Summary of the articles and selected chapters that are on the readinglist of the course Deception in clinical settings, which is a third year psychology course at the University of Groningen. I wrote this summary in , although I have heard from multiple student that the articles from those years al...
Deception in clinical settings
Clinical assessment of malingering and deception (Rogers & Bender)
Chapter 1: Introduction to response styles
Two implications of the study by Ellison et al:
1. Decisions about response styles (disclosure or deceive) are often rational and
multidetermined
2. These decisions are often individualized responses to interpersonal variables (e.g. good
relationships with a coworker) or situational demands (e.g. explanation of poor
performance).
Most individuals engage in a variety of response styles that reflect their personal goals in a particular
setting.
All individuals fall short of full and accurate self-disclosure, irrespective of the social context.
Fundamentals of response styles; four categories:
1. Nonspecific terms; should be considered first to reduce
the understandable tendency of overreaching data when
conclusions about specific response styles cannot be
convincingly demonstrated.
Unreliability is a very general term that raises
questions about the accuracy of reported
information. It makes no assumption about the
individual’s intent or the reasons for inaccurate data. This term is useful when faced with
conflicting clinical data.
Nondisclosure describes a withholding of information. It makes no assumptions about
intentionality.
Self-disclosure refers to how much individuals
reveal about themselves.
Deception is an all-encompassing term to describe
any consequential attempts by individuals to distort Three terms to be avoided in clinical and
or misrepresent their self-reporting. Deception forensic practice:
includes acts of deceit often accompanied by
1. Suboptimal effort
nondisclosure.
(incomplete/submaximal effort);
Dissimulation is a general term to describe a wide
sometimes misused as a proxy for
range of deliberate distortions or
malingering. This term lacks
misrepresentations of psychological symptoms.
precision and may be applied to
2. Overstated pathology;
nearly any client or professional.
Malingering; the intentional production of false or
2. Overreporting (self-unfavorable
grossly exaggerated physical or psychological
reporting) simply refers to an
symptoms, motivated by external incentives.
unexpectedly high level of item
Factitious presentations; intentional production or
endorsement, especially on
feigning of symptoms that is motivated by the
multiscale inventories. The term
desire to assume a sick role. The deceptive behavior
lacks clarity with respect to its
is evident even in the absence of obvious external
content.
rewards.
3. Secondary gain does have clear
definitions but has conflicting
meanings.
, Feigning; the deliberate fabrication or gross exaggeration of psychological or physical
symptoms, without any assumptions about its goals.
3. Simulated adjustment;
Defensiveness; the masking of psychological difficulties. The polar opposite of
malingering. The deliberate denial or gross minimization of physical and/or psychological
symptoms.
Social desirability; tendency for certain individuals to present themselves in the most
favorable manner relative to social norms and more. Denial of negative characteristics
and the attribution of positive qualities.
Impression management; deliberate efforts to control others’ perceptions of an
individual. More situationally driven than social desirability.
4. Other response styles;
Irrelevant responding; the individual does not become psychologically engaged in the
assessment process. The given responses are not necessarily related to the content of
the clinical inquiry. This process of disengagement may reflect intentional disinterest or
simply carelessness.
Random responding; completing the remainder without any consideration of their
content.
Acquiescent responding (yea-saying)
Disacquiesent responding (nay-saying)
Role assumption; individuals may occasionally assume the role or character of another
person in responding to psychological measures.
Hybrid responding; an individual’s use of more than one response style in a particular
situation.
Common misconceptions about malingering
- Malingering is rare; malingering is not rare either in forensic or clinical settings
- Malingering is a static response style; most efforts at malingering appear to be related to
specific objectives in a particular context
- Malingering is an antisocial act by an antisocial person
- Deception is evidence of malingering
- Malingering is similar to the iceberg phenomenon; any observable feigning, similar to the
visible tip of an iceberg, represent a persuasive pattern of malingering
- Malingering precludes genuine disorders; implicit assumption is that malingering and
genuine disorders are mutually exclusive
- Syndrome-specific feigning scales measure syndrome-specific malingering
- Malingering has stable base rates
Clinical and research models
Motivational basis of response styles:
- Utility model; (maintenance of a positive image and minimization of social sanctions) the
general category of stimulated adjustment is likely the most common constellation of
response styles and it encompasses defensiveness, impression management and social
desirability. For example; a male executive may not want to acknowledge his depression,
because to do so would be a personal sign of weakness.
- Pathogenic; underlying disorder motivates the malingered presentation.
- Criminological; malingering is typically an anti-social act that is likely to be committed by
anti-social persons
,Simulators may attempt to maximize the predicted utility of their efforts by using both overstated
pathology and simulated adjustment. The latter response style may serve two-related goals:
1. Enhance credibility of the disability claim
2. Emphasize magnitude of the purported loss
Four basic research designs: Two basic
designs complement each other with their respective
strengths: Simulation designs can provide
unparalleled control over internal validity, whereas
known-group comparisons are unequalled in their
consideration of external validity.
1. Simulation design
Use an analogue design
Excellent internal validity, using
standardized methods and relying partly
on an experimental design, with the
random assignment of participants to
different experimental conditions
Inclusion of clinical comparison groups
can become more challenging for
research on simulated adjustment
The lack of an operationalized, clinical
comparison sample represents a
fundamental flaw in simulation research
2. Known-groups comparisons
To minimize misclassifications, it is
critically important to remove an
indeterminant group
Known-group comparisons should strive
for high classification rates (>90%) in
order to earn the designation of ‘known
groups’. In doing so, the removal of too-
close-to-call cases is essential to minimize
both measurement and classification
errors
3. Differential prevalence design
Because of challenges in establishing
known-groups comparisons, this design attempts to substitute an expedient proxy, such
as referral status for well-established criteria. As a common example, researchers might
lump all clients with litigation into a suspected feigning group and all nonlitigating clients
into a genuine group
4. Partial criterion
Bootstrapping comparison (using one measure to improve another measure)
External measure should have moderately good classification abilities (perhaps > 75%).
Rather than simply using the term external criterion for all levels of accuracy, researchers
are provided with two definitions; known-groups (high accuracy in group membership)
and partial criterion (perhaps >75% accuracy in group membership)
, Chapter 5: Syndromes associated with deception
Deception is a central component of malingering in the fifth edition of the Diagnostic and Statistical
Manual of Mental Disorders.
Malingering is described by DSM-5 in terms of faked presentations and external motivations.
Individuals have various motives for deception at different times;
- The same person may feign psychosis in a pretrial competency-to-proceed evaluation to
delay going to trial an after conviction feign psychosis in a correctional environment for a
different reason
- The same individual may become defensive and deny mental health problems as a potential
parole release date draws closer
Deception is a multidimensional construct that manifests differently across situations and settings.
Deception is not taxonomic, rather it should be viewed as a dimensional construct that can change in
direction and intensity. Deception is frequently adaptive but not always. Individuals who engage in
deceptive behaviors are not always insightful and aware of their reasons for deceiving.
Challenges and pitfalls when evaluating malingering and deception
- Evaluators must carefully consider examinees’ motivations. The definition of malingering
requires a close review. It necessitates that feigning must be intentional.
- Clinicians must not equate isolated test results
with a classification of feigning or malingering.
Psychological testing is useful to properly
assessing malingering and deception. However, a
single score on a psychological test must never be
considered in a vacuum.
- The behaviors associated with malingering are not
taxonomic.
Pure malingering; total fabrication
False imputation; no exaggeration but
misattributing symptoms to a compensable
cause
- Clinicians should consider explanatory models of
malingering
- Clinicians, as much as possible, must be exacting
in their use of language
DSM-5 diagnoses associated with deception
Deception and disorders of childhood and adolescence;
- Oppositional defiant and conduct disorders; Oppositional defiant disorder (ODD) and
conduct disorder (CD) are now found in the section of DSM-5 labeled “Disruptive, Impulse-
Control, and Conduct Disorders.” These disorders have been grouped together because they
involve problems with self-control that may bring them into conflict with others.
New DSM-5 criteria also allow for a specifier regarding whether behaviors include limited
prosocial emotions, including lack of remorse and the presence of callousness. As such,
for a CD diagnosis, it would be important to discern how adolescents think and feel
about their deceptive behavior.
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