A Lab Model for Symptom Exaggeration: What do we Need?

Abstract

This article reflects on the current state of the art in research on individuals who exaggerate their symptoms (i.e., feigning). We argue that the most commonly used approach in this field, namely simply providing research participants with instructions to overreport symptoms, is valuable for validating measures that tap into symptom exaggeration, but is less suitable for addressing the theoretical foundations of feigning. That is, feigning serves to actively mislead others and is done deliberately. These characteristics produce experiences (e.g., feelings of guilt) in individuals who feign that lab research in its current form is unable to accommodate for. Paradigms that take these factors into account may not only yield more ecologically valid data, but may also stimulate a shift from the study of how to detect feigning to more fundamental issues. One such issue is the cognitive dissonance (e.g., feelings of guilt) that-in some cases-accompanies feigning and that may foster internalized fabrications. We present three studies (N's = 78, 60, and 54) in which we tried to abate current issues and discuss their merits for future research.

The Self-Report Symptom Inventory (SRSI) is sensitive to instructed feigning, but not to genuine psychopathology in male forensic inpatients: An initial study

“…A second limitation of our study was that we instructed patients to feign symptoms and did not include a separate "known" group that exhibits poor symptom validity. Instructed feigners may behave differently than such known groups (Niesten et al, 2017). Specifically, instructed feigning may inflate sensitivity and specificity rates of an SVT.…”

A multi-method approach to the detection of fabricated symptoms

“…Healthy experimental participants and the conditions under which they are tested differ in important aspects from patients undergoing real-world forensic or clinical assessments. Thus, even with the most careful consideration of optimizing a simulation design (such as described by Nies & Sweet, 1994, or more recently Rogers, 2018;Niesten et al, 2017), the results of experimental simulation studies will be of limited generalizability. In particular, estimates of sensitivity and specificity have to be judged with greatest caution; they rather reflect to upper limits of classification accuracy of an instrument than its real diagnostic potential.…”

“…Thus, students were asked to either genuinely report about their (subclinical) symptoms or to fabricate non-existing complaints. This is important to note because, as such, the simulation design cannot fully emulate clinical assessment in a real-world setting (Niesten et al, 2017;Rogers, 2018).…”

“…The last, and possibly the most important issue concerns the restrictions associated with the simulation design applied in our research. Investigating malingering in an artificial environment eliminates two important features of this phenomenon: the deceit and the intent of a deceiver (Merten, 2017;Niesten, et al, 2017;Nies & Sweet, 1994). All the participants who were asked to malinger were instructed to feign certain conditions and were offered an incentive to do so.…”

“…The simulation design is adequate for validating measures used in symptom validity assessment. However, it does not allow a closer examination of underpinnings of malingering (Niesten et al, 2017;Merten et al, 2017). Thus, Niesten and her colleagues (2017) have proposed a new methodology for investigating malingering that may be associated with greater ecological validity.…”