February 2009  << Back  

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 BOOK REVIEWS

Clinical Assessment of Malingering and Deception. Third edition

Alan D. Schmetzer, MD

Indiana University School of Medicine, Indianapolis, IN, USA

The first edition of this book was published in 1988, had 14 contributors in addition to the editor, and was divided into 17 chapters totaling 384 pages. Dr. Rogers edited a second version, which was copyrighted in 1997 and had 19 chapters. This third edition has 34 contributors, 24 chapters, and 539 pages. Dr. Rogers indicates in his preface that hardly any paragraphs or even sentences in this latest edition remain from the earlier versions. What does remain is a combination of definitions, conceptualizations, and practical suggestions—some might say “wisdom”—that covers most anything within the field of deception that is likely to be encountered in mental health practice.

Edited by Richard Rogers, PhD; Guilford Press, New York, New York; 2008; ISBN: 978-1-58385-699-1; $65.00 (paperback), 539 pp.

The first section consists of 2 chapters that introduce the reader to the field of personal “response styles,” the underlying factor for determining veracity in the clinical interview. Chapter 1 begins with what the editor/author calls “non-specific terms,” the sort of descriptors that encompass the behaviors in question—“unreliability,” “nondisclosure,” “deception,” and “dissimulation.” The amount of “self-disclosure” that one might encounter—or for that matter, give oneself—varies in an interview but is never, even in psychotherapy or other “intimate” relationships, likely to approximate 100%. There are always things patients would rather not tell us or, if they tell, will wish to place in the best possible light or distort by diminishing or embellishing.

Dr. Rogers then goes on to describe more specific terminology useful in describing such behaviors, such as “malingering,” “factitious presentations,” and “feigning.” While the first 2 terms (at least in DSM-IVTR) ascribe motivation, the third does not—one might feign psychological or physical symptoms due to various and indeterminate internal and external motivations. Other response styles, such as “irrelevant,” “random,” and “hybrid” are discussed, as well as the possibility of a respondent assuming a different identity for the purposes of responding, called “role assumption.” This then is the framework that the book sets forward to put detection of deceit into the appropriate context. Dr. Rogers and his coauthors have individually and collectively given this area a great deal of thought, and one of the major benefits of this book is that it allows the reader to become familiar with all of this effort in summary fashion.

The next segment of the book contains 7 chapters organized around diagnoses in which deception may be more likely. Some, such as conduct disorder and oppositional defiant disorder, have deceit listed as a major symptom. Others, such as substance abuse, have highly emphasized denial as a part of the disorder. Still others might or might not involve deception depending on the motivations and circumstances of the patient—for example, psychotic symptoms in a jail inmate who may be ill or who may wish to move to a more protected mental health bed in the facility. Multiple suggestions for determining the veracity of the presentation are given, utilizing both history and observation as well as physical examination.

The following section, “Psychometric methods,” discusses the use of the MMPI-2, other multi-scale inventories, projective testing, and neuropsychological batteries in assessing clinical deception. While very useful, these tests are not always easily and reliably available to nonpsychologists, and so this segment may not be as helpful to some as to others. The chapter on feigned memory loss and amnesia, however, is so rich in context and general discussion that even those who do not use standardized testing may find assistance in their evaluations of patients with memory complaints.

The fourth section discusses specialized techniques, and again not everyone will have all of these possibilities available in a given clinical setting. However, the discussions of polygraph examinations, recovered and false memories, assessment of alleged sex offenders, structured interviews, and brief screening measures are all worthwhile. Indeed, this section has changed the most from its presentation in the first and second editions.

There also is a new section in this edition dealing with “Specialized applications”—deception by children and adolescents, forensic examinations, and assessment of persons for suitability in law enforcement. This very welcome and should be of great help to those dealing with such situations.

Finally, the book includes a 2-chapter summary dealing with the state of the art in clinical assessment of deception and comments on researching response styles, respectively. This is followed by references and an author and subject index.

One criticism of this book might be that it is highly ambitious. Trying to cover the field of deception in 24 chapters is quite an undertaking. And there are chapters that are very densely written, which may force the reader to go back and review what came before for clarity. Fortunately, most of the chapters have a nice, flowing style, however, and make the book as a whole less intimidating.

This is a text that I purchased in its first edition some 20 years ago when I was working in a facility that contracted with the local county jail and state prisons to assess and treat their populations. I soon found it to be just as applicable when patients demanded to be admitted to the hospital from our Crisis Intervention Service. How is one to decide who is truly in deep psychological pain and who really wants a temporary place to hide because a street deal went bad? This book provides practical, utilitarian answers to such questions. But more importantly, it provides a framework for considering the possibilities in a clear and logical manner. Because each of our patients and their situations are different, this framework stands the test of time even when “the answers” change. Psychiatrists, psychologists, social workers, crisis clinicians—those in training for all of the above—and general physicians who do disability evaluations will likely find something in Clinical Assessment of Malingering and Deception that will help them negotiate the clinical minefields of what seems to be the ever-more deceitful environment in which we labor.