During the last decades, symptom validity has become an important topic in the neuropsychological and psychiatric literature with respect to how it relates to malingering, factitious disorder, and somatoform complaints. We conducted a survey among neuropsychologists (N = 515) from six European countries (Germany, Italy, Denmark, Finland, Norway, and the Netherlands). We queried the respondents about the tools they used to evaluate symptom credibility in clinical and forensic assessments and other issues related to symptom validity testing (SVT). Although the majority of the respondents demonstrated technical knowledge about symptom validity, a sizeable minority of the respondents relied on outdated notions (e.g., the idea that clinicians can determine symptom credibility based on intuitive judgment). There is little consensus among neuropsychologists on how to instruct patients when they are administered SVTs and how to handle test failure. Our findings indicate that the issues regarding how to administer and communicate the SVT results to patients warrant systematic research.

The current study examined the prevalence of cognitive underperformance and symptom over-reporting in a mixed sample of psychiatric patients (N = 183). We employed the Amsterdam Short-Term Memory Test (ASTM) to measure cognitive underperformance and the Structured Inventory of Malingered Symptomatology (SIMS) to measure the tendency to over-report symptoms. We also administered neuropsychological tests (e.g., Concept Shifting Task; Rey's Verbal Learning Test) and the Symptom Checklist-90 (SCL-90) to the patients. A total of 34% of them failed the ASTM, the SIMS or both tests. ASTM and SIMS scores were significantly, albeit modestly, correlated with each other (r = -.22). As to the links between underperformance, over-reporting, neuropsychological tasks, and the SCL-90, the association between over-reporting on the SIMS and SCL-90 scores was the most robust one. The subsample that only failed on the ASTM performed significantly worse on a compound index of memory performance. Our findings indicate that underperformance and over-reporting are loosely coupled dimensions and that particularly over-reporting is intimately linked to heightened SCL-90 scores.

Some mental-health patients exaggerate their symptoms. Clinicians and laypeople often interpret this symptom overreporting as a sign of malingering (Martin, Schroeder, & Odland, 2015; Thompson, Lin, & Parsloe, 2018), a label with negative connotations such as dishonesty and antisocial traits. These connotations are also evident in how the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5; American Psychiatric Association, 2013) portrays malingering. According to the DSM-5, the defining feature of malingering is the intentional overreporting of symptoms, motivated by financial or legal benefits. However, whereas malingerers will engage in symptom overreporting, not everyone who overreports symptoms is a malingerer. When this is overlooked, misunderstandings may arise. Consider, as an example, a widely used test called the Structured Inventory of Malingered Symptomatology (SIMS; Smith & Burger, 1997). The SIMS asks respondents to indicate whether or not they suffer from atypical symptoms; for example, "Sometimes I lose all feeling in my hand so that it is as if I have a glove on." Using the SIMS, a clinician may test whether, relative to normative data, a patient endorses a heightened number of atypical symptoms. If so, the patient is said to overreport symptoms, and questions can be raised 837681C DPXXX10.

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We asked students, clinicians, and people from the general population attending a public university lecture (n = 401) whether they knew others who (had) feigned symptoms. We also asked about the type of symptoms and the motives involved. A slight majority of proxy respondents (59%) reported that they knew a person who (had) feigned symptoms, and 34% knew a person who had admitted to them having feigned symptoms. According to our respondents, the most often feigned symptoms were headache/migraine, common cold/fever, and stomachache/nausea, and the most important reasons for doing so were sick leave from work, excusing a failure, and seeking attention from others. We conclude that feigning is part of the normal behavioral repertoire of people and has little to do with deviant personality traits and/or criminal motives. Also, the current emphasis in the neuropsychological literature on malingering, i.e., feigning motivated by external incentives, might be one-sided given that psychological motives, notably seeking attention from others and excuse making, seem to be important determinants of everyday feigning.