Samenvatting - Deception in clinical settings (PSB3E-M13)
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Course
Deception in clinical settings (PSB3EM13)
Institution
Rijksuniversiteit Groningen (RuG)
The summary consists of a summary of the book and the lectures. The summary is written with bullet points and concisely, and also includes images for further explanation
Week 1. Introduction
Clinicians are trained to believe patients, therefore they are often not aware of the potential
for deception in the clinical setting. However, some patients deliberately produce false or
grossly exaggerate symptoms. To gain external incentives (malingering) or to assume the
sick role (factitious disorders) The general issue of inconsequential deception must be
carefully considered. Two extremes of deception:
1. Taint hypothesis: Any evidence of non genuine responding/deception is likely that
there are further deceptions in a client’s story. Deception must therefore be
documented. Especially important in forensic psychology to establish the reliability of
mental health claims.
2. 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.
The decision of what evidence of response styles should be included are influenced by two
dimensions:
1. accuracy vs completeness of their conclusion
2. use vs misuse of clinical findings by others
A common error is the overspecification of reaction styles. For example, many criminal
offenders are miscategorized as malingers based on their manipulative behavior. Its
therefore important to use the two-step approach for minimizing overspecification:
- Does the clinical data support a non-specific description?
- if so, is there sufficient data to determine a specific response style
Non specific terms:
- Unreliability, raises questions about the accuracy of reported information. No
- Nondisclosure, describes withholding of information. No assumption is made about
the intentions of the individual or the reason for inaccurate data.
- Self-disclosure refers to how much individuals reveal about themselves.
- Deception, any consequential attempts by individuals to distort or misrepresent their
self reporting. Deception consists of deception and often disclosure. It is a
multidimensional construct. Deception can change in direction and intensity and is
often adaptive, but not always
- Dissimulation, a general term to describe a wide range of deliberate distortions or
misrepresentations of psychological symptoms.
,Three terms that should be avoided in clinical and forensic settings:
1. suboptimal effort: is sometimes used as a proxy for malingering. However, this term
can be used with any client because effort is determined by internal and external
factors.
2. overreporting: refers to an unexpectedly high level of item endorsement, also known
as self-deprecating reporting
3. Secondary gain: does have clear definitions but has conflicting meaning
- Psychodynamic perspective: secondary gain is part of an unconscious
process to protect the individual that is motivated by intrapsychic needs and
defenses
- Behavioral medicine perspective: illness behaviors are perpetuated by the
social context, not by the individual
- Forensic perspective: individuals deliberately use their illness to gain special
attention and material gains
Malingering: the intentional production of false or grossly exaggerated physical or
psychological symptoms, motivated by external incentives, such as financial compensation.
It is not a disorder, but a ‘clinical concern’ and it is time limited,
Common misconceptions about malingering:
- it’s rare
- grinding is a statistical reaction style
- it is an antisocial act by an antisocial person
- deception is evidence of malingering
- malingering is similar to the iceberg phenomenon
- malingering excludes real disorders
- syndrome-specific feigning scales with syndrome-specific malingering
Factitious presentations are characterized by the intentional production or feigning of
symptoms that is motivated by the desire to assume a ‘sick role’. The patient has knowledge
of sick behavior.
Feigning is the deliberate fabrication or gross exaggeration of psychological or physical
symptoms, without any assumptions about its goals. Psychological testing can be used to
identify feigning.
→ feigning and malingering must be intentional
Exaggeration is het opzettelijk overdrijven van iets, vaak om een punt te maken, een effect
te versterken, of om de aandacht te trekken.Bijvoorbeeld, als iemand zegt: "Ik heb je
duizend keer gezegd om dat niet te doen!" dan is dit een overdrijving, omdat het
,onwaarschijnlijk is dat ze dat letterlijk duizend keer hebben gezegd. Het doel is om de
nadruk te leggen op het belang van de waarschuwing.
Different diagnosis:
Differential diagnosis: Is it a real medical or mental condition, or is it factitious disorder or
malingering
1. Somatic symptom and related disorders
- Prominence of somatic symptoms associated with significant distress and
impairment
- Different forms (e.g. conversion disorder and illness anxiety disorder)
- Illness anxiety disorder: Preoccupation with fears of having a serious illness
- Conversion disorder: Sensory or motor symptoms without any physiological
cause
, The sole diagnosis of FD is rare and hard to tackle →importance of comorbid
disorders overlap with:
- personality disorders
- Mood disorders
- Substance abuse disorder
- Adjustment disorder
- Eating disorder
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’. This
involves denial of negative characteristics
- 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:
- 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, 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 ‘yes-saying’ which is
rarely experienced in its pure form.
- Disacquiescent responding is the opposite of acquiescent responding,
characterized as ‘no-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.
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