title: The Mild Brain Injury Atypical Symptoms (mBIAS) scale in a mixed clinical sample.
abstract: BACKGROUND
  The Mild Brain Injury Atypical Symptoms (mBIAS) scale was developed as a symptom validity test (SVT) for use with patients following mild traumatic brain injury. This study was the first to examine the clinical utility of the mBIAS in a mixed clinical sample presenting to a Department of Veterans Affairs (VA) neuropsychology clinic.
  
  
  METHODS
  Participants were 117 patients with mixed etiologies (85.5% male; age: M = 39.2 years, SD = 11.6) from a VA neuropsychology clinic. Participants were divided into pass/fail groups using two different SVT criteria, based on select validity scales from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2): first, Infrequency Scale (F) scores: (a) MMPI-F-Fail (n = 21) and (b) MMPI-F-Pass (n = 96); and, second, Symptom Validity Scale (FBS) scores: (a) MMPI-FBS-Fail (n = 36) and (b) MMPI-FBS-Pass (n = 81).
  
  
  RESULTS
  The mBIAS demonstrated good internal consistency, and each item contributed meaningfully to the total score. At a symptom exaggeration base rate of 35%, an mBIAS cutoff of ≥11 was optimal for screening symptom exaggeration when groups were classified using both F and FBS scales. This cutoff score resulted in very high specificity (.89 to .94); moderate-high positive predictive power (.71 to .75) and negative predictive power (.72 to .79); and low-moderate sensitivity (.31 to .57). At all base rates of probable somatic exaggeration, a cutoff of ≥16 resulted in perfect specificity and positive predictive power, but very low sensitivity.
  
  
  CONCLUSIONS
  The mBIAS has potential for use in samples outside of mild traumatic brain injury. In settings where the symptom exaggeration base rate is 35%, a cutoff of ≥11 may be used as a "red flag" for further evaluation, but should not be relied on for clinical decision making. At all base rates of probable somatic exaggeration, psychologists with patients who score ≥16 can be confident that those patients were exaggerating. Importantly, however, this cutoff may fail to identify a large proportion of patients who are exaggerating.
authors.affiliation: a Defense and Veterans Brain Injury Center , Silver Spring , MD , USA.|b Walter Reed National Military Medical Center , Bethesda , MD , USA.|c National Intrepid Center of Excellence , Bethesda , MD , USA.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Lippa
authors.affiliation: d John D. Dingell Department of Veterans Affairs Medical Center , Detroit , MI , USA.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Axelrod
authors.affiliation: a Defense and Veterans Brain Injury Center , Silver Spring , MD , USA.|b Walter Reed National Military Medical Center , Bethesda , MD , USA.|c National Intrepid Center of Excellence , Bethesda , MD , USA.|e Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada.
authors.forename: Rael T
authors.initials: RT
authors.lastname: Lange
mesh_terms: D000328:Adult; D001924:Brain Concussion / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008950:MMPI; D008297:Male; D008306:Malingering / Q000175:diagnosis* / Q000209:etiology; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D012680:Sensitivity and Specificity; D014728:Veterans
keywords: Diagnosis; Exaggeration; Military; Symptom validity