The Detection of Deception

doi:10.1016/S0733-8619(18)30044-6

Neurologic Clinics

Volume 13, Issue 2, May 1995, Pages 255-265

https://doi.org/10.1016/S0733-8619(18)30044-6 Get rights and content

In clinical situations, patient honesty and self-interest usually coincide; however, in legal circumstances patients may be motivated to skillfully deceive physicians. Research raises doubt concerning the capacity of health providers to detect malingering, particularly when there is less known about conditions and expected symptom patterns. This article reviews research on malingering detection, and methods are discussed that can supplement medical examination and increase the accuracy of malingering detection.

References (0)

Cited by (54)

Lying in neuropsychology
2014, Neurophysiologie Clinique
Citation Excerpt :
A major flaw in several SVTs is indeed their simplicity, and it is likely that only naive subjects would be misled by the falsely difficult nature of this type of test. In most cases, even if deliberately trying to boost difficulty level, patient performance will not be so low that it drops below chance [44]. It is this type of observation that led Dodrill [34] to remark that if, occasionally, we can establish that a lack of effort took place, it is virtually impossible to establish that it did not happen.
The issue of lying occurs in neuropsychology especially when examinations are conducted in a forensic context. When a subject intentionally either presents non-existent deficits or exaggerates their severity to obtain financial or material compensation, this behaviour is termed malingering. Malingering is discussed in the general framework of lying in psychology, and the different procedures used by neuropsychologists to evidence a lack of collaboration at examination are briefly presented and discussed. When a lack of collaboration is observed, specific emphasis is placed on the difficulty in unambiguously establishing that this results from the patient's voluntary decision.
La question du mensonge se pose en neuropsychologie surtout lorsque les examens sont conduits dans un cadre médicolégal. Lorsqu’un sujet présente intentionnellement des déficits inexistants ou lorsqu’il exagère leur gravité dans le but d’obtenir une compensation financière ou matérielle, on parle de simulation (malingering). Dans cet article, la simulation est discutée dans le cadre plus général des travaux en psychologie sur le mensonge. Les différentes procédures utilisées par les neuropsychologues pour établir une absence de collaboration sont brièvement présentées et discutées. Enfin, lorsqu’un manque de collaboration est établi, une attention particulière a été apportée à la question de savoir si cela résulte d’une décision volontaire et consciente du patient.
Malingering dysphagia and odynophagia electromyographic assessment
2009, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Citation Excerpt :
The evaluation of many conditions rests substantially on history and symptomatic complaints, and the examinee often provides much or all of this information. Limitations in methodology and knowledge can make it very difficult to determine whether the examinee's presentation makes sense medically [13]. Some methods of malingering detection were developed and have gained a body of supportive research.
The article discusses the usefulness and investigation technique of suspected malingering dysphagia/odynophagia by surface electromyography (sEMG) of deglutition.
Forty patients with suspected malingering dysphagia (group 1), 40 patients with dysphagia/odynophagia due to tonsillectomy (group 2), and 40 healthy individuals (group 3) were involved in the study. The timing, amplitude, and graphic patterns of activity of the masseter, submental, and trapezius muscles were examined during voluntary single water swallows (“normal”) and continuous drinking of 100 mL of water. The muscle activity in oral, pharyngeal, and initial esophageal stages of swallowing was measured, and graphic records were evaluated in relation to timing and voltage.
The main sEMG patterns of malingering dysphagia/odynophagia are prolonged time of the voluntary oral phase of a swallow (80% of cases, n = 32, P < .01 vs healthy volunteers) with normal timing of the reflex pharyngeal and initial esophageal phases and normal amplitude voltage. In 42.5% of cases (n = 17, P < .05 vs healthy volunteers), tension of skeletal muscles normally not involved in deglutition was observed during single swallowing being at the same time absent during continuous drinking.
Dysphagia due to malingering has no pathologic sEMG patterns associated with deglutition. Skeletal muscle tension during deglutition, being observed in some cases, has no connection with the act of swallowing itself. Prolonged oral phase of a swallow is factitious, nonpathologic. Surface EMG, being noninvasive, nonradiographic and inexpensive, can be used for patients with suspected malingering dysphagia, thus avoiding expensive and time-consuming investigation.
Prevalence of Malingering in Patients With Chronic Pain Referred for Psychologic Evaluation in a Medico-Legal Context
2009, Archives of Physical Medicine and Rehabilitation
Citation Excerpt :
Psychosocial factors, including somatization, are a high prevalence phenomenon in primary care50 and neurology practices51 and have important implications for outcome in chronic pain.52-55 The formal examination of psychologic causality (via both formal psychologic evaluations and quantitative physical capacity examinations) is important because under most circumstances, psychologic overlay and malingering cannot be reliably identified in the clinical evaluation in the absence of specialized tests.56-60 The fact that much of the excess disability seen in patients with pain reflects complicating psychologic factors emphasizes the need for care in the use of the term malingering.
Greve KW, Ord JS, Bianchini KJ, Curtis KL. Prevalence of malingering in patients with chronic pain referred for psychologic evaluation in a medico-legal context.
To provide an empirical estimate of the prevalence of malingered disability in patients with chronic pain who have financial incentive to appear disabled.
Retrospective review of cases.
A private neuropsychologic clinic in a southeastern metropolitan area.
Consecutive patients (N=508) referred for psychologic evaluation related to chronic pain over a 10-year period (1995–2005).
Not applicable.
Prevalence of malingering was examined using 2 published clinical diagnostic systems (Malingered Pain-Related Disability and Malingered Neurocognitive Dysfunction) as well as statistical estimates based on well validated indicators of malingering.
The prevalence of malingering in patients with chronic pain with financial incentive is between 20% and 50% depending on the diagnostic system used and the statistical model's underlying assumptions. Some factors associated with the medico-legal context such as the jurisdiction of a workers' compensation claim or attorney representation were associated with slightly higher malingering rates.
Malingering is present in a sizable minority of patients with pain seen for potentially compensable injuries. However, not all excess pain-related disability is a result of malingering. It is important not to diagnose malingering reflexively on the basis of limited or unreliable findings. A diagnosis of malingering should be explicitly based on a formal diagnostic system.
Forensic neuropsychological assessment
2024, Behavioral Sciences and the Law
A Large-Scale Investigation of the Classification Accuracy of Various Performance Validity Tests in a Medical-Legal Setting
2023, Psychology and Neuroscience
Two Cases of Malingered Crime-Related Amnesia
2023, Topics in Cognitive Science

View all citing articles on Scopus

View full text