summary chapters and articles - Deception in clinical settings
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Course
Deception in clinical settings (PSB3EM13)
Institution
Rijksuniversiteit Groningen (RuG)
Summary of the articles and chapters required for the exam of Deception in clinical settings 2023/2024.
Rogers, R. & Bender, S.D. (2018). Clinical assessment of malingering and deception: chapters 1, 5, 11 , 13, 20
Kirkwood, M. (2015). Validity testing in child and adolescent assessment: ch...
Two key implications of the study by Ellison et al.:
Decisions about response styles are often rational and multidetermined
These decisions are often individualized responses to interpersonal variables or situational
demands.
This model of individualized decisions counters a misconception that response styles are inflexible
trait-like characteristics of certain individuals. Most individuals engage in a variety of response styles
that reflect their personal goals in a particular setting.
Clients in evaluative contexts may experience internal and external influences on their self-reporting.
Within a forensic context, clients are influenced by lexogenic effects (adversarial effects of litigation),
their diagnosis, identity and intentional goals.
Taint hypothesis: any evidence of nongenuine responding is likely to signal a broader but presently
undetected dissimulation. Therefore, practitioners have a responsibility to document any observed
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 these two extremes, practitioners need to decide on a case-by-case basis how to balance
the need to document particular response styles with something consequences of categorizing an
examinee as nongenuine.
In forensic practice, determinations of malingering are generally perceived as playing a decisive role
in legal outcomes, because they fundamentally question mental health claims.
Professionals must decide what evidence of response styles should be routinely included in clinical
reports. Their decisions are influenced by at least two dimensions:
Accuracy versus completeness of their conclusion.
Use versus misuse of clinical findings by others.
Fundamentals of response styles:
Basic concepts and definitions:
Nonspecific terms:
A very common error appears to be the overspecification of response styles. When disabled clients
express ambivalence toward clinical or medical interventions, their less-than-wholehearted attitudes
are sometimes misconstrued as evidence of secondary gain. The assumption for errors in
overspecification of response styles is that practitioners approach this diagnostic classification by
trying to determine which specific response style best fits the clinical data.
A two-step approach is recommended. This approach asks to make an explicit decision between
nonspecific (general) descriptions and specific response styles. Non-specific descriptions should be
considered first to reduce the tendency of overreaching data when conclusions about specific
response styles cannot be convincingly demonstrated.
,Nonspecific terms:
Unreliability: a term that raises questions about the accuracy of reported information. It
makes no assumption about the individual’s intent or reason for inaccurate data.
Nondisclosure: describes a withholding of information. It also makes no assumptions about
intentionality.
Self-disclosure: refers to how much individuals reveal about themselves. Lack of self-
disclosure does not imply dishonesty but simply an unwillingness to share information.
Deception: describes any consequential attempts by individuals to distort or misrepresent
their self-reporting. Deception includes acts of deceit often accompanied by nondisclosure.
Dissimulation: general term to describe a wide range of deliberate distortions or
misrepresentations of psychological symptoms.
Overstated pathology:
Malingering: the intentional production of false or grossly exaggerated physical or
psychological symptoms, motivated by external incentives.
Factitious presentations: the intentional production or feigning of symptoms that motivated
by the desire to assume a sick role. This deceptive behavior is evident even in absence of
external rewards.
Feigning: is the fabrication or gross exaggeration of psychological or physical symptoms
without any assumption about its goals. This term is introduced because measures of
response styles often cannot assess specific underlying motivations. Therefore, psychological
tests can be used to establish feigning but not malingering.
Three terms to be avoided in clinical and forensic practice because of their lack of well-defined and
validated descriptions:
Suboptimal effort: this term lack precisions and may be applied to nearly any client. The
effort of any individual may be affected by a variety of internal and external factors.
Overreporting: refers to a high level of item endorsement and is sometimes equated with
feigning. This term lacks clarity with respect to its content and had been used to describe
both deliberate and unintentional acts.
Secondary gain: the problem with this term stems from the presence of conflicting meanings.
Simulated adjustment:
Three terms are used to describe specific response styles that are associated with simulated
adjustment:
Defensiveness: refers to the deliberate denial or gross minimization of physical or
psychological symptoms. It’s the polar opposite of malingering.
Social desirability: is the tendency for individual to present themselves in the most favorable
manner relative to social norms and mores. It involves both denial of negative characteristics
and attribution of positive qualities.
Impression management: refers to efforts to control others’ perceptions of an individual. It
often involves a specific set of circumstances, such as personnel selection.
Other response styles:
, Irrelevant responding: refers to a response style in which the individual does not become
engaged in the assessment process. The given responses are not related to the content. This
may reflect disinterest or carelessness.
Random responding: is a subset of irrelevant responding based on chance factors.
Acquiescent responding: is referred to as “yea-saying”.
Disacquiescent responding: is characterized as “nay-saying”.
Role assumption: individuals may assume the role or character of another person in
responding to psychological measures.
Hybrid responding: describes an individual’s use of more than one response style in a
particular situation.
Domains of dissimulation:
three broad domains encompass most attempts at dissimulation: feigned mental disorders, feigned
cognitive abilities and feigned medical complaints/symptoms.
Common misconceptions about malingering:
Malingering is rare: some clinicians simply ignore the possibility of malingering, but large-
scale surveys suggest that malingering is not rare. Malingering should be systematically
evaluated.
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: this error arises from confusing
common characteristics with discriminating characteristics, which differentiate malingerers
from nonmalingerers.
Deception is evidence of malingering: this is based on the logical notion that malingerers lie;
therefore, liars malinger.
Malingering is similar to the iceberg phenomenon: this is based on the theory that any
observable feigning (tip of the iceberg) represents a pattern of malingering.
Malingering precludes genuine disorders: an implicit assumption is that malingering and
genuine disorders are mutually exclusive.
Syndrome-specific feigning scales measure syndrome-specific malingering: it is more likely to
identify feigned mental disorders than feigned somatic complaints.
Malingering has stable base rates: base rates for malingering variates across settings and
even within the same setting, between referral questions and individual circumstances.
Clinical and research models:
Motivational basis of response styles:
The motivational basis for response styles is sometimes referred to as explanatory models. Selection
of response styles is often based on the options available and the desired outcome. Individuals can
deliberately modify their “self-deceptive” responses to achieve a desired goal.
The adaptational model describes the fact that malingers attempt to engage in a cost-benefit analysis
in choosing to feign impairments. Two other explanatory models have been posited for malingering:
pathogenic and criminological.
The pathogenic model conceptualized an underlying disorder as motivating the malingered
presentation. A distinctive feature of the pathogenic model is the prediction of further deterioration.
Research does not support this model.
, The criminological model explains the primary motivation for malingering. It states that malingering is
typically an anti-social act that is likely to be committed by anti-social persons. This model includes
four indicators: forensic context, antisocial background, uncooperativeness, and discrepancies with
objective findings. This indicators are wrong in almost all cases, and therefore should not be used as a
screen for malingering. The fundamental problem with this 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:
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