Clinical Assessment of Malingering and Deception

The authors' title selection is certainly apropos for this masterful work on psychiatry and the law. It is, indeed, a handbook, full of insightful information, discussed in a format uniquely the authors'. The presentation of the material, in my view, is a tribute to their highly imaginative, clinical minds. My only regret is that, unlike most handbooks, it is not small enough to carry in your coat pocket. The book is one of the most clinically creative works to come out in the field of forensic psychiatry. It has successfully achieved what the authors stated it consistently strives to accomplish, that is, "1) always to interrelate the legal and the clinical aspects of an issue; and 2) to convey, whenever possible, something of the history of the law's approach to a problem, in the recognition that today's rule is, in most cases, merely the most recent unstable equilibrium that the

Clinical Handbook of Psychiatry and the Law

This article provides an overview of the history of substance use and misuse and chronicles the long shared history humans have had with psychoactive substances, including alcohol. The practical and personal functions of substances and the prevailing views of society towards substance users are described for selected historical periods and within certain cultural contexts. This article portrays how the changing historical and cultural milieu influences the prevailing medical, moral, and legal conceptualizations of substance use as reflected both in popular opinion and the consensus of the scientific community and represented by the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM). Finally, this article discusses the efforts to classify substance use disorders (SUDs) and associated psychopathology in the APA compendium. Controversies both lingering and resolved in the field are discussed, and implications for the future of SUD diagnoses are identified.

The Classification of Substance Use Disorders: Historical, Contextual, and Conceptual Considerations

Psychological injuries concern conditions produced by negligent actions, such as in motor vehicle accidents, and that result in claims for damages, such as in tort. In the psychological injury context, malingering refers to fabrications or gross exaggerations of psychological conditions for purposes of monetary gain. As much as the diagnoses that might result in such cases (e.g., posttraumatic stress disorder, PTSD), chronic pain, persistent postconcussive syndrome (PPCS) after a mild traumatic brain injury (mTBI) are considered contentious, so is the attribution of malingering and related negative response biases. This paper reviews the literature since the publication of the book by Young (2014) on the topic of malingering in the context of psychological injury cases. In particular, it examines the recent literature on the definition of malingering, and its prevalence or base rate, in the forensic disability and related context. The paper reviews not only recent articles, but also the 2015 Institute of Medicine book on the topic of use of validity tests in social security disability examinations. It examines the seminal work of Larrabee, Millis, and Meyers (2009) on the prevalence of malingering and indicates its consistencies. The paper concludes that (a) the definition of malingering can be improved and (b) the prevalence of malingering according to the recent research, as well as in Young’s 2014 book on the topic, is less than Larrabee’s catchy phrase that is prominent in some circles in the literature of 40 ± 10 %. More likely, it gravitates around 10 to 20 % so that, instead of 40 ± 10 %, the most appropriate percentage of malingering and related negative response biases in the disability and forensic context, as well as the clinical context, might be 15 ± 15 %, in general, with the percentage possibly being more than that for cases such as mTBI involving PPCS. These findings are pertinent to practice and for court.

Malingering in Forensic Disability-Related Assessments: Prevalence 15±15 %

This document is intended as a review of legal and psychiatric factors to offer practical guidance in the performance of forensic evaluations. It is a guideline developed through the participation of forensic psychiatrists who routinely conduct a variety of forensic assessments and who have

http://jaapl.org/content/jaapl/43/2_Supplement/S3.full.pdf

Mike Norko

Papers

AAPL Practice Guideline for the Forensic Assessment