CLINICAL ASSESSMENT OF MALINGERING AND DECEPTION R. Rogers (editor) New York. NY. The Guilford Press. 1988. 570 pages
To assume the veracity of a patient's report is naive, yet there are no foolproof ways to establish "the truth" in every case. Rogers and his contributors provide a thorough, methodical, and practical guide to grappling with this difficult issue. They do not pretend to provide magical or absolute answers. They also do not attempt to address all of the reasons that a patient's report might not be true. The emphasis oí the book is on dissimulation, that is, the deliberate distortion of symptoms, rather than on the unconscious end oï the spectrum of motivations (eg, conversion disorder). Dissimulation is viewed as inclusive of malingering (overreporting of symptoms) and defensiveness (underreporting of symptoms).
The book is divided into four parts beginning with a view of malingering and deception through the lens of the clinician. Various contributors focus on how dissimulation is manifested in medical syndromes, psychosis, sociopathy, amnesia, posttraumatic stress disorders, and in children. The second part reviews psychometric approaches to the assessment of dissimulation (objective, projective, and neuropsychological testing), and the third outlines specialized methods, such as the drug-assisted interview, polygraphs, hypnosis, plethysmography (in male sex offenders), and structured interviews. The fourth part is an integrative summary by Rogers of the current status of these clinical methods and a projective look toward future research possibilities in the realm of dissimulation.
Despite the number and diversity of contributors Rogers, as editor, maintains a remarkable uniformity in the overall themes. He has clearly prepared his contributors to utilize the concept of the Threshold Model (to alert the clinician to patients at significant risk for dissimulation) and the Clinical Decision Model (necessary criteria to establish the existence of dissimulation). Although the Threshold Models are rather broad throughout the book, the clinical Decision Models arc conservative by Roger's view because "greater harm may be caused in misclassifying a disturbed patient as a malingerer than in not accurately identifying all malingerers."
This book is not, however, a quickand-easy guide to lie detection. Rather, it demonstrates the complexity of this major clinical issue. While any psychiatric clinician might benefit from reviewing this infrequently addressed area of work, practitioners in forensic and consultation services could be expected to receive the highest yield. There are ample and appropriate case examples as well as a number of very helpful suggestions for clinical management. For instance, sample statements are offered for confronting a suspected dissimulator and warnings are given about the use of pejorative statements in describing suspected dissimulators.
Important messages of this book include the fact that while all assessment techniques are susceptible to deception, structured interviews and psychometric testing seem to offer the best hope for its detection. A comprehensive, m u 1 1 i - m o d e I approach is wise in attempting to confirm dissimulation, bearing in mind that polygraph y and plethysmography can be manipulated, information obtained through hypnosis may not be acceptable in court, and research indicates that drug-assisted interviews rarely detect a malingerer. Rogers offers realistic and concrete proposals in His final chapter to guide researchers in that elusive search for "the truth."