Samenvatting van de leerstof van het vak deception in clinical settings. De samenvatting is in het engels geschreven: het document kan taalfouten bevatten.
Week 1 – Introduction…………………………………………………………………………………………………………………….2
Chapter 1: An introduction to response styles
Chapter 5: Syndromes associated with deception
Week 2 – Factitious disorders and Munchausen syndrome by proxy……………………………………………….9
Chapter 11: Factitious disorders in medical and psychiatric practices
Article: Munchausen by Proxy Syndrome – Day & Moseley (2010)
Week 3 – Malingering of cognitive dysfunctions and psychiatric disorder: Introduction…………………15
Article: A model to approaching and providing feedback to patients regarding invalid test
performance in clinical neuropsychological evaluations – Carone, Iverson & Bush (2010)
Chapter 13: Feigned medical presentations
Week 4 – Malingering of cognitive dysfunctions and psychiatric disorder: Amnesia………….……………19
Chapter 20: Recovering memories of childhood sexual abuse
Week 5 – validity testing in child and adolescent assessment……………………………………………………….…22
Chapter 1: A rationale for performance validity testing in child and adolescent assessment
Chapter 6: Clinical strategies to assess the credibility of presentations in children
Chapter 7: Motivations behind noncredible presentations: Why children feign and how to
make this determination
Week 6 – Residual effects of malingering………………………………………………………………………………………..27
Article - The residual effect of feigning: How intentional faking may evolve into a less
conscious form of symptom reporting – Merkelbach, Jelicic, & Pieters (2011)
Week 1 – Introduction
Rogers, R. & Bender, S.D. (2018). Clinical assessment of malingering and deception (4e edition).
Chapter 1: An introduction to response styles
Complete and accurate self-disclosure remains a rarity even in the uniquely supportive context of a
psychotherapeutic relationship. Even the most involved clients may intentionally conceal and distort
important data about themselves.
Deceptions routinely occur in personal relationships, including intimate relationships, with relatively
few espousing the belief that complete honesty is needed for a successful romantic relationship.
Interestingly, these authors found that most persons believe they are much better than their
partners at ‘successful’ (undetected) deceptions.
Beyond therapy and relationships, deceptions commonly occur in the workplace, including the
concealments of mental disorders. Employees affected by mental disorders annually elect not to
disclose their conditions due to public stigma or more specific concerns about potential damage to
their careers. Decisions about response styles (disclose or deceive) are often rational and
multidetermined. These decisions are often individualized responses to interpersonal variables (e.g.,
a good relationship with a coworkers) or situational demands (e.g., explanation of poor
performance).
Decisions to deceive or disclose are part and parcel of relationships across a spectrum of social
contexts. For instance, impression management plays a complex role in the workplace, especially
with reference to what has been termed concealable stigmas. Most individuals engage in a variety of
response styles that reflect their personal goals in a particular setting. Certain behaviors, such as
substance abuse, may be actively denied in one setting and openly expressed in another.
The general issue of inconsequential deceptions should be considered carefully. Simply as a thought
experiment, two extreme alternatives are presented:
Taint hypothesis: any evidence of nongenuine responding is likely to signal a broader but
presently undetected dissimulation. Therefore practitioners have a professional
responsibility to document any observed, even if isolated, deceptions.
Beyond-reasonable doubt standard: invoking the stringent standard of proof in criminal
trials, only conclusive evidence of a response style, such as feigning, should be reported.
Between the extremes, practitioners need to decide on a case-by-case basis how to balance the need
to document sustained efforts regarding a particular response style with sometimes very serious
consequences of categorizing an examinee as a nongenuine responder.
Fundamentals of response styles
Nonspecific terms – Very common error appears to be the overspecification of response styles. The
working assumptions for errors in overspecification of response styles is that practioners approach
this diagnostic classification by trying to determine which specific response style, even when the data
are inconclusive, or even conflicting. A two-step approach is recommended:
1. Do the clinical data support a nonspecific description?
2. If yes, are there ample data to determine a specific response style?
This approach asks practitioners to make an explicit decision between nonspecific or general
descriptions and specific response styles. Nonspecific terms:
Unreliability, raises questions about the accuracy of reported information.
Nondisclosure, describes withholding of information.
Self-disclosure, refers to how much individuals reveal about themselves.
Deception, any consequential attempts by individuals to distort or misrepresent their self-
reporting.
Dissimulation, a general term to describe a wide range of deliberate distortions or
misrepresentations of psychological symptoms.
,3
Overstated Pathology – important distinctions must be realized between malingering and other
terms used to describe overstated pathology. This subsection addresses three recommended terms:
- Malingering: the intentional production of false or grossly exaggerated physical or
psychological symptoms, motivated by external incentives.
- Factitious presentations are characterized by the intentional production or feigning of
symptoms that is motivated by the desire to assume a ‘sick role’.
- Feigning is the deliberate fabrication or gross exaggeration of psychological or physical
symptoms, without any assumptions about its goals.
Three terms should be avoided in clinical and forensic practice are summarized because they lack
well-defined and validated descriptions:
- Suboptimal effort (incomplete or submaximal effort) is sometimes misused as a proxy for
malingering.
- Overreporting simply refers to an unexpectedly high level of item endorsement, especially on
multiscale inventories. It has also been called self-unfavorable reporting.
- Secondary gain, the problem for professional practice stems from the presence of conflicting
meanings. From a psychodynamic perspective, secondary gain is part of an unconscious
process to protect the individual that is motived by intrapsychic needs and defenses. From a
behavioral medicine perspective, illness behaviors are perpetuated by the social context, not
by the individual. From a forensic perspective, individuals deliberately use their illness to gain
special attention and material gains.
Stimulated adjustment – three closely related terms are used to describe specific response styles that
are associated with stimulated adjustment:
- Defensiveness is defined as the opposite of malingering. This term refers to the deliberate
denial or gross minimization of physical and/or psychological symptoms.
- Social desirability is the pervasive tendency for certain individuals to ‘present themselves in
the most favorable manner relative to social norms and mores’.
- Impression management refers to deliberate efforts to control others’ perceptions of an
individual; its purpose may range from maximizing social outcomes to the portrayal of a
desired identity.
Other response styles – four others response styles are outlined:
- 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.
o Random responding, subset of irrelevant responding. A likely example would be the
completion of the Minnesota Multiphasic Personality Inventory in less than five
minutes. The individual had completed the remainder without any consideration of
their content.
- Acquiescent responding, this style is commonly referred to as ‘yea-saying’ which is rarely
experienced in its pure form.
- Disacquiescent responding is the opposite of acquiescent responding, characterized as ‘nay-
saying’.
- Role assumption, individuals may occasionally assume the role or character of another
person in responding to psychological measures.
- Hybrid responding, this style describes an individual’s use of more than one response style in
a particular situation. For example, honest responding about most facets of their lives but
engage in defensiveness with respect to substance abuse.
, 4
Malingering is unique among response styles in its number of associated myths and misconceptions.
Common misconceptions are summarized:
- Malingering is rare.
- 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. The erroneous assumption appears to be
that any observable feigning, similar to the visible tip of an iceberg, represents a pervasive
pattern of malingering.
- Malingering precludes genuine disorders. An implicit assumption is that malingering an
genuine disorders are mutually exclusive.
- Syndrome-specific feigning scales measure syndrome-specific malingering. syn- drome-
specific feigning scales must be able differentiate designated syndrome-specific feigning from
generic feigning.
- Malingering has stable base rates.
Clinical and Research Models
The motivational basis for response styles, sometimes referred to as explanatory models, has far-
reaching implication for clinical and forensic practice. Decisions to dissimulate, such as acting in
socially desirable ways or feigning medical complaints, can be viewed in terms of their predicted
utility. Often, selection of a particular response style is based on the options available and the
desired outcome.
Within the general category of overstated pathology, conceptual and empirical work has focused
primarily on malingering. Again, the prevailing model relies on expected utility. Described as the
adaptational model, malingerers attempt to engage in a cost–benefit analysis in choosing to feign
psychological impairment. Two other explanatory models have been posited for malingering:
Pathogenic: Influenced by psychodynamic thinking, the pathogenic model conceptualizes an
underlying disorder as motivating the malingered presentation. The malingerers, in an
ineffectual effort to control their genuine impairment, voluntarily produce symptoms. As
their condition deteriorates, they presumably become less able to control the feigned
disorders.
Criminological: Its underlying logic is that malingering is typically an antisocial act that is likely
to be committed by antisocial persons. The fundamental problem with the criminological
model is that it relies on common rather than distinguishing characteristics of malingering.
Overview of Research Designs
Four basic research designs are used in most studies of response styles. 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. Because of the challenges in establishing the independent
categorization required for known-group comparisons, two other designs have been introduced.
These designs differ markedly in methodological rigor, from patently simplistic (i.e., differential
prevalence design) to potentially sophisticated (partial criterion). See table 1.1 on the next page.
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