1
Summary Deception in Clinical
Settings
, 2
Table of Contents
Week 1
1. An Introduction to Response Styles…………………………………………………… 3
5. Syndromes Associated with Deception……………………………………………… 8
Week 2
11. Factitious Disorders in Medical and Psychiatric Practices……………………… 13
Munchausen by proxy syndrome (2010)………………………………………………... 20
Week 3
Feigned Medical Presentations…………………………………………………………… 24
A Model to Approaching and Providing Feedback to Patients Regarding
Invalid Test Performance in Clinical Neuropsychological Evaluations (2010)……. 29
Week 4
20. Recovering Memories of Childhood Sexual Abuse……………………………….. 33
Week 5
1. A rationale for performance validity testing in child and adolescent
assessment……………………………………………………………………………………… 39
7. Motivations behind noncredible presentations: Why children feign and
how to make this determination…………………………………………………………… 45
Week 6
The residual effect of feigning: How intentional faking may evolve into a less
conscious form of symptom reporting (2011)……………………………………………. 48
, 3
Week 1 Introduction
1. An Introduction to Response Styles
Complete and accurate self-disclosure is a rarity in itself, because everybody is
selective sharing personal information. The decisions we make about our response
styles, whether we disclose or deceive, are mostly rational and based on various
circumstances (multidetermined). Also, we do not have one general response style,
but individualize our response to interpersonal variables (liking or disliking the other
person) or situational demands (explaining your former behavior). Most response
styles are therefore based on personal goals in particular settings. The response styles
are both internally and externally influenced. 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.
In forensic practice, determinations of malingering are generally perceived as
playing a decisive role in legal outcomes, because they fundamentally question the
veracity and credibility of mental health claims. Mental health professionals must
decide what evidence of response styles should be routinely included in clinical and
forensic reports. Guided by professional and ethical considerations, their decisions
are likely to be influenced by at least two dimensions:
• Accuracy vs. completeness of their conclusion
• Use vs. misuse of clinical findings by others.
Fundamentals of Response Styles
Basic Concepts and Definitions
In order to perform proper research, standardization of terms and operationalization
of response styles is necessary. The response styles are divided into four categories:
• Nonspecific Terms
® The author of the article states that one of the most common mistakes
clinicians make is the overspecification of response styles. Practitioners try to
determine a specific response style that best fits the clinical data, but this often
result in specification of a response style when the data is conflicting or
unconvincing. Therefore, clinicians should always consider whether the clinical
data support nonspecific descriptions and, if so, if there is enough data to
determine a nonspecific response style. There are multiple nonspecific terms:
- Unreliability is a general term that raises questions about the accuracy of
reported information.
® It makes no assumption about the individual’s intent or reasons and is
especially useful with conflicting information
- Nondisclosure describes a withholding of information.
® It also makes no assumptions about intentionality.
- Self-disclosure refers to how much individuals reveal about themselves.
® People are considered to have high self-disclosure when they have a high
degree of openness. This is important within reciprocal relationships. A lack
does not imply dishonesty but simply an unwillingness to share personal
information.
, 4
- Deception describes any consequential attempts by individuals to distort
(vervormen) or misrepresent (verkeerd voor te stellen) their self-reporting. It
includes acts of deceit (geheimhouding) often accompanied by
nondisclosure.
® Deception may be totally separate from the patient’s described
psychological functioning (see dissimulation).
- Dissimulation is a general term to describe a wide range of deliberate
distortions (verdraaingen) 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.
• Overstated Pathology:
- Malingering: intentionally producing grossly exaggerated or false
psychological or physical symptoms motivated by external incentives. This
does not completely exclude the co-occurrence of internal motivations.
Isolated symptoms or minor exaggerations do not qualify for the diagnosis.
- Factitious presentations: intentionally producing or feigning grossly
exaggerated or false psychological or physical symptoms motivated by
assuming the sick role or an unspecified internal motivation (no external).
- Feigning: intentionally producing grossly exaggerated or false psychological
or physical symptoms without any clear motivation or goal.
® Psychologische testen kunnen feigning wel aantonen, maar malingering
niet, omdat de test geen uitspraken doet over onderliggende motieven.
® Because of the importance of well-defined and validated descriptions,
some terms should be avoided by clinicians because they lack precision,
clarity or conflicting meanings:
- Suboptimal effort/ incomplete or submaximal effort: Is sometimes misused as a
proxy for malingering. Lacks precision an may be applied to nearly any client
of professional. The ‘best’ effort may be affected by internal or external
factors
- Overreporting/ self-unfavourable reporting: unexpectedly high level of
endorsement. Lacks clarity with respect to its content and has been used to
describe both deliberate and unintentional acts
- Secondary gain: does have clear definitions, but it means something different
for certain groups (behaviorists, psychoanalytic)
• Simulated Adjustment:
- Social desirability: desire to present oneself in the most desirable way, by the
attribution of positive characteristics and denial of negative characteristics.
® Not limited to psychological characteristics (as defensiveness)
- Defensiveness: describes the intentional denial or gross minimization of
physical and psychological symptoms
® Opposite of malingering and must be distinguished from ego defenses,
which involve intrapsychic processes that distort perceptions
- Impression management: intentional efforts to control how others perceive
the individual. This is often more situationally driven than based on social
desirability, and individuals may use this response style for several different
purposes which are not prosocial.
• Other Response Styles
- Irrelevant responding refers to the lack of an individual’s psychologically
engagement in the assessment process. The given responses are not
necessarily related to the content of the clinical inquiry. This process of
Summary Deception in Clinical
Settings
, 2
Table of Contents
Week 1
1. An Introduction to Response Styles…………………………………………………… 3
5. Syndromes Associated with Deception……………………………………………… 8
Week 2
11. Factitious Disorders in Medical and Psychiatric Practices……………………… 13
Munchausen by proxy syndrome (2010)………………………………………………... 20
Week 3
Feigned Medical Presentations…………………………………………………………… 24
A Model to Approaching and Providing Feedback to Patients Regarding
Invalid Test Performance in Clinical Neuropsychological Evaluations (2010)……. 29
Week 4
20. Recovering Memories of Childhood Sexual Abuse……………………………….. 33
Week 5
1. A rationale for performance validity testing in child and adolescent
assessment……………………………………………………………………………………… 39
7. Motivations behind noncredible presentations: Why children feign and
how to make this determination…………………………………………………………… 45
Week 6
The residual effect of feigning: How intentional faking may evolve into a less
conscious form of symptom reporting (2011)……………………………………………. 48
, 3
Week 1 Introduction
1. An Introduction to Response Styles
Complete and accurate self-disclosure is a rarity in itself, because everybody is
selective sharing personal information. The decisions we make about our response
styles, whether we disclose or deceive, are mostly rational and based on various
circumstances (multidetermined). Also, we do not have one general response style,
but individualize our response to interpersonal variables (liking or disliking the other
person) or situational demands (explaining your former behavior). Most response
styles are therefore based on personal goals in particular settings. The response styles
are both internally and externally influenced. 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.
In forensic practice, determinations of malingering are generally perceived as
playing a decisive role in legal outcomes, because they fundamentally question the
veracity and credibility of mental health claims. Mental health professionals must
decide what evidence of response styles should be routinely included in clinical and
forensic reports. Guided by professional and ethical considerations, their decisions
are likely to be influenced by at least two dimensions:
• Accuracy vs. completeness of their conclusion
• Use vs. misuse of clinical findings by others.
Fundamentals of Response Styles
Basic Concepts and Definitions
In order to perform proper research, standardization of terms and operationalization
of response styles is necessary. The response styles are divided into four categories:
• Nonspecific Terms
® The author of the article states that one of the most common mistakes
clinicians make is the overspecification of response styles. Practitioners try to
determine a specific response style that best fits the clinical data, but this often
result in specification of a response style when the data is conflicting or
unconvincing. Therefore, clinicians should always consider whether the clinical
data support nonspecific descriptions and, if so, if there is enough data to
determine a nonspecific response style. There are multiple nonspecific terms:
- Unreliability is a general term that raises questions about the accuracy of
reported information.
® It makes no assumption about the individual’s intent or reasons and is
especially useful with conflicting information
- Nondisclosure describes a withholding of information.
® It also makes no assumptions about intentionality.
- Self-disclosure refers to how much individuals reveal about themselves.
® People are considered to have high self-disclosure when they have a high
degree of openness. This is important within reciprocal relationships. A lack
does not imply dishonesty but simply an unwillingness to share personal
information.
, 4
- Deception describes any consequential attempts by individuals to distort
(vervormen) or misrepresent (verkeerd voor te stellen) their self-reporting. It
includes acts of deceit (geheimhouding) often accompanied by
nondisclosure.
® Deception may be totally separate from the patient’s described
psychological functioning (see dissimulation).
- Dissimulation is a general term to describe a wide range of deliberate
distortions (verdraaingen) 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.
• Overstated Pathology:
- Malingering: intentionally producing grossly exaggerated or false
psychological or physical symptoms motivated by external incentives. This
does not completely exclude the co-occurrence of internal motivations.
Isolated symptoms or minor exaggerations do not qualify for the diagnosis.
- Factitious presentations: intentionally producing or feigning grossly
exaggerated or false psychological or physical symptoms motivated by
assuming the sick role or an unspecified internal motivation (no external).
- Feigning: intentionally producing grossly exaggerated or false psychological
or physical symptoms without any clear motivation or goal.
® Psychologische testen kunnen feigning wel aantonen, maar malingering
niet, omdat de test geen uitspraken doet over onderliggende motieven.
® Because of the importance of well-defined and validated descriptions,
some terms should be avoided by clinicians because they lack precision,
clarity or conflicting meanings:
- Suboptimal effort/ incomplete or submaximal effort: Is sometimes misused as a
proxy for malingering. Lacks precision an may be applied to nearly any client
of professional. The ‘best’ effort may be affected by internal or external
factors
- Overreporting/ self-unfavourable reporting: unexpectedly high level of
endorsement. Lacks clarity with respect to its content and has been used to
describe both deliberate and unintentional acts
- Secondary gain: does have clear definitions, but it means something different
for certain groups (behaviorists, psychoanalytic)
• Simulated Adjustment:
- Social desirability: desire to present oneself in the most desirable way, by the
attribution of positive characteristics and denial of negative characteristics.
® Not limited to psychological characteristics (as defensiveness)
- Defensiveness: describes the intentional denial or gross minimization of
physical and psychological symptoms
® Opposite of malingering and must be distinguished from ego defenses,
which involve intrapsychic processes that distort perceptions
- Impression management: intentional efforts to control how others perceive
the individual. This is often more situationally driven than based on social
desirability, and individuals may use this response style for several different
purposes which are not prosocial.
• Other Response Styles
- Irrelevant responding refers to the lack of an individual’s psychologically
engagement in the assessment process. The given responses are not
necessarily related to the content of the clinical inquiry. This process of
