Widely used by practitioners, researchers, and students--and now thoroughly revised with 70% new material--this is the most authoritative, comprehensive book on malingering and other response styles. Leading experts translate state-of-the-art research into clear, usable strategies for detecting intentional distortions in a wide range of psychological and psychiatric evaluation contexts, including forensic settings. The book examines dissimulation across multiple domains: mental disorders, cognitive impairments, and medical complaints. It describes and critically evaluates evidence-based applications of multiscale inventories, other psychological measures, and specialized methods. Applications are discussed for specific populations, such as sex offenders, children and adolescents, and law enforcement personnel.
New to This Edition Many new authors and topics. Thoroughly updated with current data, research methods, and assessment strategies. Chapters on neuropsychological models, culturally competent assessments, psychopathy, and conversion disorder. Chapters on psychological testing in child custody cases and in personnel selection/hiring.
Críticas
"With the addition of the neuropsychological perspective, this fourth edition includes everything a legal or clinical practitioner needs to know about the state of the art in deception detection. The assembled authors are impressive, and Rogers and Bender are acknowledged leaders in the field. Do not go into court in a case involving behavioral science issues without consulting this book."--Christopher Slobogin, JD, LLM, Milton Underwood Professor of Law, Vanderbilt University Law School
"The premier work on malingering and deception just got better! The fourth edition of this classic book provides up-to-date, insightful coverage of one of the most important topics in forensic mental health assessment. Rogers and Bender have assembled a world-class cast of contributors with broad research and clinical expertise. The fourth edition includes new chapters on cutting-edge topics, including neuropsychological models of feigned cognitive deficits, psychopathy, child custody, personnel selection, and more. This book is both scholarly and practical, which makes it attractive to students and experienced professionals alike. This is much more than a 'bookshelf' book--it is essential, indispensable reading for those who are or will be involved in conducting forensic mental health assessments."--David DeMatteo, JD, PhD, ABPP, Department of Psychology and Thomas R. Kline School of Law, Drexel University
"Clinicians and forensic practitioners will welcome the fourth edition of this book, particularly in the face of growing concern about the liability that may attend unwarranted use of the ‘malingering’ label. The stellar cast of contributors explores the terrain sensitively and with scholarly incisiveness, assuring the book's appeal to forensic psychology and psychiatry trainees.”--Ezra E. H. Griffith, MD, Professor Emeritus of Psychiatry and African American Studies, Yale School of Medicine
"This is an excellent book written by experts in the field. It covers deception in various populations, along with both psychological and medical illnesses. The fourth edition is justified because of the new chapters on neuropsychology and cultural assessments, along with revisions in the remaining chapters. *!” ― Doody's Review Service Published On: 2018-10-12
"This excellent and standard reference [occupies] a crucial space on many forensic psychiatrists' and psychologists' bookshelves....Useful in clinical practice, especially in institutions that serve forensic or correctional populations." (on the third edition) ― Journal of Psychiatric Practice Published On: 2008-01-01
“This is a rich volume that provides information and assessment strategies for patients who may be clinical challenges and enigmas. It is a lucid, well-written and helpful volume.” (on the third edition) ― International Journal of Social Psychiatry Published On: 2013-01-01
"Akin to the eminence of the late Hervey Cleckley or Robert Hare as authorities on the topic of psychopathy, it is not unreasonable to accord Professor Richard Rogers analogous status as one of the world's leading scholars on the assessment of malingering....Professor Rogers's text and the wealth of knowledge he has compiled from an august collection of contributors should be viewed as a mandatory item for all forensic mental health practitioners." (on the third edition) ― International Journal of Offender Therapy and Comparative Criminology Published On: 2010-02-01
Biografía del autor
Richard Rogers, PhD, ABPP, is Regents Professor of Psychology at the University of North Texas. He is a recipient of the Guttmacher Award from the American Psychiatric Association, the Distinguished Contributions to Forensic Psychology Award from the American Academy of Forensic Psychologists, and the Amicus Award from the American Academy of Psychiatry and Law. In addition, Dr. Rogers is only the fourth psychologist to receive Distinguished Professional Contributions awards for both Applied Research and Public Policy from the American Psychological Association. He is the principal author of the Structured Interview of Reported Symptoms (SIRS) and its second edition (SIRS-2), often considered the premier measure for feigned mental disorders.
Scott D. Bender, PhD, ABPP-CN, is Associate Professor of Psychiatry and Neurobehavioral Science at the University of Virginia (UVA). His primary appointment is with the Institute of Law, Psychiatry, and Public Policy at UVA, where his duties include teaching, research, and conducting forensic neuropsychological evaluations. Dr. Bender has published extensively, and his research focuses on differential diagnosis of malingering and the effects of traumatic brain injury on neurocognitive and emotional functioning. He frequently testifies on these and related matters in both criminal and civil cases.
PART I. CONCEPTUAL FRAMEWORK, 1. An Introduction to Response Styles Richard Rogers, 3, 2. Detection Strategies for Malingering and Defensiveness Richard Rogers, 18, 3. Neuropsychological Models of Feigned Cognitive Deficits Scott D. Bender and Richard Frederick, 42, 4. Beyond Borders: Cultural and Transnational Perspectives of Feigning and Other Response Styles Amor A. Correa, 61, PART II. DIAGNOSTIC ISSUES, 5. Syndromes Associated with Deception Michael J. Vitacco, 83, 6. Malingered Psychosis Phillip J. Resnick and James L. Knoll, IV, 98, 7. Malingered Traumatic Brain Injury Scott D. Bender, 122, 8. Denial and Misreporting of Substance Abuse Lynda A. R. Stein, Richard Rogers, and Sarah Henry, 151, 9. Psychopathy and Deception Nathan D. Gillard, 174, 10. The Malingering of Posttraumatic Disorders Phillip J. Resnick, Sara G. West, and Chelsea N. Wooley, 188, 11. Factitious Disorders in Medical and Psychiatric Practices Gregory P. Yates, Mazheruddin M. Mulla, James C. Hamilton, and Marc D. Feldman, 212, 12. Conversion Disorder and Illness Deception Richard A. A. Kanaan, 236, 13. Feigned Medical Presentations Robert P. Granacher, Jr., and David T. R. Berry, 243, PART III. PSYCHOMETRIC METHODS, 14. Assessment of Malingering and Defensiveness on the MMPI-2 and MMPI-2-RF Dustin B. Wygant, Brittany D. Walls, Stacey L. Brothers, and David T. R. Berry, 257, 15. Response Style on the Personality Assessment Inventory and Other Multiscale Inventories Marcus T. Boccaccini and Jessica R. Hart, 280, 16. Dissimulation on Projective Measures: An Updated Appraisal of a Very Old Question Kenneth W. Sewell and Ashley C. Helle, 301, 17. Feigned Amnesia and Memory Problems Richard Frederick, 314, 18. Assessment of Feigned Cognitive Impairment Using Standard Neuropsychological Tests Natasha E. Garcia-Willingham, Chelsea M. Bosch, Brittany D. Walls, and David T. R. Berry, 329, PART IV. SPECIALIZED METHODS, 19. Assessing Deception: Polygraph Techniques and Integrity Testing William G. Iacono and Christopher J. Patrick, 361, 20. Recovered Memories of Childhood Sexual Abuse Richard J. McNally, 387, 21. Detection of Deception in Sex Offenders Philip H. Witt and Daniel J. Neller, 401, 22. Structured Interviews and Dissimulation Richard Rogers, 422, 23. Brief Measures for the Detection of Feigning and Impression Management Glenn Smith, 449, PART V. SPECIALIZED APPLICATIONS, 24. Deception in Children and Adolescents Randall T. Salekin, Franz A. Kubak, Zina Lee, Natalie Harrison, and Abby P. Clark, 475, 25. Use of Psychological Tests in Child Custody Evaluations: Effects of Validity Scale Scores on Evaluator Confidence in Interpreting Clinical Scales Jonathan W. Gould, Sol R. Rappaport, and James R. Flens, 497, 26. Malingering: Considerations in Reporting and Testifying about Assessment Results Eric Y. Drogin and Carol S. Williams, 514, 27. Evaluating Deceptive Impression Management in Personnel Selection and Job Performance Julia Levashina, 530, 28. Assessment of Law Enforcement Personnel: The Role of Response Styles Rebecca L. Jackson and Kimberly S. Harrison, 552, PART VI. SUMMARY, 29. Current Status of the Clinical Assessment of Response Styles Richard Rogers, 571, 30. Researching Response Styles Richard Rogers, 592, Author Index, 615, Subject Index, 638,
CHAPTER 1
An Introduction to Response Styles
Richard Rogers, PhD
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. Baumann and Hill (2016) found that outpatient clients sometimes did not divulge personal matters related to sexual experiences, substance abuse, and relationship experiences. Despite imagining positive gains from such personal disclosures, many clients elected not to be fully forthcoming about deeply personal issues. Deceptions in therapy are not relegated to undisclosed personal issues. In surveying 547 former or current therapy clients, Blanchard and Farber (2016) found that many minimized their distress (53.9%) and symptom severity (38.8%). Regarding their therapists, appreciable percentages resorted to deceit in pretending to like their comments/suggestions (29.4%), overstating the effectiveness of therapy (28.5%), and pretending to do homework or other actions (25.6%). Even more concerning was the frequency of these therapy-focused deceptions, which occurred moderate or greater amounts of time. To put these findings in context, therapists also vary considerably in their numbers and types of self-disclosures (Levitt et al., 2016).
Deceptions routinely occur in personal relationships, including intimate relationships, with relatively few (27%) espousing the belief that complete honesty is needed for a successful romantic relationship (Boon, & McLeod, 2001). Interestingly, these authors found that most persons believe they are much better (Cohen's d = 0.71) than their partners at "successful" (undetected) deceptions. Even in intimate relationships, willingness to self-disclose is variable and multidetermined (Laurenceau, Barrett, & Rovine, 2005). Romantic partners may have implicitly understood rules about what dishonesties may be allowed in their intimate relationships (Roggensack & Sillars, 2014).
Beyond therapy and relationships, deceptions commonly occur in the workplace, including the concealments of mental disorders. Most of the 17 to 20% of 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 (De Lorenzo, 2013). A national survey of professionals and managers by Ellison, Russinova, MacDonald-Wilson, and Lyass (2003) has important implications for understanding individuals' disclosures and deceptions regarding mental disorders. The majority of these employees had disclosed their psychiatric conditions to their supervisors and coworkers. However, many disclosures were not entirely voluntary (e.g., they were given in response to pressure to explain health-related absences), and about one-third regretted their decisions because of negative repercussions. Moreover, the degree of self-disclosure (e.g., diagnosis, symptoms, or im4 I . Conceptual Framework pairment) and the timing of the disclosures were highly variable. Nondisclosing employees were typically motivated by fears of job security and concerns about stigma. What are the two key implications of the study by Ellison et al.? First, decisions about response styles (disclose or deceive) are often rational and multidetermined; this theme is explored later in the context of the adaptational model. Second, 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. For example, malingerers are sometimes misconstrued as having an invariant response style, unmodified by circumstances and personal motivations.
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. Jones and King (2014) provide a penetrating analysis of determinants for whether employees disclose, conceal, or signal (i.e., "testing the waters," p. 1471) about themselves (e.g., gender identity) and their own personal experiences (e.g., childhood traumas). 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. Social desirability and impression management may prevail during the job application process but later be abandoned once hiring is completed.
Clients in an evaluative context may experience internal and external influences on their self-reporting. Within a forensic context, for example, clients may respond to the adversarial effects of litigation — sometimes referred to as the lexogenic effects — in which their credibility is implicitly questioned (Rogers & Payne, 2006). As observed by Rogers and Bender (2003), these same clients may also be influenced internally by their diagnosis (e.g., borderline personality disorder), identity (e.g., avoidance of stigmatization), or intentional goals (e.g., malingering). By necessity, most chapters in this volume focus on one or more response style within a single domain (e.g., mental disorders, cognitive abilities, or medical complaints).
In summary, all individuals fall short of full and accurate self-disclosure, irrespective of the social context. To be fair, mental health professionals are often not fully forthcoming with clients about their assessment and treatment methods (Bersoff, 2008). In providing informed consent, how thoroughly do most practitioners describe therapeutic modalities, which they do not provide? This question is not intended to be provocative; it is simply a reminder that professionals and their clients alike may not fully embrace honesty at any cost.
In the context of clinical assessments, mental health professionals may wish to consider what level of deception should be documented in their reports. One reasoned approach would be to record only consequential deceptions and distortions. For instance, Norton and Ryba (2010) asked coached simulators to feign incompetency on the Evaluation of Competency to Stand Trial — Revised (ECSTR; Rogers, Tillbrook, & Sewell, 2004). However, many simulators could be categorized as doublefailures; they failed to elude the ECST-R Atypical scales (i.e., screens for possible feigning) and also failed to produce anything more than normal to mild impairment (i.e., they appeared competent) on the ECST-R Competency scales. What should be done with such inconsequential distortions? In this specific case, the answer may be characterized as straightforward. Simply as screens, the ECST-R Atypical scales cast a wide net, so that few possible feigners are missed. As a result, no comment is needed, because substantial numbers of genuine responders score above the cutoff scores.
The general issue of inconsequential deceptions should be considered carefully. Simply as a thought experiment, two extreme alternatives are presented: the taint hypothesis and the beyond-reasonable-doubt standard.
1. 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.
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.
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 the sometimes very serious consequences of categorizing an examinee as a nongenuine responder.
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. While it is likely that some genuinely disordered persons may attempt to malinger, the question remains unanswered whether fact finders simply dismiss all mental health issues as unsubstantiated. 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: (1) accuracy versus completeness of their conclusion, and (2) use versus misuse of clinical findings by others. For example, a forensic psychologist may conclude that the examinee's false denial of drug experimentation during his or her undergraduate years is difficult to establish and potentially prejudicial to a posttraumatic stress disorder (PTSD)-based personal injury case.
As an introduction to response styles, this chapter has the primary goal of familiarizing practitioners and researchers with general concepts associated with malingering and deception. It operationalizes response styles and outlines common misconceptions associated with malingering and other forms of dissimulation. Conceptually, it distinguishes explanatory models from detection strategies. Because research designs affect the validity of clinical findings, a basic overview is provided. Finally, this chapter outlines the content and objectives of the subsequent chapters.
FUNDAMENTALS OF RESPONSE STYLES
Basic Concepts and Definitions
Considerable progress continues to been made in the standardization of terms and operationalization of response styles. Such standardization is essential to any scientific endeavor for ensuring accuracy and replicability. This section is organized conceptually into four categories: nonspecific terms, overstated pathology, simulated adjustment, and other response styles.
Nonspecific Terms
Practitioners and researchers seek precision in the description of response styles. Why then begin the consideration of response styles with nonspecific terms? It is my hope that moving from general to specific categories will limit decisional errors in the determination of response styles. As a consultant on malingering and related response styles, I find that a very common error appears to be the overspecification of response styles. For instance, criminal offenders are frequently miscategorized as malingerers simply because of their manipulative behavior, which may include asking for special treatment (e.g., overuse of medical call for minor complaints) or displaying inappropriate behavior (e.g., a relatively unimpaired inmate exposing his genitals). When disabled clients express ambivalence toward clinical or medical interventions, their less-than-wholehearted attitudes are sometimes misconstrued as prima facie evidence of secondary gain (see Rogers & Payne, 2006).
The working assumption for errors in the over-specification of response styles is that practitioners approach this diagnostic classification by trying to determine which specific response style best fits the clinical data. Often, this approach results in the specification of a response style, even when the data are inconclusive, or even conflicting. As outlined in Box 1.1, a two-step approach is recommended.
This approach asks practitioners to make an explicit decision between nonspecific or general descriptions and specific response styles. Clearly, conclusions about specific response styles are generally more helpful to clinical conclusions than simply nonspecific descriptions. Therefore, nonspecific descriptions should be considered first to reduce the understandable tendency of overreaching data when conclusions about specific response styles cannot be convincingly demonstrated.
Nonspecific terms are presented in a bulleted format as an easily accessible reference. Terms are defined and often accompanied with a brief commentary:
• Unreliability is a 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. This
• Nondisclosure simply describes a withholding of information (i.e., omission). Similar to unreliability, it makes no assumptions about intentionality. An individual may freely choose whether to divulge information, or alternatively, feel compelled by internal demands (e.g., command hallucinations) to withhold information.
• Self-disclosure refers to how much individuals reveal about themselves (Jourard, 1971). 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 (Hall, 2011). A lack of self-disclosure does not imply dishonesty but simply an unwillingness to share personal information.
• Deception is an all-encompassing term to describe any consequential attempts by individuals to distort or misrepresent their self-reporting. As operationalized, deception includes acts of deceit 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 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
Important distinctions must be realized between malingering and other terms used to describe overstated pathology. For example, the determination of malingering requires the exclusion of factitious presentations (see Vitacco, Chapters 5, Yates, Mulla, Hamilton, & Feldman, Chapter 11, this volume). This subsection addresses three recommended terms: malingering, factitious presentations, and feigning. It also includes three quasi-constructs (secondary gain, overreporting, and suboptimal effort) that should be avoided in most clinical and forensic evaluations.
Recommended terms to categorize overstated pathology:
1. Malingering has been consistently defined by DSM nosology as "the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives" (American Psychiatric Association, 2013, p. 726). An important consideration is magnitude of the dissimulation; it must be the fabrication or gross exaggeration of multiple symptoms. The 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.
2. Factitious presentations are characterized by the "intentional production or feigning" of symptoms that is motivated by the desire to assume a "sick role" (APA, 2000, p. 517). However, the description of the motivation is no longer specified; DSM-5 (APA, 2013, p. 324) offers only the following: "The deceptive behavior is evident even in the absence of obvious external rewards." Thus, the diagnosis of factitious disorders does not preclude external incentives but rather requires some unspecified internal motivation. This nonexclusion of external motivations makes sense, since internal and external motivations can often cooccur (Rogers, Jackson, & Kaminski, 2004).
3. Feigning is the deliberate fabrication or gross exaggeration of psychological or physical symptoms, without any assumptions about its goals (Rogers & Bender, 2003, 2013). This term was introduced because standardized measures of response styles (e.g., psychological tests) have not been validated to assess an individual's specific motivations. Therefore, determinations can often be made for feigned presentations but not their underlying motivations. To underscore this point, psychological tests can be used to establish feigning but not malingering.
Widely used by practitioners, researchers, and students--and now thoroughly revised with 70% new material--this is the most authoritative, comprehensive book on malingering and other response styles. Leading experts translate state-of-the-art research into clear, usable strategies for detecting intentional distortions in a wide range of psychological and psychiatric evaluation contexts, including forensic settings. The book examines dissimulation across multiple domains: mental disorders, cognitive impairments, and medical complaints. It describes and critically evaluates evidence-based applications of multiscale inventories, other psychological measures, and specialized methods. Applications are discussed for specific populations, such as sex offenders, children and adolescents, and law enforcement personnel.
New to This Edition
Many new authors and topics.
Thoroughly updated with current data, research methods, and assessment strategies.
Chapters on neuropsychological models, culturally competent assessments, psychopathy, and conversion disorder.
Chapters on psychological testing in child custody cases and in personnel selection/hiring.
Críticas
"With the addition of the neuropsychological perspective, this fourth edition includes everything a legal or clinical practitioner needs to know about the state of the art in deception detection. The assembled authors are impressive, and Rogers and Bender are acknowledged leaders in the field. Do not go into court in a case involving behavioral science issues without consulting this book."--Christopher Slobogin, JD, LLM, Milton Underwood Professor of Law, Vanderbilt University Law School
"The premier work on malingering and deception just got better! The fourth edition of this classic book provides up-to-date, insightful coverage of one of the most important topics in forensic mental health assessment. Rogers and Bender have assembled a world-class cast of contributors with broad research and clinical expertise. The fourth edition includes new chapters on cutting-edge topics, including neuropsychological models of feigned cognitive deficits, psychopathy, child custody, personnel selection, and more. This book is both scholarly and practical, which makes it attractive to students and experienced professionals alike. This is much more than a 'bookshelf' book--it is essential, indispensable reading for those who are or will be involved in conducting forensic mental health assessments."--David DeMatteo, JD, PhD, ABPP, Department of Psychology and Thomas R. Kline School of Law, Drexel University
"Clinicians and forensic practitioners will welcome the fourth edition of this book, particularly in the face of growing concern about the liability that may attend unwarranted use of the ‘malingering’ label. The stellar cast of contributors explores the terrain sensitively and with scholarly incisiveness, assuring the book's appeal to forensic psychology and psychiatry trainees.”--Ezra E. H. Griffith, MD, Professor Emeritus of Psychiatry and African American Studies, Yale School of Medicine
"This is an excellent book written by experts in the field. It covers deception in various populations, along with both psychological and medical illnesses. The fourth edition is justified because of the new chapters on neuropsychology and cultural assessments, along with revisions in the remaining chapters. *!” ― Doody's Review Service Published On: 2018-10-12
"This excellent and standard reference [occupies] a crucial space on many forensic psychiatrists' and psychologists' bookshelves....Useful in clinical practice, especially in institutions that serve forensic or correctional populations." (on the third edition) ― Journal of Psychiatric Practice Published On: 2008-01-01
“This is a rich volume that provides information and assessment strategies for patients who may be clinical challenges and enigmas. It is a lucid, well-written and helpful volume.” (on the third edition) ― International Journal of Social Psychiatry Published On: 2013-01-01
"Akin to the eminence of the late Hervey Cleckley or Robert Hare as authorities on the topic of psychopathy, it is not unreasonable to accord Professor Richard Rogers analogous status as one of the world's leading scholars on the assessment of malingering....Professor Rogers's text and the wealth of knowledge he has compiled from an august collection of contributors should be viewed as a mandatory item for all forensic mental health practitioners." (on the third edition) ― International Journal of Offender Therapy and Comparative Criminology Published On: 2010-02-01
Biografía del autor
Richard Rogers, PhD, ABPP, is Regents Professor of Psychology at the University of North Texas. He is a recipient of the Guttmacher Award from the American Psychiatric Association, the Distinguished Contributions to Forensic Psychology Award from the American Academy of Forensic Psychologists, and the Amicus Award from the American Academy of Psychiatry and Law. In addition, Dr. Rogers is only the fourth psychologist to receive Distinguished Professional Contributions awards for both Applied Research and Public Policy from the American Psychological Association. He is the principal author of the Structured Interview of Reported Symptoms (SIRS) and its second edition (SIRS-2), often considered the premier measure for feigned mental disorders.
Scott D. Bender, PhD, ABPP-CN, is Associate Professor of Psychiatry and Neurobehavioral Science at the University of Virginia (UVA). His primary appointment is with the Institute of Law, Psychiatry, and Public Policy at UVA, where his duties include teaching, research, and conducting forensic neuropsychological evaluations. Dr. Bender has published extensively, and his research focuses on differential diagnosis of malingering and the effects of traumatic brain injury on neurocognitive and emotional functioning. He frequently testifies on these and related matters in both criminal and civil cases.
Extracto. © Reimpreso con autorización. Reservados todos los derechos.
Clinical Assessment of Malingering and Deception
By Richard Rogers, Scott D. Bender
The Guilford Press
Copyright © 2018 The Guilford Press
All rights reserved.
ISBN: 978-1-4625-3349-7
Contents
PART I. CONCEPTUAL FRAMEWORK,
1. An Introduction to Response Styles Richard Rogers, 3,
2. Detection Strategies for Malingering and Defensiveness Richard Rogers, 18,
3. Neuropsychological Models of Feigned Cognitive Deficits Scott D. Bender and Richard Frederick, 42,
4. Beyond Borders: Cultural and Transnational Perspectives of Feigning and Other Response Styles Amor A. Correa, 61,
PART II. DIAGNOSTIC ISSUES,
5. Syndromes Associated with Deception Michael J. Vitacco, 83,
6. Malingered Psychosis Phillip J. Resnick and James L. Knoll, IV, 98,
7. Malingered Traumatic Brain Injury Scott D. Bender, 122,
8. Denial and Misreporting of Substance Abuse Lynda A. R. Stein, Richard Rogers, and Sarah Henry, 151,
9. Psychopathy and Deception Nathan D. Gillard, 174,
10. The Malingering of Posttraumatic Disorders Phillip J. Resnick, Sara G. West, and Chelsea N. Wooley, 188,
11. Factitious Disorders in Medical and Psychiatric Practices Gregory P. Yates, Mazheruddin M. Mulla, James C. Hamilton, and Marc D. Feldman, 212,
12. Conversion Disorder and Illness Deception Richard A. A. Kanaan, 236,
13. Feigned Medical Presentations Robert P. Granacher, Jr., and David T. R. Berry, 243,
PART III. PSYCHOMETRIC METHODS,
14. Assessment of Malingering and Defensiveness on the MMPI-2 and MMPI-2-RF Dustin B. Wygant, Brittany D. Walls, Stacey L. Brothers, and David T. R. Berry, 257,
15. Response Style on the Personality Assessment Inventory and Other Multiscale Inventories Marcus T. Boccaccini and Jessica R. Hart, 280,
16. Dissimulation on Projective Measures: An Updated Appraisal of a Very Old Question Kenneth W. Sewell and Ashley C. Helle, 301,
17. Feigned Amnesia and Memory Problems Richard Frederick, 314,
18. Assessment of Feigned Cognitive Impairment Using Standard Neuropsychological Tests Natasha E. Garcia-Willingham, Chelsea M. Bosch, Brittany D. Walls, and David T. R. Berry, 329,
PART IV. SPECIALIZED METHODS,
19. Assessing Deception: Polygraph Techniques and Integrity Testing William G. Iacono and Christopher J. Patrick, 361,
20. Recovered Memories of Childhood Sexual Abuse Richard J. McNally, 387,
21. Detection of Deception in Sex Offenders Philip H. Witt and Daniel J. Neller, 401,
22. Structured Interviews and Dissimulation Richard Rogers, 422,
23. Brief Measures for the Detection of Feigning and Impression Management Glenn Smith, 449,
PART V. SPECIALIZED APPLICATIONS,
24. Deception in Children and Adolescents Randall T. Salekin, Franz A. Kubak, Zina Lee, Natalie Harrison, and Abby P. Clark, 475,
25. Use of Psychological Tests in Child Custody Evaluations: Effects of Validity Scale Scores on Evaluator Confidence in Interpreting Clinical Scales Jonathan W. Gould, Sol R. Rappaport, and James R. Flens, 497,
26. Malingering: Considerations in Reporting and Testifying about Assessment Results Eric Y. Drogin and Carol S. Williams, 514,
27. Evaluating Deceptive Impression Management in Personnel Selection and Job Performance Julia Levashina, 530,
28. Assessment of Law Enforcement Personnel: The Role of Response Styles Rebecca L. Jackson and Kimberly S. Harrison, 552,
PART VI. SUMMARY,
29. Current Status of the Clinical Assessment of Response Styles Richard Rogers, 571,
30. Researching Response Styles Richard Rogers, 592,
Author Index, 615,
Subject Index, 638,
CHAPTER 1
An Introduction to Response Styles
Richard Rogers, PhD
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. Baumann and Hill (2016) found that outpatient clients sometimes did not divulge personal matters related to sexual experiences, substance abuse, and relationship experiences. Despite imagining positive gains from such personal disclosures, many clients elected not to be fully forthcoming about deeply personal issues. Deceptions in therapy are not relegated to undisclosed personal issues. In surveying 547 former or current therapy clients, Blanchard and Farber (2016) found that many minimized their distress (53.9%) and symptom severity (38.8%). Regarding their therapists, appreciable percentages resorted to deceit in pretending to like their comments/suggestions (29.4%), overstating the effectiveness of therapy (28.5%), and pretending to do homework or other actions (25.6%). Even more concerning was the frequency of these therapy-focused deceptions, which occurred moderate or greater amounts of time. To put these findings in context, therapists also vary considerably in their numbers and types of self-disclosures (Levitt et al., 2016).
Deceptions routinely occur in personal relationships, including intimate relationships, with relatively few (27%) espousing the belief that complete honesty is needed for a successful romantic relationship (Boon, & McLeod, 2001). Interestingly, these authors found that most persons believe they are much better (Cohen's d = 0.71) than their partners at "successful" (undetected) deceptions. Even in intimate relationships, willingness to self-disclose is variable and multidetermined (Laurenceau, Barrett, & Rovine, 2005). Romantic partners may have implicitly understood rules about what dishonesties may be allowed in their intimate relationships (Roggensack & Sillars, 2014).
Beyond therapy and relationships, deceptions commonly occur in the workplace, including the concealments of mental disorders. Most of the 17 to 20% of 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 (De Lorenzo, 2013). A national survey of professionals and managers by Ellison, Russinova, MacDonald-Wilson, and Lyass (2003) has important implications for understanding individuals' disclosures and deceptions regarding mental disorders. The majority of these employees had disclosed their psychiatric conditions to their supervisors and coworkers. However, many disclosures were not entirely voluntary (e.g., they were given in response to pressure to explain health-related absences), and about one-third regretted their decisions because of negative repercussions. Moreover, the degree of self-disclosure (e.g., diagnosis, symptoms, or im4 I . Conceptual Framework pairment) and the timing of the disclosures were highly variable. Nondisclosing employees were typically motivated by fears of job security and concerns about stigma. What are the two key implications of the study by Ellison et al.? First, decisions about response styles (disclose or deceive) are often rational and multidetermined; this theme is explored later in the context of the adaptational model. Second, 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. For example, malingerers are sometimes misconstrued as having an invariant response style, unmodified by circumstances and personal motivations.
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. Jones and King (2014) provide a penetrating analysis of determinants for whether employees disclose, conceal, or signal (i.e., "testing the waters," p. 1471) about themselves (e.g., gender identity) and their own personal experiences (e.g., childhood traumas). 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. Social desirability and impression management may prevail during the job application process but later be abandoned once hiring is completed.
Clients in an evaluative context may experience internal and external influences on their self-reporting. Within a forensic context, for example, clients may respond to the adversarial effects of litigation — sometimes referred to as the lexogenic effects — in which their credibility is implicitly questioned (Rogers & Payne, 2006). As observed by Rogers and Bender (2003), these same clients may also be influenced internally by their diagnosis (e.g., borderline personality disorder), identity (e.g., avoidance of stigmatization), or intentional goals (e.g., malingering). By necessity, most chapters in this volume focus on one or more response style within a single domain (e.g., mental disorders, cognitive abilities, or medical complaints).
In summary, all individuals fall short of full and accurate self-disclosure, irrespective of the social context. To be fair, mental health professionals are often not fully forthcoming with clients about their assessment and treatment methods (Bersoff, 2008). In providing informed consent, how thoroughly do most practitioners describe therapeutic modalities, which they do not provide? This question is not intended to be provocative; it is simply a reminder that professionals and their clients alike may not fully embrace honesty at any cost.
In the context of clinical assessments, mental health professionals may wish to consider what level of deception should be documented in their reports. One reasoned approach would be to record only consequential deceptions and distortions. For instance, Norton and Ryba (2010) asked coached simulators to feign incompetency on the Evaluation of Competency to Stand Trial — Revised (ECSTR; Rogers, Tillbrook, & Sewell, 2004). However, many simulators could be categorized as doublefailures; they failed to elude the ECST-R Atypical scales (i.e., screens for possible feigning) and also failed to produce anything more than normal to mild impairment (i.e., they appeared competent) on the ECST-R Competency scales. What should be done with such inconsequential distortions? In this specific case, the answer may be characterized as straightforward. Simply as screens, the ECST-R Atypical scales cast a wide net, so that few possible feigners are missed. As a result, no comment is needed, because substantial numbers of genuine responders score above the cutoff scores.
The general issue of inconsequential deceptions should be considered carefully. Simply as a thought experiment, two extreme alternatives are presented: the taint hypothesis and the beyond-reasonable-doubt standard.
1. 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.
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.
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 the sometimes very serious consequences of categorizing an examinee as a nongenuine responder.
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. While it is likely that some genuinely disordered persons may attempt to malinger, the question remains unanswered whether fact finders simply dismiss all mental health issues as unsubstantiated. 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: (1) accuracy versus completeness of their conclusion, and (2) use versus misuse of clinical findings by others. For example, a forensic psychologist may conclude that the examinee's false denial of drug experimentation during his or her undergraduate years is difficult to establish and potentially prejudicial to a posttraumatic stress disorder (PTSD)-based personal injury case.
As an introduction to response styles, this chapter has the primary goal of familiarizing practitioners and researchers with general concepts associated with malingering and deception. It operationalizes response styles and outlines common misconceptions associated with malingering and other forms of dissimulation. Conceptually, it distinguishes explanatory models from detection strategies. Because research designs affect the validity of clinical findings, a basic overview is provided. Finally, this chapter outlines the content and objectives of the subsequent chapters.
FUNDAMENTALS OF RESPONSE STYLES
Basic Concepts and Definitions
Considerable progress continues to been made in the standardization of terms and operationalization of response styles. Such standardization is essential to any scientific endeavor for ensuring accuracy and replicability. This section is organized conceptually into four categories: nonspecific terms, overstated pathology, simulated adjustment, and other response styles.
Nonspecific Terms
Practitioners and researchers seek precision in the description of response styles. Why then begin the consideration of response styles with nonspecific terms? It is my hope that moving from general to specific categories will limit decisional errors in the determination of response styles. As a consultant on malingering and related response styles, I find that a very common error appears to be the overspecification of response styles. For instance, criminal offenders are frequently miscategorized as malingerers simply because of their manipulative behavior, which may include asking for special treatment (e.g., overuse of medical call for minor complaints) or displaying inappropriate behavior (e.g., a relatively unimpaired inmate exposing his genitals). When disabled clients express ambivalence toward clinical or medical interventions, their less-than-wholehearted attitudes are sometimes misconstrued as prima facie evidence of secondary gain (see Rogers & Payne, 2006).
The working assumption for errors in the over-specification of response styles is that practitioners approach this diagnostic classification by trying to determine which specific response style best fits the clinical data. Often, this approach results in the specification of a response style, even when the data are inconclusive, or even conflicting. As outlined in Box 1.1, a two-step approach is recommended.
This approach asks practitioners to make an explicit decision between nonspecific or general descriptions and specific response styles. Clearly, conclusions about specific response styles are generally more helpful to clinical conclusions than simply nonspecific descriptions. Therefore, nonspecific descriptions should be considered first to reduce the understandable tendency of overreaching data when conclusions about specific response styles cannot be convincingly demonstrated.
Nonspecific terms are presented in a bulleted format as an easily accessible reference. Terms are defined and often accompanied with a brief commentary:
• Unreliability is a 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. This
• Nondisclosure simply describes a withholding of information (i.e., omission). Similar to unreliability, it makes no assumptions about intentionality. An individual may freely choose whether to divulge information, or alternatively, feel compelled by internal demands (e.g., command hallucinations) to withhold information.
• Self-disclosure refers to how much individuals reveal about themselves (Jourard, 1971). 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 (Hall, 2011). A lack of self-disclosure does not imply dishonesty but simply an unwillingness to share personal information.
• Deception is an all-encompassing term to describe any consequential attempts by individuals to distort or misrepresent their self-reporting. As operationalized, deception includes acts of deceit 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 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
Important distinctions must be realized between malingering and other terms used to describe overstated pathology. For example, the determination of malingering requires the exclusion of factitious presentations (see Vitacco, Chapters 5, Yates, Mulla, Hamilton, & Feldman, Chapter 11, this volume). This subsection addresses three recommended terms: malingering, factitious presentations, and feigning. It also includes three quasi-constructs (secondary gain, overreporting, and suboptimal effort) that should be avoided in most clinical and forensic evaluations.
Recommended terms to categorize overstated pathology:
1. Malingering has been consistently defined by DSM nosology as "the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives" (American Psychiatric Association, 2013, p. 726). An important consideration is magnitude of the dissimulation; it must be the fabrication or gross exaggeration of multiple symptoms. The 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.
2. Factitious presentations are characterized by the "intentional production or feigning" of symptoms that is motivated by the desire to assume a "sick role" (APA, 2000, p. 517). However, the description of the motivation is no longer specified; DSM-5 (APA, 2013, p. 324) offers only the following: "The deceptive behavior is evident even in the absence of obvious external rewards." Thus, the diagnosis of factitious disorders does not preclude external incentives but rather requires some unspecified internal motivation. This nonexclusion of external motivations makes sense, since internal and external motivations can often cooccur (Rogers, Jackson, & Kaminski, 2004).
3. Feigning is the deliberate fabrication or gross exaggeration of psychological or physical symptoms, without any assumptions about its goals (Rogers & Bender, 2003, 2013). This term was introduced because standardized measures of response styles (e.g., psychological tests) have not been validated to assess an individual's specific motivations. Therefore, determinations can often be made for feigned presentations but not their underlying motivations. To underscore this point, psychological tests can be used to establish feigning but not malingering.
(Continues...) Excerpted from Clinical Assessment of Malingering and Deception by Richard Rogers, Scott D. Bender. Copyright © 2018 The Guilford Press. Excerpted by permission of The Guilford Press.
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