The prevalence of feigning and concealment of Covid-19 infections in an international sample.

We asked 463 participants from 21 countries whether they had feigned and/or concealed having a coronavirus infection during the pandemic period. 384 respondents (83%) reported having experienced a coronavirus infection. They were, on average, younger and reported more chronic health issues than participants who said they had never been infected. 65 (14%) admitted to having feigned the infection. Prevalence doubled (28%) when asked if they knew anyone who had feigned a coronavirus infection. Main motives for feigning were to stay at home and to obtain sick leave. As to having concealed a coronavirus infection, 56 (12%) responded affirmatively, but when asked about others, the prevalence reached 51% (n = 210). The most common reasons for concealment were to avoid letting others know and to not miss an event. Thus, both feigning and concealing infections can occur on a nontrivial scale, directly affecting prevalence rates in studies that rely on self-reported data collected from social platforms.

#StudentsToo. prevalence of sexual assault reports among students of three European universities and their actions post-assault.

OBJECTIVE: Previous research has indicated high rates of sexual assault (SA) among US students (> 25%). Yet this type of investigation has been less frequent at European universities. METHODS: We conducted an investigation at three universities, two Dutch universities (N = 95 and N = 305) and one university in Belgium (N = 307). Students were asked to estimate the prevalence of SA, and to report about their personal experience. We defined SA as any situation in which students were inappropriately touched, forced to a sexual act without their consent, or were (sexually) verbally intimidated. RESULTS: 56% of students (Location 1: n = 54/95; Location 2: n = 172/305; Location 3: n = 172/307) across all three samples reported experiencing SA. The disclosed assaults were mostly unwanted sexual contact (i.e., groping) by male strangers aged 18-35 years. One-third of the sample reported to have done nothing post-assault, and among those who took actions, the majority disclosed the assault to friends, but rarely to family members. Also, 3-5% of students (Location 1: n = 3; Location 2: n = 11; Location 3: n = 11) (falsely) denied the assault. Seeking justice and needing support were important motivators of action, whereas psychological factors (i.e., memory distrust) were antagonists of this. Finally, besides psychological factors, fear of interpersonal consequences (e.g., being labelled as a "drama queen") was a strong influence to either deny or try to forget the assault. CONCLUSION: SA appears to be frequent among European students and further investigation including other European universities is warranted.

Prevalence Estimates of Symptom Feigning and Malingering in Spain.

Symptom feigning and malingering should be evaluated in forensic contexts due to their important socio-economic consequences. Despite this, to date, there is little research in Spain that evaluates its prevalence. The aim of this study was to investigate this issue using the perception of the general population, students, and professionals of medicine and forensic psychology. Three adapted questionnaires were applied to a total of 1003 participants (61.5% women) from 5 different groups. Approximately two-thirds of participants reported knowing someone who feigned symptoms, and one-third disclosed feigning symptoms themselves in the past. Headache/migraine, neck pain, and anxious-depressive symptoms were the most commonly chosen. Experts in psychology and forensic medicine estimated a prevalence of 20 to 40% of non-credible symptom presentations in their work settings and reported not having sufficient means to assess the distorted presentation of symptoms with certainty. Professionals and laypersons alike acknowledge that non-credible symptom presentations (like feigning or malingering) are relevant in Spain and occur at a non-trivial rate, which compares with estimates in other parts of the world.

The Impact of Different Forms of Coaching on the Structured Inventory of Malingered Symtomatology (SIMS).

BACKGROUND: Psychometric symptom validity instruments (SVTs) can be vulnerable to coaching, which can negatively affect their performance. Our aim was to assess the impact that different types of coaching may have on the sensitivity of the Structured Inventory of Malingered Symptomatology (SIMS). METHODS: A simulation design was used with 232 non-clinical adults divided into five experimental simulation conditions and 58 patients with anxious-depressive symptomatology derived from a traffic accident. All simulators received a basic scenario and, in addition, the second group was instructed on the symptomatology, the third was warned about the risk of exaggerating the presentation, the fourth received a combination of the two previous groups and the fifth received specific training on SVTs. RESULTS: The discriminative ability of the SIMS was higher in the basic and symptom information groups, and it decreased significantly in the specific training group on SVTs. CONCLUSIONS: SIMS seems not to be severely impacted by a variety of symptom coaching styles, although test coaching diminished its performance.

The English-language version of the Self-Report Symptom Inventory: a pilot analogue study with feigned head injury sequelae.

Questionnaire-based symptom validity tests (SVTs) are an indispensable diagnostic tool for evaluating the credibility of patients' claimed symptomatology, both in forensic and in clinical assessment contexts. In 2019, the comprehensive professional manual of a new SVT, the Self-Report Symptom Inventory (SRSI), was published in German. Its English-language version was first tested in the UK. This experimental analogue study investigated 20 adults simulating minor head injury symptoms and 21 honestly responding participants. The effect sizes of differences between the two groups were large, with the simulating group endorsing a higher number of pseudosymptoms, both on the SRSI and the Structured Inventory of Malingered Symptomatology, and scoring lower on the Reliable Digit Span than the control group. The results are similar to those obtained in previous research of different SRSI language versions, supporting the effort to validate the English-language SRSI version.

The Impact of Different Forms of Coaching on the Structured Inventory of Malingered Symtomatology (SIMS)(AU) / El Impacto de Diferentes Formas de Coaching en el Inventario Estructurado de Simulación de Síntomas (SIMS)(AU)

Background: Psychometric symptom validity instruments (SVTs) can be vulnerable to coaching, which can negatively affect their performance. Our aim was to assess the impact that different types of coaching may have on the sensitivity of the Structured Inventory of Malingered Symptomatology (SIMS). Methods: A simulation design was used with 232 non-clinical adults divided into five experimental simulation conditions and 58 patients with anxious-depressive symptomatology derived from a traffic accident. All simulators received a basic scenario and, in addition, the second group was instructed on the symptomatology, the third was warned about the risk of exaggerating the presentation, the fourth received a combination of the two previous groups and the fifth received specific training on SVTs. Results: The discriminative ability of the SIMS was higher in the basic and symptom information groups, and it decreased significantly in the specific training group on SVTs. Conclusions: SIMS seems not to be severely impacted by a variety of symptom coaching styles, although test coaching diminished its performance.(AU)

Antecedentes: Los instrumentos psicométricos de validez de síntomas (SVTs) pueden ser vulnerables a la preparación, lo que puede afectar negativamente a su rendimiento. Nuestro objetivo evaluar el impacto que diferentes tipos de preparación pueden tener en la sensibilidad del Inventario Estructurado de Simulación de Síntomas (SIMS). Método: Se utilizó un diseño de simulación con 232 adultos no clínicos divididos en cinco condiciones de simulación y 58 pacientes con sintomatología ansioso-depresiva derivada de un accidente de circulación. Todos los simuladores recibieron un escenario básico y, además, el segundo grupo fue instruido sobre la sintomatología a presentar, el tercero fue advertido sobre el riesgo de exagerar su presentación, el cuarto recibió una combinación de los dos grupos anteriores y el quinto recibió un entrenamiento específico sobre SVTs. Resultados: La capacidad discriminativa del SIMS fue más elevada en el grupo de escenario básico e información de síntomas, disminuyendo significativamente en el grupo de entrenamiento sobre SVTs. Conclusiones: El SIMS parece no verse afectado severamente por las diferentes formas de coaching, no obstante, la preparación específica sobre el test disminuye su rendimiento.(AU)

Symptom coaching and symptom validity tests: An analog study using the structured inventory of malingered symptomatology, Self-Report Symptom Inventory, and Inventory of Problems-29.

In this pilot and exploratory study, we tested the robustness of three self-report symptom validity tests (SVTs) to symptom coaching for depression, with and without additional information available on the Internet. Specifically, we divided our sample (N = 193) so that each subject received either the Structured Inventory of Malingered Symptomatology (SIMS; n = 64), the Self-Report Symptom Inventory (SRSI; n = 66), or the Inventory of Problems-29 (IOP-29; n = 63). Within each of the three subgroups, approximately one third of participants were instructed to respond honestly (Genuine Condition, nSIMS = 21; nSRSI = 24; nIOP-29 = 26) and approximately two-thirds were instructed to feign depression. One half of the feigners were presented with a vignette to increase their compliance with instructions and were given information about symptoms of depression (Coached Feigning, nSIMS = 25; nSRSI = 18; nIOP-29 = 21), and the other half were given the same vignette and information about symptoms of depression, plus two Internet links to review before completing the test (Internet-Coached Feigning, nSIMS = 18; nSRSI = 24; nIOP-29 = 16). Overall, the results showed that the genuine conditions yielded the lowest total scores on all three measures, while the two feigning conditions did not significantly differ from each other. Looking at the detection rates for all feigning participants, all three measures showed satisfactory results, with IOP-29 performing slightly better than SIMS and SIMS performing slightly better than SRSI. Internet-Coached Feigners scored slightly lower on all three measures than feigners who were coached without the Internet links. Taken together, the results of this preliminary and exploratory study suggest that all three SVTs examined are sensitive to feigned depression even in the presence of symptom coaching, both with and without additional Internet-based information.

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.

Consistency does not aid detection of feigned symptoms, overreporting does: Two explorative studies on symptom stability among truth tellers and feigners.

Practitioners always want to exclude the possibility that a patient is feigning symptoms. Some experts have suggested that an inconsistent symptom presentation across time (i.e., intraindividual variability) is indicative of feigning. We investigated how individuals with genuine pain-related symptoms (truth tellers; Study 1 n = 32; Study 2 n = 48) and people feigning such complaints (feigners; Study 1 n = 32; Study 2 n = 28) rated the intensity of their symptoms across a 5-day period. In both studies, feigners reported on all 5 days significantly higher symptom intensities than people with genuine complaints, but the two groups did not differ with regard to symptom (in)consistency. Thus, persistently inflated, rather than inconsistent, reports of symptom intensity over time are suggestive of feigning. The implications and limitations of our work are discussed.

Overlooking Feigning Behavior May Result in Potential Harmful Treatment Interventions: Two Case Reports of Undetected Malingering.

Clinicians tend to overestimate their ability to recognize feigning behavior in psychiatric patients, especially if it concerns patients who have been admitted for observation. Feigning can be either externally motivated (e.g., for financial compensation, known as malingering) or internally motivated (e.g., to assume the "sick role," known as factitious disorder). Persistent presentation of severe symptoms is usually associated with the factitious disorder. We present two patients with strong external incentives who consistently and convincingly feigned severe psychiatric symptoms during a protracted period of inpatient observation in a specialized center; both were engaged in a procedure for medical asylum. The first case presented with the clinical picture of a psychotic depression with severe motor symptoms, and the second case showed symptoms of a chronic post-traumatic stress disorder with secondary psychotic symptoms. Both cases were thoroughly investigated but feigning was overlooked, and unnecessary and harmful treatment interventions were given. To prevent iatrogenic damage, we recommend a critical attitude that takes malingering as an option into account in settings where patients are often involved in high stake legal procedures. A clinical sign that might indicate feigning is therapy-resistant symptoms. To rule out feigning a comprehensive, multimethod approach is required, but an active stance toward collateral information is essential. Specialized psychological tests may be useful for preliminary screening, but for their use in culturally diverse populations as in refugee mental health more research is needed.

Detecting feigned high impact experiences: A symptom over-report questionnaire outperforms the emotional Stroop task.

BACKGROUND AND OBJECTIVES: The Modified Stroop Task (MST) effect refers to a prolonged reaction time (RT) in color-naming words related to an individual's disorder. Some authors argue that its absence in people who claim symptoms might be an indication of feigning. METHOD: We tested whether the MST effect is robust against feigning attempts and compared its absence as an index of feigning with over-reporting tendencies on a symptom questionnaire (i.e., the Self-Reported Symptom Inventory (SRSI)). We included participants (n = 22) who i) reported current high impact of aversive experiences (High scorers), ii) reported current low impact (Low scorers) of aversive experiences (n = 24), and iii) actors (n = 18) with low impact, but instructed to feign current high psychological impact of aversive life events (Simulators). We administered the MST, including impact-related, neutral, and feigning-related words, and the SRSI. RESULTS: We found no MST effect for impact-related words in the high scorers group, or for feigning-related words in the simulators. Relative to high scorers and low scorers, simulators exhibited significantly longer RTs on all types of words and they also endorsed significantly more bogus symptoms on the SRSI. Thus, the SRSI was a more sensitive measure of feigning than the absence of an MST effect. LIMITATION: Some limitations are related to our reliance on a sub-clinical student sample, whereas others reflect the unresolved issues surrounding the MST. Thus, the generalizability of our results is uncertain. CONCLUSION: Our findings add to the doubts on the idea that the MST can be used to differentiate between genuine and feigned complaints.

Verifiability on the run: an experimental study on the verifiability approach to malingered symptoms.

Several studies on the verifiability approach found that truth-tellers report more verifiable details than liars. Therefore, we wanted to test whether such a difference would emerge in the context of malingered symptoms. We obtained statements from undergraduates (N = 53) who had been allocated to three different conditions: truth-tellers, coached malingerers and naïve malingerers. Truth-tellers carried out an intensive physical exercise and after a short interval wrote a report about their experience and elicited symptoms. The two malingering groups had to fabricate a story about the physical activity and its symptoms. Truth-tellers did not generate more verifiable details than malingerers. However, malingerers reported more non-verifiable details than truth-tellers. Coached and naïve malingerers did not differ in this respect. Relative to truth-tellers, naïve malingerers reported more symptoms-related non-verifiable details, while coached malingerers reported more exercise-related non-verifiable details. Focusing on non-verifiable details may inform the detection of malingered symptoms.

The Modified Stroop Task Is Susceptible to Feigning: Stroop Performance and Symptom Over-endorsement in Feigned Test Anxiety.

Some researchers argue that the modified Stroop task (MST) can be employed to rule out feigning. According to these authors, modified Stroop interference effects are beyond conscious control and therefore indicative of genuine psychopathology. We examined this assumption using a within-subject design. In the first session, students (N = 22) responded honestly, while in the second session they were asked to read a vignette about test anxiety and then fake this condition. During both sessions, we administered an MST consisting of neutral, anxiety-related, and test anxiety-related words. Participants also completed the Self-Report Symptom Inventory (SRSI; Merten et al., 2016) that focuses on over-reporting of pseudosymptoms. Our feigning instructions were successful in that students succeeded in generating the typical MST effect by providing longer response latencies on anxiety related (r = 0.43) and test anxiety-related (r = 0.31) words, compared with neutral words. Furthermore, students endorsed significantly more pseudosymptoms on the SRSI (r = 0.62) in the feigning session than in the honest control condition. We conclude that the MST effect is not immune to feigning tendencies, while the SRSI provides promising results that require future research.

Posttraumatic Stress Disorder and Diminished Criminal Responsibility as "New Evidence" in Criminal Revision Procedures.

Posttraumatic stress disorder (PTSD) may affect victims of crime, but may also be reported by offenders. In the postappeal phase, offenders may claim to suffer from chronic PTSD and argue that this indicates diminished criminal responsibility at the time the index crime was committed. As members of a Dutch criminal cases review commission, we recently encountered two cases in which PTSD was presented as new evidence that would justify a reopening of the case. In this article, we argue that such claims are problematic in that clinical decision making resulting in a PTSD diagnosis adheres to quite different standards than those dictating forensic fact-finding. The two cases illustrate the difference between criminal and clinical fact-finding.

Alexithymia as a potential source of symptom over-reporting: An exploratory study in forensic patients and non-forensic participants.

The traditional interpretation of symptom over-reporting is that it indicates malingering. We explored a different perspective, namely that over-reporting of eccentric symptoms is related to deficits in articulating internal experiences (i.e., alexithymia). Given that alexithymia has been linked to sleep problems and that fatigue may fuel inattentive responding to symptom lists, we administered measures of alexithymia (TAS-20) and symptom over-reporting (SIMS), but also sleep quality (SLEEP-50) to forensic psychiatric outpatients (n = 40) and non-forensic participants (n = 40). Forensic patients scored significantly higher on all three indices than non-forensic participants. In the total sample as well as in subsamples, over-reporting correlated positively and significantly with alexithymia, with rs being in the 0.50-0.65 range. Sleep problems were also related to over-reporting, but in the full sample and in the forensic subsample, alexithymia predicted variance in over-reporting over and above sleep problems. Although our study is cross-sectional in nature, its results indicate that alexithymia as a potential source of over-reporting merits systematic research.

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.