Malingering and malingering-like aspects of mild closed head injury

Objective techniques such as neuroimaging cannot conclusively document axonal shearing or other trauma resulting from closed brain injury. Consequently, clinicians must rely upon clinical evaluation and psychological and neuropsychological assessment. Because of the subjectivity inherent in these measures, they are susceptible to confounding due to malingering behaviors. Indicators of malingering in mild closed brain injury and approaches to differential diagnosis are discussed. Findings of a study comparing the neuropsychologlcal test results of normal subjects simulating neurological injury with the test results of normal controls, litigants with actual minor brain injury, and nonlitigants with actual minor brain injury are presented. The study concludes that comprehensive multidisciplinary evaluations are required to detect malingering in cases of minor closed brain injury. Guidelines are suggested for the detection and diagnosis of malingering, which continues to represent a major challenge in the assessment of individuals with brain concussion.