Deception and fraudulent presentations
Malingering, factitious disorder, psychological overlay, hysterical reaction,
exaggeration: these are but a few of the terms used when a presentation
of injury or claim appears questionable and may be deceptive. Each of these
terms implies a slightly different model of behaviour, not all of which
are intentionally fraudulent, but may be misleading.
Relying on self report
Examiners in personal injury, whether medical or psychological, have to
rely in large part on self report of pain, difficulty, depression and
so on. Psychological perceptions are far from commensurate with objective
tissue damage even outside of claims and litigation. How then can authenticity
be probed and tested? Some methods have stood the test of time well. These
include a meticulous history, cross referenced as far as possible so that
recognisable courses of post traumatic reaction are documented. In many
cases the final outcome depends as much or more on what happens or fails
to happen after an accident, as much as it depends on the seriousness
of the accident. Early assessment and intervention provides a vital benchmark
for employers for example when looking at how post traumatic reactions,
resentment and hopelessness begin to escalate or are made worse by extraneous
factors. Honest reporters tell a story of multiple attempts to cope with
problems as much as listing the difficulties. Those who fabricate have
no real memory to draw on regarding coping efforts and outcomes and produce
very thin unconvincing narratives. We use a very similar technique when
assessing the credibility of victims of crime. It was the American military
police who found that they could get beyond the impasse of one person's
word against another in rape cases, for example, by giving the alleged
victim full opportunity to disclose the aftermath, coping and dilemmas
which invariably follow real assaults.
Psychological tests: old and new
The use of psychological tests is useful in picking up underlying problems
which are aggravating a chronic failure to recover and should be treated
in their own right. An obssessional personality is one such. It is now
possible to predict from tests in advance which patients are likely to
make a poor adjustment to major surgery. Doctors use such findings to
consider either conservative alternatives, or to ensure post surgical
support and information is arranged sufficiently. We use screening tests
on claimants and also have someone close to them separately complete the
test as predicting the way the claimant does. Briefed not to guess, if
they are truly drawing on common knowledge and not exaggerating then a
fair degree of convergence should occur. Certain reading tests are "robust"
to brain damage when other tests show significant decrements. We can estimate
pre-morbid intellectual level this way, but sometimes we run the reading
test twice and see if the "word attack" failures are the same
both times. Reading performance should not change over an hour or two.
Quantifying improbability
We have recently added two new American tests to our battery for assessing
deception in psychological functioning. One, the Structured Interview
of Reported Symptoms (SIRS), provides claimants with the opportunity to
endorse very rare symptoms, very rare combinations of symptoms, apparently
blatant symptoms, improbable unbearable and subtle symptom associations
and so on. Because of the serious consequences, it is biased not to misclassify
someone as feigning even if some people are classified honest wrongly.
Another new test is the Test of Memory Malingering. This for all the world
appears to be a test of memory but in fact it is much easier than it looks.
Even people with severe brain damage or dementia, if they complete the
test at all, obtain almost perfect scores. If feigners are given feedback
as to how extraordinarily well they are doing (no more than expected)
if then they start to fail a few items, this again points to being extremely
improbable if genuinely trying to do their best.
Honest claimants are hardly ever aware these protocols are for detecting
feigning, and often they help a genuine case to stand up and point to
a way of alleviating genuine problems which have been overlooked.
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