Forced-choice testing provides evidence of malingering

Assessment of motivation using forced-choice testing is described and illustrated with case reports. Two injured workers with protracted disability complained of numbness and loss of sensation in their fingers. Each patient received a forced-choice, multiple-choice finger graphesthesia test, with a 0.5 probability of guessing correctly on each item. Both patients performed significantly below the chance level, indicating that they had deliberately provided wrong answers. One patient did not exaggerate until the difficulty level of the task was enhanced. Forced-choice testing, particularly with enhancement of difficulty levels, is proposed as a specific measure to detect faked poor performance. Identification of malingering reduces the risk of iatrogenic damage. The subjective complaints of malingerers must be viewed with skepticism.