Context Psychopaths belong to a larger group of persons with antisocial personality disorder and are characterized by an inability to have emotional involvement and by the repeated violation of the rights of others. It was hypothesized that this behavior might be the consequence of deficient fear conditioning. Objective To study the cerebral, peripheral, and subjective correlates of fear conditioning in criminal psychopaths and healthy control subjects. Design An aversive differential pavlovian delay conditioning paradigm with slides of neutral faces serving as conditioned and painful pressure as unconditioned stimuli. Setting The Department of Medical Psychology at the University of Tubingen, Tubingen, Germany. Participants Ten male psychopaths as defined by the Hare Psychopathy Checklist–Revised and 10 age- and education-matched healthy male controls. The psychopaths were criminal offenders on bail and waiting for their trial or were on parole. The healthy controls were recruited from the community. Main Outcome Measures Brain activation based on functional magnetic resonance imaging, electrodermal responses, emotional valence, arousal, and contingency ratings. Results The healthy controls showed enhanced differential activation in the limbic-prefrontal circuit (amygdala, orbitofrontal cortex, insula, and anterior cingulate) during the acquisition of fear and successful verbal and autonomic conditioning. The psychopaths displayed no significant activity in this circuit and failed to show conditioned skin conductance and emotional valence ratings, although contingency and arousal ratings were normal. Conclusion This dissociation of emotional and cognitive processing may be the neural basis of the lack of anticipation of aversive events in criminal psychopaths.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/208744/yoa40213.pdf

Deficient Fear Conditioning in Psychopathy A Functional Magnetic Resonance Imaging Study

Comprehensive forensic evaluations are predicated on the accurate appraisal of response styles that may affect evaluatees' clinical presentation and experts' conclusions associated with psycholegal issues. In the assessment of malingering, forensic experts often rely heavily on standardized measures that have been validated exclusively via analogue research. While such research augments internal validity, the threats to external validity are readily apparent. As the first study of these threats, type of incentive (positive versus negative), context (a familiar versus unfamiliar scenario), and relevance to the participants was investigated systematically with a between-subjects factorial design. A sample of 231 undergraduates was asked to either (a) feign major depression and given an easily understood description of this disorder or (b) serve as controls responding honestly. They were administered a brief measure of psychopathology (Hopkins Symptom Checklist; Derogatis, Lipman, Rickels, Uhlenhuth, & Covi, 1974) and a recent screen for malingering (Screening Inventory of Malingered Symptoms or SIMS; Smith, 1992) in 1 of 18 experimental conditions. Results suggested that incentive had a main effect on the SIMS. More specifically, simulators under negative incentives appeared more focused in their feigning; they produced more bogus depressed symptoms, but fewer symptoms unrelated to depression. Interactions were also observed between context and incentive, and context and relevance. Implications of these results are explored for both analogue research on malingering and current forensic practice.

Assessment of malingering with simulation designs: Threats to external validity.

Have we forgotten the base rate problem? Methodological issues in the detection of distortion.

The current study examined the utility of the recently released Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008) validity scales to detect feigned psychopathology in a criminal forensic setting. We used a known-groups design with the Structured Interview of Reported Symptoms (SIRS; Rogers, Bagby, & Dickens, 1992) as the external criterion to determine groups of probable malingering versus nonmalingering. A final sample of 125 criminal defendants, who were administered both the SIRS and the MMPI-2-RF during their evaluations, was examined. The results indicated that the two MMPI-2-RF validity scales specifically designed to detect overreported psychopathology, F-r and F(P)-r, best differentiated between the malingering and nonmalingering groups. These scales added incremental predictive utility to one another in this differentiation. Classification accuracy statistics substantiated the recommended cut scores in the MMPI-2-RF manual (Ben-Porath & Tellegen, 2008) in this forensic setting. Implications for these results in terms of forensic assessment and detection of malingering are discussed.

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Utility of the MMPI-2-RF (Restructured Form) validity scales in detecting malingering in a criminal forensic setting: a known-groups design.

The assessment of malingering is a fundamental component of forensic evaluations that should be considered with each referral. In systematizing the evaluation of malingering, one option is the standardized administration of screens as an initial step. The current study assessed the effectiveness of three common screening measures: the Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001), the Structured Inventory of Malingered Symptomatology (SIMS; Widows & Smith, 2004), and the Evaluation of Competency to Stand Trial-Revised Atypical Presentation Scale (ECST-R ATP; Rogers, Tillbrook, & Sewell, 2004). Using the Structured Interview of Reported Symptoms (SIRS) as the external criterion, 100 patients involved in competency to stand trial evaluations were categorized as either probable malingerers (n=21) or nonmalingerers (n=79). Each malingering scale produced robust effect sizes in this known-groups comparison. Results are discussed in relation to the comprehensive assessment of malingering within a forensic context.

An evaluation of malingering screens with competency to stand trial patients: a known-groups comparison.

Explanatory models of malingering strive to understand the primary motivation underlying attempts to feign. Rogers, Sewell, and Goldstein (1994) provided empirical support for the conceptualization of pathogenic, criminological, and adaptational models. In the current study, a prototypical analysis of 221 forensic experts results in a slightly refined formulation: the adaptational model was decomposed into its two broad dimensions (cost–benefit analysis and adversarial setting). An important finding is that the factor structure for the explanatory models remained stable when applied to both forensic and nonforensic cases. As a first investigation, significant differences were observed in prototypical cases of malingering by the category of referral (forensic or nonforensic) and by type of feigning (mental disorders, cognitive impairment, and medical syndromes). Surprisingly, the feigning of medical syndromes appeared to play a relatively prominent role in both forensic and nonforensic cases and to be influenced by the apparent adversarial context of the assessment. Finally, important gender differences were observed, especially with nonforensic prototypical cases of malingering.

Kathleen Leonard

Papers

A comparison of forensic and nonforensic malingerers: A prototypical analysis of explanatory models.