Malingering - StatPearls - NCBI Bookshelf
Few studies have actually investigated the motivational basis of malingering and char- ANTISOCIAL PERSONALITY DISORDER AND MALINGERING This study investigated the relationship among psychopathology, intelligence Adult; African Americans; Antisocial Personality Disorder/complications; Anxiety. Apr 15, The assessment of malingering presents a significant challenge for that has little or no relationship to the development of the symptoms. and (4) the presence in the patient of antisocial personality disorder (ASPD). . and it has been used to investigate the feigning of other conditions, such as PTSD
Malingering and Personality Disorder 2 Malingering and Personality Disorder 2 The Structured Interview of Reported Symptoms SIRS is a item structured interview that is composed of detailed, repeated, and general inquires…created for the detection of malingering in order to measure specific strategies identified in the literature p.
These findings suggest that while deception may be an inherent characteristic of APD, many did not choose a strategy to malinger a psychiatric disorder p.
That is, for those with APD, malingering was not necessarily viewed as an advantageous approach p. Employing validated psychometric measures to detect malingering, together with clinical history variables and clinical presentation indicators characteristic of malingering in combination, in our view, represents the best forensic practice.
Using APD, as suggested by the DSM-IV, as a diagnosis suggestive of malingering, is we believe of limited utility, as the rate of false positive and false negative misdiagnosis would be so high as to preclude opinions based on APD diagnosis from admissibility in court p.
This study investigated whether the diagnosis of antisocial personality disorder APD reliably assists in the forensic clinical evaluation of malingering. Furthermore, patients with APD who were suspected by clinicians to be malingering were not more likely to be classified as responding genuinely using the SIRS.
These findings challenge the recommendation issued by the Diagnostic and Statistical Manual of Mental Disorders 4th ed. Prior research has typically relied on clinical diagnosis for establishing the presence of a personality disorder rather than systematic diagnostic interviews.
Without a systematic approach, clinicians may be more inclined to diagnose an individual with APD when they suspect malingering and, conversely, to suspect malingering in patients who exhibit evidence of an antisocial personality style p. Psychopathy and malingering of psychiatric disorder in criminal defendants. Because the use of deception is an important clinical characteristic of psychopathy, there is intuitive appeal to the idea that psychopathy and malingering are associated.
There is, however, very little research showing that psychopaths are more likely to malinger. This study aimed to determine whether psychopathic criminal defendants were more likely to attempt to feign psychiatric disorder by comparing severe, moderate, and mild psychopaths as determined by their scores on validated measures of malingering.
Malingering and Personality Disorder
Data analysis results suggest that psychopathy is not a clinically useful indictor of malingering. The theoretical association between APD and malingering described in the DSM-IV may serve to strengthen the belief in a psychopathy-malingering association, as most forensic mental health professionals now view psychopathy as a more valid and predictive condition than antisocial personality disorder p.
A systematic review and meta-analysis. The Clinical Neuropsychologist, 28 8 Thus, the SIMS presents patients, claimants, defendants, or research participants with a list of 75 implausible symptoms or statements that are to be endorsed or rejected p.
Researchers in this study meta-analytically reviewed studies that used the SIMS to detect feigned psychopathology. Data analysis found that the SIMS 1 is able to differentiate well between instructed feigners and honest responders; 2 generates heightened scores in groups that are known to have a raised prevalence of feigning e.
Additionally, researchers found that the diagnostic power of the traditional cut scores of the SIMS is not so much limited by their sensitivity—which is satisfactory—but rather by their substandard specificity. This, however, can be worked around by combining the SIMS with other symptom validity measures and by raising the cut score, although the latter solution sacrifices sensitivity for specificity p.
Overall, researchers conclude that though they found the SIMS to be a fairly sensitive test that is reasonably robust again coaching, a serous weakness of the SIMS is its poor specificity when the original cut scores are employed. These cut scores are more effective in ruling feigning out than ruling it in p. Researchers advise clinicians to adopt a position of respectful skepticism toward respondents with a heightened SIMS scores. The burden of proof for the conclusion that an individual feigns symptoms rests on the shoulders of diagnostic experts.
A deviant SIMS score alone does not meet the burden of proof, but it should be an impetus for follow-up investigation p.
Malingering and Personality Disorder
Evaluating the gold standard: A review and meta-analysis of the Structured Interview of Reported Symptoms. DSM-5 states that if any combination of the following 4 complains is present in a patient, then malingering should be considered.
The medicolegal context of the presentation, for example, a lawyer sending his client for evaluation or patient presents with an illness while facing trial Marked discrepancy between the individual's "claimed stress or disability" and "objective finding and observation" Lack of compliance with diagnostic evaluation, treatment regimen and follow up care Presence of anti-social personality disorder History and Physical A careful and detailed history taking is necessary to rule out malingering.
Watch carefully for discrepancies in person's behavior while taking prolonged, detailed history. Dig deep into patient's personality anti-social personality disorder, histrionic personality traits. Find out about the legal status of the patient. Ask rapid questions and see the incoherence between answers.
Ask an open-ended and leading questions. Questioning about symptoms not related to the "illness faked by the patient" may also induce a positive answer. The patient not knowing much about the assumed disease may say yes to any question. Watch for exaggeration of psychiatric symptoms like hallucinations and delusions. Mental Status Exam Appearance and behavior: May appear disheveled, uncombed hair, untidy clothing, no eye contact, no rapport building.
Irritated hostile behavior Mood: Answers low or elated and never normal euthymic. Cannot mimic lack of effect, anhedonia Thoughts: Exaggerated delusions, but cannot mimic formal thought disorders like schizophrenia; confused at times with true psychiatric thought disorders as patient with psychosis or schizophrenia can have bizarre delusions and unshakable beliefs Perception: Exaggerated hallucinations, both visual and auditory Insight: Have good insight about the disease.
Almost always acknowledge suffering from the disease they fake Cognition: