Validity of symptom reports of asylum seekers in a psychiatric hospital: A descriptive study

Presenting the consequences of feigning: Does it diminish symptom overendorsement? An analog study

Feigning causes personal and societal consequences, in both civil and criminal context. We investigated whether presenting the consequences of feigning can diminish symptom endorsement in feigned Posttraumatic Stress Disorder (PTSD). We randomly allocated non-native English speaking undergraduates (N = 145) to five conditions: 1) Truth tellers (n = 31), 2) Civil context feigners (n = 27), 3) Civil context warned feigners (n = 26), 4) Criminal context feigners (n = 29), and 5) Criminal context warned feigners (n = 32). All feigning groups received a vignette depicting a situation in which claiming PTSD would be beneficial. One vignette referred to the personal injury claim, whereas the second was about the aggravated assault charges. Additionally, one feigning group from each setting received information about the consequences of feigning (i.e., warned feigners). After receiving the instructions, all participants were administered the Self-Report Symptom Inventory (SRSI), a measure of symptom endorsement. Truth tellers endorsed fewer symptoms than all feigning groups, which mostly did not differ. Yet, criminal warned feigners (59%) were significantly less frequently detected on the SRSI as overreporters than other feigning groups (86.2%-89%). Hence, emphasizing the negative consequences of overreporting may diminish symptom endorsement, but only in high-stake situations. The implications and limitations (e.g., online measure administration) of this work are discussed.

Cry for help as a root cause of poor symptom validity: A critical note

When patients fail symptom validity tests (SVTs) and/or performance validity tests (PVTs), their self-reported symptoms and test profiles are unreliable and cannot be taken for granted. There are many well-established causes of poor symptom validity and malingering is only of them. Some authors have proposed that a cry for help may underlie poor symptom validity. In this commentary, we argue that cry for help is a (1) metaphorical concept that is (2) difficult to operationalize and, at present, (3) impossible to falsify. We conclude that clinicians or forensic experts should not invoke cry for help as an explanation for poor symptom validity. To encourage conceptual clarity, we propose a tentative framework for explaining poor symptom validity.

What constitutes a high-quality, comprehensive medico-legal asylum affidavit in the United States immigration context? A multi-sectoral consensus-building modified Delphi

In the United States, clinicians are often called upon to provide their expertise to generate expert evidence in cases of individuals seeking asylum or other forms of international protection. Due to a lack of validated guidelines specific to the U.S. immigration context, clinical evaluations produced for immigration proceedings in the United States vary in their format, structure, and content, which can be confusing for practitioners and for adjudicators assessing the weight these evaluations should be afforded in asylum proceedings. We sought to review critical components of a medico-legal asylum evaluation from an interdisciplinary perspective of key stakeholders, by collecting and synthesizing expert opinions to reach consensus on what constitutes a high-quality, comprehensive medical or psychological affidavit for U.S. immigration cases. The consensus process incorporated a three-step modified Delphi method, which took place between September and December 2021 and consisted of two rounds of online questionnaires and a synchronous video conference meeting. The areas most experts agreed on included, by order of highest agreement (combining answers of "strongly agree" and "agree"): A narrative form or checklist is preferable to a predetermined template (95%); Primary care physicians should describe their qualifications to diagnose mental health conditions (81%); Use of citation is helpful, with caveats (77%); Clinicians should include an assessment of malingering (72%); Clinicians should include an executive summary/summary of conclusions at the top of the affidavit (72%); Clinicians should reference the Istanbul Protocol and explain its relevance (66%); It may be beneficial for clinicians to describe the anticipated process of healing (57%); Clinicians may include treatment recommendations (52%). Results of this and future consensus-building efforts and resulting guidance should be used to enhance overall quality of medico-legal reports and incorporated in training programs developed for clinicians, attorneys and adjudicators.

Traits and Distorted Symptom Presentation: a Scoping Review

Are personality traits related to symptom overreporting and/or symptom underreporting? With this question in mind, we evaluated studies from 1979 to 2020 (k = 55), in which personality traits were linked to scores on stand-alone validity tests, including symptom validity tests (SVTs) and measures of socially desirable responding (SDR) and/or supernormality. As to symptom overreporting (k = 14), associations with depression, alexithymia, apathy, dissociation, and fantasy proneness varied widely from weak to strong (rs .27 to .79). For underreporting (k = 41), inconsistent links (rs − .43 to .63) were found with narcissism, whereas alexithymia and dissociation were often associated with lower SDR tendencies, although effect sizes were small. Taken together, the extant literature mainly consists of cross-sectional studies on single traits and contexts, mostly offering weak correlations that do not necessarily reflect causation. What this field lacks is an overarching theory relating traits to symptom reporting. Longitudinal studies involving a broad range of traits, samples, and incentives would be informative. Until such studies have been done, traits are best viewed as modest concomitants of symptom distortion.

[Validity of the "Structured Inventory of Malingered Symptomatology" [SIMS] in the Assessment of Healthy Individuals and Patients with Psychiatric Disorders Outside the Forensic Context]

OBJECTIVE

Assessment of the rate of false-positive results of the Structured Inventory of Malingered Symptomatology (SIMS) in healthy controls and authentic patients outside the forensic or rehabilitative context.

METHODS

Beyond the SIMS scores, further variables (PANSS, Hamilton scale, MMSE) were obtained. SIMS scores of healthy individuals were compared with the SIMS scores of the different groups of patients. Additionally, correlations between the SIMS scores and other variables were investigated.

RESULTS

Patients with psychotic disorders (n=30) or depressive episodes (n=32) more frequently achieved SIMS scores >16 as compared to healthy controls. In comparison, patients with amnestic disorders (n=15) had inconspicuous SIMS scores. Depressed patients with positive SIMS results were significantly more likely to be diagnosed with another psychiatric disorder and the scores of these patients on the Hamilton scale were correlated with positive results on 2 subscales of the SIMS (NI, AF).

CONCLUSION

If this instrument is to applied in clinical practice in the future, further validation of the SIMS is necessary. The specificity of the SIMS seems to be context-related.

Plausibility Judgments of Atypical Symptoms Across Cultures: an Explorative Study Among Western and Non-Western Experts

Symptom validity tests (SVTs) are predicated on the assumption that overendorsement of atypical symptoms flags symptom exaggeration (i.e., questionable symptom validity). However, few studies have explored how practitioners from different cultural backgrounds evaluate such symptoms. We asked professionals working in Western (n = 56) and non-Western countries (n = 37) to rate the plausibility of uncommon symptoms taken from the Structured Inventory of Malingered Symptomatology (SIMS), dissociative symptoms from the Dissociative Experience Scale (DES-T), and standard symptoms (e.g., anxiety, depression) from the Brief Symptom Inventory-18 (BSI-18). Western and non-Western experts gave similar plausibility ratings to atypical, dissociative, and standard symptoms: both groups judged BSI-18 symptoms as significantly more plausible than either dissociative or atypical symptoms, while the latter two categories did not differ. Our results suggest that the strategy to detect symptom exaggeration by exploring overendorsement of atypical items might work in a non-western context as well.

Symptom overreporting and dissociative experiences: A qualitative review

We discuss a phenomenon that has received little attention to date in research on dissociative phenomena, namely that self-reports of these phenomena overlap with the tendency to overendorse eccentric items. We review the literature documenting the dissociation-overreporting link and then briefly discuss various interpretations of this link: (1) overreporting is an artifact of measuring dissociative symptoms; (2) dissociative psychopathology engenders overreporting of eccentric symptoms through fantasy proneness or impairments in internal monitoring; (3) an overreporting response style as is evident in malingerers, for example, promotes reports of dissociative symptoms. These three interpretations are not mutually exclusive. Also, the dissociation-overreporting link may have different origins among different samples. Because overreporting may introduce noise in datasets, we need more research specifically aimed at disentangling the dissociation-overreporting link. We suggest various avenues to accomplish this goal.