Summary Deception In Clinical Settings (PSB3E-M13)
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Course
Deception In Clinical Settings (PSB3EM13)
Institution
Rijksuniversiteit Groningen (RuG)
This is a summary for the course Deception in Clinical Settings. I wrote this in the year 2021 and me and my friends all studied with it. It got us all high grades and everyone said it was easy to work with.
Index
LECTURE 1: Introduction (p. 3 – 9)
Rogers, R. & Bender, S.D. (2018). Clinical assessment of malingering and deception (4th
edition). New York: Guilford Press.
- Chapter 1: An introduction to response styles (R. Rogers), pp. 3 – 17. Link
Rogers, R. & Bender, S.D. (2018). Clinical assessment of malingering and deception (4th
edition). New York: Guilford Press.
- Chapter 5: Syndromes associated with deception (M. Vitacco), pp. 83 – 97. Link
LECTURE 2: Factitious disorders and Munchausen syndrome by proxy (p. 10 – 21)
Rogers, R. & Bender, S.D. (2018). Clinical assessment of malingering and deception (4th
edition). New York: Guilford Press.
- Chapter 11: Factitious disorders in medical and psychiatric practices (G. Yates, M.
Mulla, J. Hamilton, M. Feldman), pp. 212 - 235. Link
Day, D.O., & Moseley, R.L. (2010). Munchausen by proxy syndrome. Journal of Forensic
Psychology Practice, 10, 13-36. Link
LECTURE 3: Malingering of cognitive dysfunctions and psychiatric disorders I. (p. 22 – 28)
Carone, D.A., Iverson, G.L., & Bush, S.S. (2010). A model to approaching and providing
feedback to patients regarding invalid test performance in clinical neuropsychological
evaluations. The Clinical Neuropsychologist, 24, 759-778. Link
Rogers, R. & Bender, S.D. (2018). Clinical assessment of malingering and deception (4th
edition). New York: Guilford Press.
- Chapter 13: Feigned medical presentations (R. Granacher, D. Berry), pp. 243 - 253.
Link
LECTURE 4: Malingering of cognitive dysfunctions: Amnesia (p. 29 – 33)
Rogers, R. & Bender, S.D. (2018). Clinical assessment of malingering and deception (4th
edition). New York: Guilford Press.
- Chapter 20: Recovering memories of childhood sexual abuse (R. McNally), pp. 387-
400. Link
LECTURE 5: Validity testing in child and adolescent assessment (p. 34 – 42)
Kirkwood, M. (2015). Validity testing in child and adolescent assessment. New York:
Guilford Press. - Chapter 1: A rationale for performance validity testing in child and
adolescent assessment (Michael Kirkwood), pp. 3 – 21. Link
Kirkwood, M. (2015). Validity testing in child and adolescent assessment. New York:
Guilford Press. - Chapter 6: Clinical strategies to assess the credibility of presentations in
children (Dominic Carone), pp. 107 – 124. Link
Kirkwood, M. (2015). Validity testing in child and adolescent assessment. New York:
Guilford Press. - Chapter 7: Motivations behind noncredible presentations: Why children
feign and how to make this determination (David Baker and Michael Kirkwood), pp. 125 –
144. Link
LECTURE 6: Residual effects of malingering (Dr. Isabella Niesten) (p. 43 – 45)
Merckelbach, H., Jelicic, M., & Pieters, M. (2011). The residual effect of feigning: How
intentional faking may evolve into a less conscious form of symptom reporting. Journal of
Clinical and Experimental Neuropsychology, 33(1), 131-139, Link
LECTURE 7: (p. 46 – 53)
Topic 1: A case report on malingered amnesia (Dr. Isabella Niesten, ONLINE via
Blackboard)
Topic 2: Polygraph
Rogers, R. & Bender, S.D. (2018). Clinical assessment of malingering and deception (4th
edition). New York: Guilford Press.
- Chapter 19: Assessing deception: Polygraph techniques and integrity testing (W.G.
Iacono & C.J. Patrick), pp. 361-386. Link
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Clinical Assessment of Malingering and Deception – Rogers & Bender (Book)
Lecture 1
Chapter 1: An introduction to response styles
- Clients: minimise distress, symptom severity, pretend to like comments/suggests of therapist,
overstating effectiveness of therapy, pretending to do homework etc.
- Intimate relationship: partners have varying degrees of self-disclosure and usually think they
are better at deceiving the other.
- Workplace: non-disclosing mental disorders out of fear of job security and stigma.
- Concealable stigmas: part of impression management. Basically, what you disclose and what
not across various social contexts
- Lexogenic effects: clients’ reaction when their credibility is implicitly questioned
- Some clinicians only record consequential deceptions and distortions.
o Using the Evaluation of Competency to Stand Trial-Revised (ECST-R)
- Issue with inconsequential deceptions:
1. Taint hypothesis: nongenuine responding as an indication of presently undetected
dissimulation (person pretending).
2. Beyond-reasonable-doubt standard: only conclusive evidence of a response style
should be reported (e.g., feigning).
- Clinicians’ decision of which evidence to include in a forensic report:
1. Accuracy versus completeness of clinicians’ conclusion
2. Use versus misuse of clinical findings by others
Fundamentals of Response Styles:
Basic Concepts and Definitions Nonspecific Terms
- Important because: Often mis-categorization of criminal offenders due to their manipulative
behaviour. Now, nonspecific terms allow for a general description
- Should be used when there is insufficient evidence for a specific term
o Unreliability: questions accuracy of reported information; no assumption about
individuals’ intent.
o Nondisclosure: withholding information; no assumptions about intent.
o Self-disclosure: high when high degree of openness; important in reciprocal
relationships.
o Deception: any consequential attempt to distort or misrepresent self-reporting;
includes deceit and nondisclosure.
o Dissimulation: range of deliberate distortions or misrepresentations of psychological
symptoms; practically helpful for clinicians
Overstated Pathology
1. Malingering: “the intentional production of false or grossly exaggerated physical or
psychological symptoms, motivated by external incentives”; magnitude is important here, so
that it includes multiple symptoms and gross exaggeration; also, external incentive is not
required, there are also internal motivations.
2. Factitious presentations: “intentional production or feigning” of symptoms motivated by
wanting a “sick role”; there must be no external reward present.
3. Feigning: deliberate fabrication or gross exaggeration of psychological or physical
symptoms, without any assumptions about its goals; can be tested.
- Three terms to be avoided:
1. Suboptimal effort: misused for malingering; lacks precision; “best effort” may be affected
by variety of internal and external factors.
2. Overreporting: unexpectedly high level of item endorsement; “Self-unfavourable
reporting”; lacks clarity.
3. Secondary gain: conflicting meanings in psychodynamic perspective (unconscious
process), behavioural medicine (social context), and forensic perspective (use illness for
gain).
, 4
Simulated Adjustment
1. Defensiveness: opposite of malingering; refers to deliberate denial or minimization of
symptoms; refers mainly to the concealment of psychological impairment.
2. Social desirability: tendency to present self in most favourable manner relative to the social
norms; involves denial of neg characteristics as well as pos.
3. Impression management: deliberate efforts to control others’ perceptions of an individual;
more situationally driven; such as hyper-competitiveness or “playing dumb”.
Other Response Styles
1. Irrelevant responding: individual not psychologically engaged in the assessment process;
given responses are not necessarily related to the clinician’s question; maybe disengagement
or carelessness; patterns may emerge.
2. Random responding: subset of irrelevant responding because based on chance factors.
3. Acquiescent responding: “yea-saying”.
4. Disacquiescent responding: “nay-saying”.
5. Role assumption: playing a role while answering; poorly understood.
6. Hybrid responding: more than one response style in one situation.
Domains of Dissimulation:
- Response styles are not pervasive.
o Might change depending on domain (mental disorders, cognitive abilities, medial
complaints)
Common Misconceptions about Malingering
Malingering is rare
Malingering is a static response style: “once a malingerer, always a malingerer” false!
Usually depends on context
Malingering is an antisocial act by an antisocial person
Deception is evidence of malingering: malingering is NOT lying
Malingering is like the iceberg phenomenon: like the taint hypothesis; false assumption that
any observable feigning is part of the metaphorical “tip of the iceberg”.
Malingering precludes genuine disorders
Syndrome-specific feigning scales measure syndrome-specific malingering
Malingering has stable base rates
Clinical and Research Models:
Motivational Basis of Response Styles
- Explanatory models: including the motivational basis for response styles.
- Simulated adjustment: encompasses defensiveness, impression management, social
desirability
o E.g., minimisation of suicidal ideation maintaining a positive image & minimise
social sanctions
- Self-focused utilities: e.g., man hiding depression to avoid appearing weak.
o Can be deliberate of unconscious
- Research: malingerers engage in a cost-benefit analysis in choosing to feign impairment; two
other explanatory models:
1. Psychodynamic: an underlying disorder motivated the malingerer; prediction of
further deterioration (no evidence)
2. Criminological: malingering is typically seen as an antisocial act that is likely to
be committed by antisocial persons; poor evidence.
Problem with criminological model: relies on common (≠ distinguishing)
characteristics of malingering
- Predominant predicted-utility model: simulators maximise their utility by using:
o overstated pathology, and
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