Monday, January 23, 2012

Why Sports Leagues Need to Pay Attention to Malingering

One of the most fascinating areas in medicine and psychology is the study of symptom exaggeration and malingering. Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs (APA,1994).

FEATURED BOOK: Mild Traumatic Brain Injury and Malingering

In a prior blog entry, I discussed why physicians need to pay attention to malingering, but sports organizations need to pay attention to this as well. In sports, players are often routinely administered a battery of tests designed to measure thinking abilities (e.g., memory, thinking speed) before the seasons begins (known as baseline testing) to be used as a comparison point after an injury during season. The purpose is to use the follow-up testing to determine if the person is recovered after the injury, although there are numerous problems with this approach. One such problem is that some players intentionally perform poorly during the baseline testing so that future test results obtained after an injury will not look to be as low as they actually are.

Famous NFL quarterback, Peyton Manning admitted to doing this when he said: "They have these new (brain) tests we have to take. Before the season, you have to look at 20 pictures and turn the paper over and then try to draw those 20 pictures. And they do it with words, too. Twenty words, you flip it over, and try to write those 20 words. Then, after a concussion, you take the same test and if you do worse than you did on the first test, you can't play. So I just try to do badly on the first test."

Another area where faking is happening in sports is in college and professional football. The technique is used to slow down the other team’s momentum in the hopes of gaining an advantage that can be used to increase the chances of winning the game. Winning games in college and professional football increases the chances of fame, fortune, and other external incentives.

Here is an example from a New York Giants Game earlier this year.

And here is an example from a recent college football game.

Here are several other examples in college football.

And here is yet another example from the NBA playoffs of malingered head injury (watch how the player's head never hits the ground). He was fined $5,000 by the NBA for faking this injury, which an NBA official described as "...a gross over-embellishment and was inconsistent with the degree of contact received on the play."

But what I found most fascinating was a panel discussion about this on television in reaction to the Giant players faking injuries because it echoed the debates that often take place on this topic in the fields of medicine and psychology. That is, on one side you have people who are upset that this is taking place, believe that authorities should do something to stop it, and that there should be stiff penalties for faking. On the other hand, the player (akin to the malingering patient) acknowledges that faking takes place but tries to excuse it as a tactical maneuver (and not cheating), advises that one should do this in a way to avoid getting caught, and brazenly states that attempts to stop it will never work because he believes it cannot be proven. The debate also raised the topic of false positives (the problem of saying someone is faking when they are not) and other issues.
Fortunately, there are reliable and valid methods that health care professionals can use to assess malingering that greatly minimize false positives. Behavioral observations, including video evidence (e.g., surveillance), can also play an important role in assessing malingering and appears to be the main tool that NFL and college football leagues will have to assess the apparent faking demonstrated in the videos above. If these leagues begin to crack down on this issue, my prediction is that more sophisticated attempts at deception will emerge rather than some of the unsophisticated measures used above.

Disclosure: The author of this blog in the co-editor of the book, Mild Traumatic Brain Injury: Symptom Validity Assessment and Malingering.

Reference: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th ed. Washington, DC: American Psychiatric Association; 1994.

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