Biased Symptom Reporting and Antisocial Behaviour in Forensic Samples: A Weak Link

Abstract

In two studies (one with 57 forensic inpatients and one with 45 prisoners) the connection between biased symptom reporting and antisocial behaviour is explored. The findings are as follows: 1) the association between symptom over-reporting and antisocial features is a) present in self-report measures, but not in behavioural measures, and b) stronger in the punitive setting than in the therapeutic setting; and 2) participants who over-report symptoms a) are prone to attribute blame for their offence to mental disorders, and b) tend to report heightened levels of antisocial features, but the reverse is not true. The data provide little support for the inclusion of antisocial behaviour (i.e. antisocial personality disorder) as a signal of symptom over-reporting (i.e. malingering) in the Diagnostic and Statistical Manual of Mental Disorders -Fifth Edition (DSM-5). The empirical literature on symptom overreporting and antisocial/psychopathic behaviour is discussed and it is argued that the utility of antisocial behaviour as an indicator of biased symptom reporting is unacceptably low.

Antisocial features are not predictive of symptom exaggeration in forensic patients

“…The only potential indicator that we found to be statistically significantly associated with symptom exaggeration is the attribution of criminal blame to external factors (such as social economic environment, victims, or society; r = .31 [.05, .53]). This result mirrors that of an earlier study (van Impelen et al ., ), where we found a modest relation between blame externalization and symptom exaggeration among internees of a youth prison ( N = 45, r = .35, [.06, .59]). Nevertheless, the strength of this association does not suffice to produce a satisfactory predictive value (43–29% detection rate, 75–60% false‐positive rate; see Table ).…”

“…The most prominent limitation of the present study is arguably the small sample size: Of the 57 patients, 10 were diagnosed with ASPD, and seven produced SIMS scores suggestive of symptom exaggeration; only one of whom was diagnosed with ASPD. However, testifying to the reliability of these findings is that they echo the results that we reported earlier based on similar data we gathered at the same forensic psychiatric hospital (van Impelen et al ., ). In that study ( N = 57), there was no overlap between patients with ASPD ( n = 9) and patients who engaged in symptom exaggeration ( n = 5).…”

“…To assess the relation between symptom exaggeration, on the one hand, and potential predictors of symptom exaggeration (i.e., offense report inaccuracy, denial of offense, offense minimization, denial of aggression, lack of remorse, and blame externalization), on the other hand, we conducted a correlational analysis and we cross‐tabulated prevalence rates of symptom exaggeration with prevalence rates of the potential predictors. Based on the results of our previous studies (van Impelen et al ., ) and the review by Niesten et al . (), we did not expect symptom exaggeration to be related to biased offense reporting (i.e., offense report inaccuracy, denial of offense, offense minimization, and denial of aggression), lack of remorse, or external blame attribution.…”

“…Since then, Rogers’ continued criticism (e.g., Rogers, ; Rogers & Shuman, ) has been corroborated by multiple empirical studies (e.g., Kucharski, Falkenbach, Egan, & Duncan, ; Pierson, Rosenfeld, Green, & Belfi, ; Sumanti, Boone, Savodnik, & Gorsuch, ). While some studies did find ASPD to be associated with symptom exaggeration (e.g., Delain, Stafford, & Ben‐Porath, ; Gacono, Meloy, Sheppard, Speth, & Roske, ), the magnitude of the associations is insufficient to be of any diagnostic value (van Impelen et al ., ).…”

“…In two previous studies, we investigated the predictive value of antisocial behaviour for symptom exaggeration in a medium security forensic psychiatric hospital in the Netherlands where patients are admitted post‐trial and found it to be non‐existent (van Impelen et al ., ). This squares with the review by Niesten, Nentjes, Merckelbach, and Bernstein (), who concluded that a general predisposition to disregard and violate rules and social norms has little predictive value for symptom exaggeration.…”