How Plausible Is the Implausible? Students’ Plausibility and Prevalence Ratings of the Self-Report Symptom Inventory

Some self-report symptom validity tests, such as the Self-Report Symptom Inventory (SRSI), rely on a detection strategy that uses bizarre, extreme, or very rare symptoms. Thus, items are constructed to invite respondents with an invalid response style to affirm pseudosymptoms that are usually not experienced by genuine patients. However, these pseudosymptoms should not be easily recognizable, because otherwise sophisticated over-reporters could strategically avoid them and go undetected. Therefore, we tested how well future psychology professionals were able to differentiate between genuine complaints and pseudosymptoms in terms of their plausibility and prevalence.Psychology students (N = 87) received the items of the SRSI online and were given the task to rate each item as to its plausibility and prevalence in the community.Students evaluated genuine symptoms as significantly more plausible and more prevalent than pseudosymptoms. However, 56% of students rated pseudosymptoms as moderately plausible, whereas 17% rated them as moderately prevalent in the general public.Overall, it appears that psychology students are successful in distinguishing bizarre, unusual, or rare symptoms from genuine complaints. Yet, the majority of students still attributed relatively high prima facie plausibility to pseudosymptoms. We contend that if such a trusting attitude is true for psychology students, it may also be the case for young psychology practitioners, which, consequently, may diminish the probability of employing self-report validity measures in psychological assessments.

A-217 Associations among Symptom Validity Tests in Combat Veterans

Objective The Neurobehavioral Symptom Inventory (NSI) is a 22-item self-report measure of non-specific cognitive and somatic symptoms, which contains an embedded measure of symptom validity (Validity 10 scale [V-10]). The mild brain injury atypical symptom (mBIAS) is a separate 5-item measure of symptom validity designed for use in mild traumatic brain injury evaluation. The current study evaluated the NSI V-10 and mBIAS in relation to the Structured Inventory of Malingered Symptomatology (SIMS) Total score and subtest scores. Method Participants were 338 veterans who completed a parent study at a VA Medical Center. All participants deployed to Iraq and/or Afghanistan, did not have a history of moderate or severe traumatic brain injury, and did not have significant neurological or psychiatric conditions. Participants completed the SIMS and the NSI with mBIAS as part of a larger battery. The sample was 86% male and 57% White, with a mean age of 42 years and education of 15 years. Results AUC values using a higher SIMS Total cutoff score were .887 for the V-10 and .735 for the mBIAS; diagnostic accuracy data at various cutoff scores are presented. For SIMS subscales, the mBIAS had higher correlations to the Psychosis (r = .48) and Low Intelligence (r = .31) scales, whereas the V-10 had higher correlations to the Neurologic Impairment (r = .73), Amnestic Disorders (r = .66), and Affective Disorders (r = .59) scales. Conclusion Current data suggest that the V-10 and mBIAS measure different symptom validity constructs and could therefore be employed in a complimentary manner.

Dissociative Disorders and Their Clinical Management Part One: Dissociative Amnesia (Including Its Variant Dissociative Fugue)

Dissociative disorders are heterogeneous with respect to clinical features, course, antecedents and treatment. Among them, dissociative amnesia occupies a special place, at times encroaching on the borders between neurology and psychiatry. Herein we describe dissociative amnesia according to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders and outline data on its epidemiology, neurobiology, neuroimaging, clinical and differential diagnosis, neuropsychology, comorbidities, prognosis, treatment and rehabilitation. To enable a neuroscientific approach to its diagnosis, we outline the memory division into short-term and long-term memory, elaborating on the content-based classification of the long-term memory systems. Dissociative amnesia most commonly manifests itself in its retrograde variants (including dissociative fugue), but anterograde variants can also occur. Dissociative amnesia may be overlooked when it occurs on a background of mixed antecedents and comorbidities. Comprehensive neuropsychological assessment – including tests tapping on all memory systems and symptom validity tests – is still insufficiently integrated in the clinical practice, although it could aid in securing an accurate diagnosis, especially in cases with mixed antecedents or concomitant forensic or litigation backgrounds. Presently there is a paucity of treatment and rehabilitation methods for dissociative amnesia. Developing research evidence-based consensus guidelines for diagnosis and treatment is an essential goal. This review contains 6 figures, 7 tables, and 60 references. Key Words : consciousness, episodic-autobiographical memory, mnestic block syndrome, neuroimaging, serial-parallel-independent model, personal identity, stressful life events, malingering, trauma, feigning

Does depression explain poor effort on Symptom Validity Tests (SVT)?

Background and aimsValid assessments require sufficient effort from the part of the testee. Motivation may be compromised, particularly in psychiatric conditions. We examined associations between response bias on free recall and self-reported symptoms in depressed and PTSD patients.Participants and methodsThis is a cross-sectional study. Patients had depression (n = 48), or PTSD or other anxiety disorders (n = 37). A control group (n = 47%) had chronic pain disorder, fibromyalgia or chronic fatigue. The Green Word Memory Test (GWMT) was administered to all subjects. The Structured Inventory of Malingered. Symptomatology (SIMS), and the Beck Depression Inventory (BDI-II) were administered in subsamples. Study outcome was self-reported depressive symptoms in Symptom Validity Test (SVT) negative cases.ResultsAverage age of the participants was 45.1 years (SD 9.5), 48.5% were female. GWMT was positive in 52.3% of all cases, GWMT and SIMS were positive in 33.8%, and GWMT and SIMS were negative in 37.7%. No significant group effects on GWMT were found. Average BDI-II scores were 32.8 (SD 13.9) for depressed patients, 28.3 (15.5) for those with anxiety disorders, and 27.6 (14.1) for controls (P = 0.43). Seventy-eight percent of depressed GWMT negative cases reported at least moderate depressive symptoms (BDI-II > 18), and 44.4% severe symptoms (BDI-II > 29). Approximately half of the GWMT negative cases with anxiety disorders and controls scored BDI-II > 18.ConclusionsNon credible test performance is prevalent in disability claimants with affective, mood disorders. However, depressive symptoms per se do not explain poor effort on cognitive tasks.Disclosure of interestThe authors have not supplied their declaration of competing interest.

How Is ADHD Assessed and Documented? Examination of Psychological Reports Submitted to Determine Eligibility for Postsecondary Disability

Objective: To examine how ADHD evaluations are documented for postsecondary students requesting disability eligibility. Method: A total of 100 psychological reports submitted for eligibility determination were coded for documentation of Diagnostic and Statistical Manual of Mental Disorders ( DSM) criteria, methods and instruments used in the evaluations, and recommended academic accommodations. Results: Results showed that a minimal number of reports (≤1%) documented that students met all DSM criteria for ADHD. Psychologists rarely documented childhood impairment, symptoms across settings, or the use of rule-outs. Symptom severity was emphasized over current impairment. The majority of psychologists utilized a multi-informant, multi-method evaluation approach, but certain methods (e.g., symptom validity tests, record reviews) were limited in use. Most reports included recommendations for academic accommodations, with extended time being the most common (72%). Conclusion: This study raises awareness to the aspects of adequate ADHD evaluation and subsequent documentation that can be improved by psychologists. Recommendations are made regarding valid documentation of ADHD for disability determination purposes.