Correlates of chemosensory malingering

Abstract

Smell and taste tests are commonly employed to quantify chemosensory sequelae of head trauma, toxic exposures, and iatrogenesis. Malingering on forced-choice chemosensory tests can be detected by improbable responding. This study determined whether chemosensory test malingerers differ from nonmalingerers in terms of age, sex, education, and a range of self-reported behaviors and symptoms, potentially providing information of value for malingering detection. Case control. Twenty-two chemosensory malingerers were identified from a large clinical database and matched, randomly, to 66 nonmalingerers on the basis of etiology. Differences in demographics and responses to intake questionnaire items were statistically assessed. Logistic regression was used to identify variables that best predicted malingering behavior. Relative to nonmalingerers, malingerers reported significantly fewer allergies, dental problems, cigarettes smoked, surgical operations, nasal sinus problems, and use of medications, and significantly more putative symptom-related psychological duress, interference with daily activities, weight loss, decreased appetite, and taste loss. Litigation involvement was higher in malingerers than nonmalingerers. Age, sex, education, and length of symptom descriptions did not differentiate malingerers from nonmalingerers. Malingerers of chemosensory tests exaggerate symptom severity and underreport factors that might be construed as contributing to their dysfunction, such as smoking behavior, medication use, and general health. This contrasts with the behavior of malingerers of psychiatric symptoms, who typically exaggerate their general health problems. These data suggest that careful review of past medical records should be used to verify patient reports to better detect chemosensory malingering in cases where financial or other external incentives are present.