, 4(11), 13–25. Retrieved from http://www.jfponline.com/Pages.asp?AID=2821#bib2

    Google Scholar 

  • Rubenzer, S. (2009). Posttraumatic stress disorder: Assessing response style and malingering. Psychological Injury and Law, 2, 114–142.

    Article  Google Scholar 

  • Singh, G. (2007). Determination of cutoff score for a diagnostic test. The Internet Journal of Laboratory Medicine, 2(1).

  • Wiedmaier, P. (2011). Normative data for three symptom validity tests: The Morel Emotional Numbing Test (MENT), the Structured Inventory of Malingered Symptomatology (SIMS) and the List of Improbable Problems (LIMP). [Schätzung von Normalbefunden fur drei Beschwerden validierungstests: Der Morel Emotional Numbing Test (MENT), der Strukturierte Fragebogen Simulierter Symptome (SFSS) und die List of Improbable Problems (LIMP)]. Germany: Dr. Müller.

  • Williams, J. M., & Jones, K. (2008). Factitious responding and malingered memory disorder. In C. Reynolds (Ed.), The detection of malingering during head injury litigation. New York: Plenum.

    Google Scholar 

  • Worthen, M. D., & Moering, R. G. (2011). A practical guide to conducting VA compensation and pension exams for PTSD and other mental disorders. Psychological Injury and Law, 4(3–4), 187–216.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kenneth R. Morel.

Additional information

Author Note

The recommendations, opinions, or views expressed in this paper are those of the author and do not reflect the official policy, opinions, or beliefs of the Department of Defense, the Department of Veterans Affairs, or the Government of the United States of America. The author developed and owns the proprietary rights to the Morel Emotional Numbing Test for Posttraumatic Stress Disorder (MENT).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Morel, K.R. Cutoff Scores for the Morel Emotional Numbing Test for PTSD: Considerations for Use in VA Mental Health Examinations. Psychol. Inj. and Law 6, 138–143 (2013). https://doi.org/10.1007/s12207-013-9151-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12207-013-9151-1

Keywords

Navigation