Summary (lectures and reading material) of Deception in Clinical Settings
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Course
Deception in Clinical Settings
Institution
Rijksuniversiteit Groningen (RuG)
It's a good summary of all the lectures and all the reading material (chapters and articles). It's organized by the lectures. So for every lecture there is, the slides and additional things the teacher said and the reading material for that lecture. Information from de lectures are in black and add...
Online exam, 2 hours, mc and open. 20 mc and 5 open
At the end 5 open questions, you can’t go back. You have to come to the point.
Important: learning goals; how many forms of deception and how do we test it. And assume
that the answer is right is wrong. Researchers developing the tools for detecting (important
the type of designs) are not sure; know how these test are validated (designs). Procedure
and test available know.
Lectures are most important.
Don’t have to study the case study’s
NOT OPEN BOOK
Open questions at least half of all the questions. At least the same to mc. Time to answer the
same or more for the open questions.
College 1 Introduction
Learning outcomes:
1. Different forms of deception in clinical settings
2. Differences between faked and genuine syndromes
3. Methods allowing the assessment and detection of various forms of deception in
clinical settings
4. Approaches to the management and treatment of faked syndromes
5. Research approaches applied in this field
6. Ethical and legal pitfalls related to deception in clinical settings
Exam pass/fail 20 MC and 5 open questions (not allowed MC)
Deception in Animals
Deception is fundamental to survival in the animal kingdom (bv faking death)
Case report
Frank William Abagnale: cheque con artist, forger and imposter. Crimes between ages 16-
21. We assume people to be honest, so he was caught late. He earned enough money to
pay back and
Assumption of honesty
Clinicians are trained to believe patients → consequently we are not aware of the potential
for deception in the clinical settings → however some patients deliberately produce false of
grossly exaggerate symptoms
➔ To gain external incentives (financial)= malingering
➔ To assume the sick role (attention) = factitious disorder
Chapter 5 Syndromes Associated with Deception
Deception is a central component of malingering
Challenges and pitfalls when evaluating malingering and deception
DSM-V continues to rely on screening indicators that are outdated and poorly validated
,Deception in Clinical settings
In evaluating feigning and related response styles, several conceptual issues warrant
consideration:
- Carefully consider examinees motivation. With malingering the feigning has to be
intentional
- Clinicians must not equate isolated test results with a classification of feigning or
malingering. Risk for false conclusions
- The behaviours associated with malingering are not taxonic (rangorde?)
- Consider explanatory models of malingering. It is clear that most types of deception
are unrelated to malingering
- Exact/ clear in their language
Common psychiatric disorders accompanied by deceptive behaviour
H5
DSM-5 diagnoses associated with deception
Deception and Disorders of Childhood and Adolescence
Oppositional Defiant (ODD) and Conduct disorder (CD). Problems with self-control that may
bring them into conflict with others. Behaviours related to deceitfulness are a core
component of both. With CD it is a part of the criteria. The deception in ODD is often
manifested in poor attitudes displayed toward people in authority.
,Deception in Clinical settings
Reactive Attachment Disorder (RAD) are known to engage in deception. Here the deception
is used as an adaptive mechanism to protect the individual form what he or she perceives as
dangerous social relationships.
Deception and Disorders of Adulthood
Factitious disorder: a psychiatric condition in which an individual presents with an illness
that is deliberately produced or falsified for the purpose of assuming the sick role.
For attention or sick role. Only to simulate when others see it. → true mental disorder with
many comorbid disorders
Malingering: the intentional production of false or grossly exaggerated physical or
psychological symptoms motivated by external incentives, such as financial compensation.
Very spontaneous.
Factitious disorder imposed by Another (FDIA) (Munchausen by Proxy) = college 3
FDIA is the new term for deceptions targeting another person either in symptom falsification
or surreptitious symptom induction, while typically pretending to be a concerned caregiver.
Three types:
1. Those calling for help
2. Active inducers
3. Doctor addicts
Underlying motivations for FDIA, may be consistent with all three explanatory models of
malingering:
- Adaptational: financial, bring family together
- Pathogenic: rigid control of family, or dysfunctional attachment to the child
- Criminogenic: manipulate or steal
Substance abuse and dependence:
Part of the disease: denial and other forms of deception in order to minimize consequences
of use and ensure continued supply of the substance
,Deception in Clinical settings
Eating disorder: clinicians are aware that patients with anorexia and bulimia nervosa use
various common deceptive practices.
examples: Dishonesty about body weight, hiding food, secretive use of laxatives, body
weight manipulation, wearing big clothes, secret exercising.
Paraphilias: sexual deviations or perversions with behaviours or sexual urges focusing on
unusual objects, activities, or situations.
example: Fetish, Exhibitionism, frotteurism, Voyeurism, Paedophilia
Personality disorders:
Common feature: Difficulties with impulse control, including exaggeration or lying
In particular: antisocial, borderline (identity disturbance), histrionic and narcissistic
personality disorder (low self-esteem), avoidant (to disengage from social situations)
Other clinical phenomena associated with deception
Provide specific situations in which malingering is common and apply explanatory models to
explain why deception occurs.
Contested Child Custody Evaluations: they want to be seen as the best parent. Parental
alienation syndrome (PAS) not sure it is a syndrome.
False-memory Syndrome (FMS): not sure
Differential diagnoses
Somatic symptom and related disorders:
- Prominence of somatic symptoms associated with significant distress and impairment
- Different forms
- Illness anxiety disorder: Preoccupation with fears of having a serious illness
- Conversion disorder: Sensory or motor symptoms without any physiological cause
, Deception in Clinical settings
It (the symptoms) sometimes speaks against biological, so you know it isn’t true
Conversion disorder: they believe they have it
You talk to a system (family, friends) to get the incentive for faking it
What about the clinicians?
Example: Gert Postel (German imposter). Successfully applied as a medical doctor several
times without ever having received medical education.
Clinicians lie to get higher on the ladder, to get somewhere. No one controls if they have that
diploma
A lot of effect is caused by the placebo effect.
Chapter 1 An Introduction to Response Styles
All individuals fall short of full and accurate self-disclosure.
The general issue of inconsequential deceptions, two extreme thought experiments
- Taint hypothesis: Any evidence of nongenuine responding should be documented
- Beyond-reasonable-doubt standard: only conclusive evidence of feigning should be
reported
Fundamentals of response styles
Nonspecific terms:
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