Palmer Borras Perez Pareja Sese and Vilarino 2013 investigated the MMPI 2 classification of fibromyalgia FM patients chronic pain patients and normal subjects subjects without a medical condition The main goal was to identify whether patients are properly classified under the MMPI 2 scales and indexes in forensic settings Furthermore the authors sought to investigate whether the responses could differentiate between genuine patients with a medical condition e g chronic pain or FM and a control group As a result of their investigation the authors worked on a new criteria that enables the proper identification of patients A total of 105 subjects completed the Spanish version of the MMPI 2 27 had been diagnosed with fibromyalgia 44 with chronic pain and 34 healthy subjects The majority of participants were female in all groups 88 9 women with FM 86 4 with chronic pain and 91 2 healthy women Patients in the study were diagnosed by professionals in the health services in Spain and were undergoing treatment Healthy patients were selected from Primary Care Services They presented with mild health problems but no pain or other significant problems such as chronic pathology and similar sociodemographic characteristics as the other participants
According to the initial analyses of the results there was a difference between participants group in acquiescence TRIN These results revealed that patients with chronic pain presented a pattern in responses that are more acquiescent In regards to VRIN all groups presented responses suggesting equal means within the normal range The authors concluded that the protocols used to diagnose chronic pain and FM patients are consistent As far as the validity scales group participant responses were statistically significantly different in the F and Fb scales as well as in the F K index Out of all groups the FM group of patients scored higher in these scales On the other hand chronic pain patients scored higher than healthy patients in the FBS and Ds scales In comparison to healthy patients FM patients presented higher scores in the Fp Ds and FBS scales and lower scores in the Dsd scale These results suggest that patients with chronic pain and FM have an inclination towards malingering For further analysis of the results the authors used a case study that followed an identification of forensic criteria per Arce Fariña Carballal and Novo 2006 2009 for what they referred to as the inconsistency study In regards to cooperation with the assessment the case study investigation corroborated with the initial analysis
The inconsistency study further identified greater levels of acquiescence through observed expected OR prevalence equal to 6 8 times for both chronic pain and FM patients in comparison to healthy patients However in a contrast to clinical cases the results e g malingering obtained in this specific study were granted as false positive Although they were considered false positive the authors performed further investigation which demonstrated that 4 cases of FM and in 1 case of chronic pain were in fact true positive fake good cases This final result in the inconsistency study should not be considered the norm as the context of analysis was a clinical and not a forensic one Although the results under the forensic evaluation were considered in the most part false positive a comparison of the results with the normative population showed a higher tendency toward malingering among FM and chronic pain patients than the normative population ORs 10 3 times in the Ds scale and 22 8 times in the FBS scale This was another step in investigation per suggestion of Arce et al 2006 2009 Further analysis demonstrated that FM patients presented greater tendencies than chronic pain patients in comparison to the normative population ORs 24 1 times in the Ds scale and F K indez and 37 1 times in F scale Next the authors were interested in further investigating the positive criteria minimizing false positives using the defensiveness scales and indexes They found a significant greater presentation of cases that would be considered as faking good than what is expected among chronic pain and FM patients in the L Wsd MP and Odecep scales For instance in regards to typical defensiveness
FM patients have greater probability than expected for Wsd ORs 4 4 times Odecep OR 5 9 times Mp 7 4 times and L 9 6 times Not only that but the L Wsd and Mp scales categorized patients as faking good Furthermore at least 13 6 and 3 7 of patients with chronic pain and FM respectively were classified by 4 defensive scales Analysis of the K S and Sd scales identified them as insensitive to the protocols used Limitations of the study included lack of certainty that patients in the study were actual patients suffering from chronic pain or FM the sample size which could impact statistical estimates the limited number of males in the study and due to that the results may not be a representation of male chronic pain and FM patients Furthermore it is not possible to generalize the findings to patients with other medical conditions There are other limitations pertaining to the use and administration of MMPI 2 e g it does not offer diagnoses and because of that this instrument should be used as part of a multi method evaluation and at times a multidisciplinary approach
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