Deception in Clinical Settings
University of Groningen, PSB3E-M13
References 1
Chapter 1 - An Introduction to Response Styles 3
Chapter 5 - Syndromes Associated with Deception 9
Lecture 1 15
Chapter 11 - Factitious Disorders in Medical and Psychiatric Practices 16
Munchausen by Proxy Syndrome 24
Lecture 2 30
Chapter 13 - Feigned Medical Presentations 34
A Model to Approaching and Providing Feedback to Patients Regarding Invalid Test
Performance in Clinical Neuropsychological Evaluations 38
Lecture 3 43
Chapter 20 - Recovering memories of childhood sexual abuse 47
Lecture 4 53
Chapter 1 - A Rationale for Performance Validity Testing in Child and Adolescent
Assessment 54
Chapter 6 - Clinical Strategies to Assess the Credibility of Presentations in Children 56
Chapter 7 - Motivations Behind Noncredible Presentations 59
Lecture 5 63
Deceptive Dynamics in Drug Addiction and Their Role in Control Beliefs and Health Status
Reporting: A Study on People With Substance Use Disorder in Treatment 66
Lecture 6 70
Chapter 19 - Assessing Deception 73
Let’s use those tests! Evaluations of crime-related amnesia claims 78
Lecture 7 80
,References
Rogers, R. & Bender, S.D. (2018). Clinical assessment of malingering and deception (4th
edition). New York: Guilford Press.
Lecture 1
● Chapter 1: An introduction to response styles(R. Rogers), pp. 3 –17.
● Chapter 5: Syndromes associated with deception (M. Vitacco), pp. 83-97.
Lecture 2
● Chapter 11: Factitious disorders in medical and psychiatric practices (G.Yates, M.
Mulla, J. Hamilton, M. Feldman), pp. 212 -235.
● Day, D.O., & Moseley, R.L. (2010). Munchausen by proxy syndrome. Journal of
Forensic Psychology Practice, 10, 13-36
Lecture 3
● 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.
● Chapter 13: Feigned medical presentations (R. Granacher, D. Berry), pp. 243-253.
Lecture 4
● Chapter 20: Recovering memories of childhood sexual abuse (R. McNally), pp.
387-400.
Lecture 5
● 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
● 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
● 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
Lecture 6
● Caputo, A. (2019). Deceptive dynamics in drug addiction and their role in control
beliefs and health status reporting: A study on people with substance use disorder in
treatment. Journal of Drug Issues, 49(4), 575–592.
https://doi.org/10.1177/002204261985329
1
,Lecture 7
● Chapter 19: Assessing deception: Polygraph techniques and integrity testing (W.G.
Iacono & C.J. Patrick), pp. 361-369.
● Peters, M.J.V., van Oorsouw, K.I.M., Jelicic, M., & Merckelbach, H (2013). Let's use
those tests! Evaluations of crime related amnesia claims, Memory, 21(5), 599-607,
DOI:10.1080/09658211.2013.771672
2
,Chapter 1 - An Introduction to Response Styles
Even most involved clients may intentionally conceal and distort important data about
themselves.
→ e.g. personal matters related to sexual experiences, substance abuse, and relationship
experience
Deceptions also occur in the workplace, including the concealment of mental disorders.
→ many employees had disclosed their psychiatric conditions to their supervisors and
coworkers, however many disclosure were not entirely voluntary, and about one third
regretted their decisions because of negative repercussions
→ 2 key implications of the study by Ellison et al.:
1. decisions about response styles (disclose or deceive) are often rational and
multidetermined
2. these decisions are often individualized responses to interpersonal variables
(e.g. a good relationship with a coworker) or situational demands (e.g. explanation
of poor performance)
→ this model of complex, individualized decisions directly counters a popular misconception
that response styles are inflexible trait-like characteristics of certain individuals
Jones and King (2014): provide a penetrating analysis of determinants for whether
employees disclose, conceal, or signal about themselves and their own personal
experiences
→ most individuals engage in a variety of response styles that reflect their personal goals in
a particular setting (e.g. substance abuse may be actively denied in one setting and openly
expressed in another)
→ social desirability and impression management may prevail during the job application
process but later be abandoned once hiring is completed
Lexogenic effects = clients may respond to the adversarial effects of litigation, in which their
credibility is implicitly questioned
→ these clients may be influenced internally by their diagnosis, identity (e.g. avoidance or
stigmatization), or intentional goals (e.g. malingering)
Mental health professionals may wish to consider what level of deception should be
documented in their reports.
→ one approach would be to record only consequential deceptions and distortions
The general issue of inconsequential deceptions should be considered carefully
→ 2 extreme alternatives are presented:
1. Taint hypothesis: Any evidence of non genuine 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.
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.
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,→ 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 the sometimes very
serious consequences of categorizing an examinee as a non genuine responder
Mental health professionals must decide what evidence of response styles should be
routinely included in clinical and forensic reports.
→ guided by ethical and professional considerations, their decisions are likely to be
influenced by at least 2 dimensions:
1. accuracy vs completeness of their conclusion
2. use vs misuse of clinical findings by others
4 categories (of the chapter):
1. nonspecific terms
2. overstated pathology
3. simulated adjustment
4. other response styles
Nonspecific terms → why start with this? because a very common error appears to be the
overspecification of response styles, even when data or inconclusive or even conflicting
Two-Step (General–Specific) Approach for Minimizing Overspecification:
1. Do the clinical data support a nonspecific (e.g., “unreliable informant”) description?
2. If yes, are there ample data to determine a specific response style?
Unreliability = 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
→ especially useful when faced with conflicting clinical data
Non disclosure = describes a withholding of information; similar to unreliability, it makes no
assumptions about intentionality, an individual may freely choose whether to divulge
information or feel compelled by internal demands to withhold information
Self-disclosure = how much individuals reveal about themselves; a lack of self-disclosure
does not imply dishonesty but simply an unwillingness to share personal information
→ persons are considered to have high self-disclosure when they evidence a high degree of
openness
→ it is often considered an important construct within the context of reciprocal relationships
Deception = an all-encompassing term to describe any consequential attempts by
individuals to distort or misrepresent their self-reporting
→ includes acts of deceit often accompanied by non disclosure
→ deception may be totally separate from the patient’s described psychological functioning
Dissimulation = general term to describe a wide range of deliberate distortions or
misrepresentations of psychological symptoms; practitioners find this term useful, because
some clinical presentations are difficult to classify and clearly do not represent malingering,
defensiveness or any specific response style.
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, 3 recommended terms of overstated pathology:
1. malingering
2. factitious presentations
3. feigning
Malingering = by DSM as “the intentional production of false or grossly exaggerated
physical or psychological symptoms, motivated by external incentives”.
→ presence of minor exaggerations or isolated symptoms does not qualify as malingering
→ its requirement of external incentives does not rule out the co-occurrence of internal
motivations
Factitious presentations = characterized by the “intentional production or feigning” of
symptoms that is motivated by the desire to assume a “sick role”.
→ the description of motivation is no longer specified; DSM offers only: the deceptive
behavior is evident even in the absence of obvious external rewards
Feigning = deliberate fabrication or gross exaggeration of psychological or physical
symptoms, without any assumptions about its goals.
→ determinations can often be made for feigned presentations but not their underlying
motivations
3 quasi-constructs that should be avoided in most clinical and forensic evaluations:
1. secondary gain
2. overreporting
3. suboptimal effort
→ ambiguous terminology like this adds unnecessary confusion to clinical and forensic
assessments
Secondary gain = (from a psychodynamic perspective) an unconscious process to protect
the individual that is motivated 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
Suboptimal effort = (incomplete or submaximal effort) person may not be giving their full or
maximum effort during an evaluation or assessment; however, this term is vague and
imprecise, as any individual may be affected by a variety of internal and external factors.
Overreporting = (self-unfavorable reporting) an unexpected highly level of item
endorsement, especially on multiscale inventories.
→ used to describe both deliberate and unintentional acts
3 terms to describe specific response styles associated with simulated adjustment:
1. defensiveness
2. social desirability
3. impression management
Defensiveness = the polar opposite of malingering; deliberate denial or gross minimization
of physical and/or psychological symptoms
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