Ruling Out Feigning in a Competency Evaluation
A 35-year-old man is referred for competency to stand trial (CST) evaluation after being charged with aggravated assault. He has a history of bipolar I disorder and cannabis use. During the interview, he is cooperative but vague. He claims he cannot remember the charges, the day of the arrest, or his attorney's name. He says he hears voices 'sometimes' but cannot describe them. On the Inventory of Legal Knowledge (ILK), he scores 12/25, below the recommended cutoff. On the Test of Memory Malingering (TOMM), he scores 45/50 on Trial 1 and 45/50 on Trial 2, which are above the cutoff for valid performance. However, on the Rey-15 Item Memory Test, he recalls only 4 items, which is below the cutoff for possible feigning. He has been observed in the jail talking coherently with other inmates about his case. His attorney reports he is 'playing games.' The prosecution argues he is malingering to avoid trial. The defense argues his bipolar disorder and cannabis use impair his memory.
1. How would you integrate the conflicting validity test results (TOMM passed, Rey-15 failed) and collateral information to form an opinion about feigning? What are the limitations of these instruments?
Read the worked answer
The TOMM and Rey-15 measure different constructs and have different sensitivity/specificity. The TOMM is a forced-choice recognition test with high specificity; passing it suggests adequate effort on that task, but it does not rule out feigning on other domains. The Rey-15 is a free-recall test with a cutoff of 9 or fewer items; recalling 4 is significantly below chance and suggests possible feigning, but it has lower specificity and can be affected by genuine memory impairment. The discrepancy between the two must be understood: the TOMM may be less sensitive to feigning in individuals who are coached or who feign only specific symptoms. The collateral information (coherent jail conversations) strongly suggests he is exaggerating. However, individuals with bipolar disorder can have genuine memory difficulties during mood episodes, and cannabis use can impair memory. The key is that his presentation is inconsistent: he claims he cannot remember his attorney's name but can discuss his case with inmates. This inconsistency is a hallmark of feigning. Also, his vague reports of auditory hallucinations without detail are suspicious. I would not rely solely on test scores; I would conduct a structured interview for malingering (e.g., SIRS-2) and review records. The ILK score of 12/25 is below the cutoff, but the ILK is a measure of legal knowledge, not feigning; low scores can reflect genuine ignorance or cognitive impairment. I would conclude that there is strong evidence of feigning, but I must also consider that his bipolar disorder may be in partial remission and that he may have some genuine memory gaps. The opinion should state that he is likely feigning amnesia and that his competency is probably intact, but recommend a follow-up evaluation when he is stable and possibly a neuropsychological evaluation.
2. What are the ethical and professional standards for conducting a CST evaluation when feigning is suspected, and how would you communicate your findings in the report and to the court?
Read the worked answer
Ethical standards: Maintain objectivity and avoid dual roles. Use multiple sources of data (clinical interview, collateral, records, psychological testing). Be aware of the base rates of feigning in forensic settings (approximately 20-30% in competency evaluations). Do not accuse the defendant of malingering without strong evidence; use neutral language such as 'inconsistent presentation' or 'symptom exaggeration.' The report should include a clear description of the methods, the test results, the limitations, and the rationale for conclusions. Address the ultimate legal question cautiously; in many jurisdictions, the evaluator provides data and an opinion on competency, but the court decides. When feigning is suspected, state that the evaluation may be invalid and that conclusions about competency are limited. Recommend further evaluation if needed. Communicate to the court in writing and, if called, testify impartially. Avoid being swayed by prosecution or defense pressures. Document all contacts and observations. If you believe the defendant is feigning, you may state that the pattern is consistent with feigning but that a definitive conclusion is not possible. Also consider that feigning may be a symptom of a factitious disorder or a genuine attempt to cope. Ensure informed consent and confidentiality limits are explained. Finally, consider the possibility that the defendant's bipolar disorder and cannabis use could genuinely impair his memory, so a repeat evaluation when sober and stable is advisable.