An International Perspective on Feigned Mental Disabilities: Conceptual Issues and Continuing Controversies

Abstract

In forensic contexts, an increased prevalence of feigned symptom presentations should be expected, although it will probably vary by the context and specific forensic issue. Forensic experts should examine this possibility proactively while maintaining a balanced perspective that actively considers clinical data for both feigning and genuine responding. Psychological measures and standardized methods developed for feigning and other response styles can facilitate these often complex determinations. The current article provides an international perspective on the issue of feigned mental disabilities. In particular, important conceptual issues are discussed, such as the categorical versus dimensional approaches to feigning, and the advisability of well-defined rather than single-point cut scores for accuracy in clinical decision-making. Salient problems of differential diagnosis include a spectrum from malingering and factitious disorders to somatoform and conversion disorders. In rendering these important diagnostic distinctions, the questions of motivations and intentions remain key. However, the establishment of motivation cannot be facilely assumed from the context. Instead, forensic psychologists and psychiatrists bear the professional burden of carefully evaluating motivation and recognizing the clinical reality that sometimes the motivation in especially challenging cases may not be fully determined. Copyright © 2017 John Wiley & Sons, Ltd.

A multi-method approach to the detection of fabricated symptoms

“…This led some workers in the field to take a sceptical position as to the utility of SVTs across different cultural settings. For example, Merten and Rogers, (2017;p. 106) wrote: "Assuming that any feigning measure is universally applicable across languages and diverse cultures is categorically unacceptable."…”

“…Furthermore, the language in which a medical or psychological examination is conducted may affect the response style of patients (Harzing, 2006;, leading to possibly inaccurate conclusions about significantly different prevalence levels of exaggerated symptomatology across countries ). However, there are only a few cross-cultural studies on symptom validity assessment (e.g., Merten & Rogers, 2017), and even less research has focused on practitioners' judgments of atypical symptoms across cultures.…”

“…Endorsing more than 16 of these atypical symptoms indicates a heightened probability of exaggerated symptom presentation (Merckelbach & Smith, 2003). Although the internal consistency of the SIMS is satisfactory, its test-retest stability is sufficient, and its ability to discriminate between symptom exaggeration and honest responding is fairly effective (with sensitivities varying between 75% and 100%; van Impelen et al, 2014), some authors have expressed concerns about using SVTs such as the SIMS in patients or defendants with a non-Western background (Merten & Rogers, 2017;. Specifically, Merten and Rogers (2017) note that the detection of exaggerated symptoms in minority groups might be complicated by culturally distinct illness expression and clinicians' stereotypes about malingering in migrant workers.…”

Differentiating factitious psychological presentations from malingering: Implications for forensic practice

“…Specialty guidelines for forensic psychologists (American Psychological Association, , p. 9) expect that practitioners will be fair and balanced in their assessments and “weigh all data, opinions, and rival hypotheses impartially.” When feigning is observed, two rival hypotheses must consider whether the presentation constitutes malingering (i.e., external motivation) or a factitious disorder (i.e., “absence of obvious external rewards;” American Psychiatric Association, , p. 324). Within the domain of feigned mental disorders, Merten and Rogers () posited a malingering bias (i.e., feigning should be attributed to malingering) for forensic examinees and a factitious bias (i.e., feigning should be attributed to the adoption of a sick role) for patients in treatment. These postulations are indirectly informed by the substantial prevalence of malingering (Rogers, Salekin, Sewell, Goldstein, & Leonard, ; Young, ) and the comparative rarity of diagnosed factitious disorders in forensic settings.…”

“…Although hundreds of studies have utilized simulation designs (Rogers & Bender, 2013) to study malingering with its external motivation, we are aware of only 2 | DIAGNOSTIC AND ETIOLOGICAL CONSIDERATIONS 2.1 | Overview Both physical and psychological deceptions have been extensively studied and provide compelling evidence that some patients intentionally falsify, exaggerate, or lie about symptoms motivated by external or internal gains (Hamilton, Feldman & Cunnien, 2008). Despite serious classificatory limitations (Merten & Rogers, 2017), feigned presentations are traditionally dichotomized into malingering and factitious disorders. Malingering is categorized as a condition "that may be the focus of clinical attention" (American Psychiatric Association, 2013a, p. 715); it is applied to feigning motivated by external goals, such as financial resources or less harsh legal sentencing (Yates, Mulla, Hamilton, & Feldman, 2018).…”