Can you tell a liar?

[Merely]

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I’m a 4th year medical student entering psychiatry. I read an article comparing the ability of psychiatrists to tell if a person was lying compared to laymen and it showed no difference. Psychiatrists have no special abilities in this regard. However, do you guys know if there’s any literature showing psychologists or forensic psychologists are able to better determine a liar from a truth teller compared to a laymen? It’s an interesting discussion to say the least and I’d appreciate any insights.

 

[Justanothergrad]

Read Paul Meehl's work on clinical judgement.

 

[Fan_of_Meehl]

I’m a 4th year medical student entering psychiatry. I read an article comparing the ability of psychiatrists to tell if a person was lying compared to laymen and it showed no difference. Psychiatrists have no special abilities in this regard. However, do you guys know if there’s any literature showing psychologists or forensic psychologists are able to better determine a liar from a truth teller compared to a laymen? It’s an interesting discussion to say the least and I’d appreciate any insights.

Essentially, no. I think there were a couple of studies that showed that some professionals in law enforcement (detectives and such) may be able to do better than chance, but the studies on mental health professionals attempting to do this own their own ('clinical judgment') without the aid of specific objective assessment instruments and the appropriate algorithms indicate that utilizing 'clinical judgment' is insufficient to reliably/validly detect malingering. It's actually relieving, in a way...even though the lay public (and clueless administrators) may think that you have some magical powers to detect lying/malingering, you know better and so you don't try to be some sort of superhero with psychic powers. You develop clinical hypotheses, collect data over time, and refine your clinical case formulation. You say what you can say (and defend with data and reasoning appealing to the professional literature) and you don't go beyond that. You shouldn't make assertions that aren't backed up by evidence and logic that anyone can follow once you lay it out for them (they should generally reach the same conclusions if you've laid out your argument well enough). Not the kind of exciting stuff that makes for good television, but it's a logical and feasible approach that can also be enjoyable.

 

[BuckeyeLove]

If someone gets a 7, 5, and 2 on a TOMM....yes, I can "tell a liar."

 

[PsyDr]

We have tests that can prove someone is not being honest with accuracies in the range of 99%+.

You can also use the eckman facial action coding system, which requires hours of work and is completely different than what tv shows.

 

[AbnormalPsych]

***Flashbacks to my VA neuro testing cases***

 

[Sanman]

***Flashbacks to my VA neuro testing cases***

Ha, me too. Frankly, I can't understand why anyone would want to get into that work. Even the tests that we have for malingering really prove that the patient put forth a sub-optimal effort and the results of the examination cannot be considered accurate (i.e. the person is not trying to do well). Whether that means they are lying regarding whatever the referral question is up for debate (rather than bored, in a chemically altered state, etc). I often wondered how many of the vets I saw for testing had tbi/ptsd issues and tanked the vailidity/malingering measures because they were trying to play up their sx due to the convoluted benefits system vs those that were truly just lying for secondary gain.

 

[WisNeuro]

I often wondered how many of the vets I saw for testing had tbi/ptsd issues and tanked the vailidity/malingering measures because they were trying to play up their sx due to the convoluted benefits system vs those that were truly just lying for secondary gain.

It's really the same thing. Both of these instances are examples of secondary gain.

 

[Sanman]

It's really the same thing. Both of these instances are examples of secondary gain.

True, but just because there are motives of secondary gain present does not negate the fact that these conditions might be present. If I use my broken arm as an excuse to get easy duty/extra benefits at work, it doesn't mean I don't have a broken arm. My point, I feel that many will try to game the system when money is at stake. I am curious as to what portion are justly entitled. Questions that make me never want to do C&P work.

 

[PsyDr]

True, but just because there are motives of secondary gain present does not negate the fact that these conditions might be present. If I use my broken arm as an excuse to get easy duty/extra benefits at work, it doesn't mean I don't have a broken arm. My point, I feel that many will try to game the system when money is at stake. I am curious as to what portion are justly entitled. Questions that make me never want to do C&P work.

Symptom exaggeration for secondary gain is still malingering.

 

[Justanothergrad]

Exaggeration of symptoms is far more common in the VA than outright "faking", but it's still a form of malingering/feigning. This is probably due (at least in part) to the higher rate of prevalence for mental health symptoms to start with (I feel like I was literally just writing a paper about this)

***Flashbacks to my VA neuro testing cases***

I mean, to be fair shouldn't that read "Flashback to my all VA work". Although it varies by VA service clinic, I found that somewhere between 40-65% of folks who fail primary embedded validity indicators in a 7 year national sample (PTSD Clinic was the worst by far).

 

[WisNeuro]

True, but just because there are motives of secondary gain present does not negate the fact that these conditions might be present. If I use my broken arm as an excuse to get easy duty/extra benefits at work, it doesn't mean I don't have a broken arm. My point, I feel that many will try to game the system when money is at stake. I am curious as to what portion are justly entitled. Questions that make me never want to do C&P work.

Of course, they may have something actually going on, but, as PSYD said, exaggeration of symptoms is still malingering and invalidates the data just the same. Additionally, it's not just C&P work, these issues are rampant even in the general clinics. In my last clinic, my rates of PVT failure (even being generous) was around 45% give or take a few percentage points.

 

[Justanothergrad]

Additionally, it's not just C&P work, these issues are rampant even in the general clinics. In my last clinic, my rates of PVT failure (even being generous) was around 45% give or take a few percentage points.

I would argue that's partially because C&P utilize historic records, so all services provided are within the scope of evidence used for C&P determination. It creates an oddly enmeshed treatment & forensic setting for the VA.

 

[WisNeuro]

I would argue that's partially because C&P utilize historic records, so all services provided are within the scope of evidence used for C&P determination. It creates an oddly enmeshed treatment & forensic setting for the VA.

No need to argue it, I'd wager that almost everyone who has worked in an assessment setting in the VA would agree with the sentiment.

 

[PsyDr]

I would argue that's partially because C&P utilize historic records, so all services provided are within the scope of evidence used for C&P determination. It creates an oddly enmeshed treatment & forensic setting for the VA.

You means like how any personal injury case seeks treatment to support the idea that their injury caused and continues to cause harm? Or how claimants for social security uses medical records to support their case?

It's not just the VA and it's not just disability.

 

[Justanothergrad]

You means like how any personal injury case seeks treatment to support the idea that their injury caused and continues to cause harm? Or how claimants for social security uses medical records to support their case?

It's not just the VA and it's not just disability.

Thats true. The VA is just different in that all medical services are provided within that context so it encourages different approaches to treatment on a daily basis beyond what is typical in other disability settings.

No need to argue it, I'd wager that almost everyone who has worked in an assessment setting in the VA would agree with the sentiment.

Right up until some silly administrator starts to think feigning would never be a regular occurrence ^_^

 

[Sanman]

Of course, they may have something actually going on, but, as PSYD said, exaggeration of symptoms is still malingering and invalidates the data just the same. Additionally, it's not just C&P work, these issues are rampant even in the general clinics. In my last clinic, my rates of PVT failure (even being generous) was around 45% give or take a few percentage points.

Oh, I agree that it invalidates the data and the tests are useless is helping determine their case. The question I have is whether malingering on a given day should invalidate the benefits claim all together. IDK, I guess that is beyond the scope of what is being asked and we can really only speak to the results that are in front of us. I just remember the heated battles between neuropsych and treatment teams on this when I was an intern and it left a bad taste in my mouth.

 

[WisNeuro]

Oh, I agree that it invalidates the data and the tests are useless is helping determine their case. The question I have is whether malingering on a given day should invalidate the benefits claim all together. IDK, I guess that is beyond the scope of what is being asked and we can really only speak to the results that are in front of us. I just remember the heated battles between neuropsych and treatment teams on this when I was an intern and it left a bad taste in my mouth.

Exactly, when it comes down to it, I am not opining on whether or not they deserve benefits. I honestly could not care less whether they do or not. I am there to do a clinical evaluation and inform treatment planning. If they want to f*ck around and waste everyone's time and delay services for other people who actually need the services, that's on them. Luckily, my having to deal with this has significantly decreased. Probably at 5-10% PVT failure rate now, and most of these I know before they come in based on chart review. Only reason I still accept them is favors for high volume referral sources.

 

[psych.meout]

Ha, me too. Frankly, I can't understand why anyone would want to get into that work. Even the tests that we have for malingering really prove that the patient put forth a sub-optimal effort and the results of the examination cannot be considered accurate (i.e. the person is not trying to do well). Whether that means they are lying regarding whatever the referral question is up for debate (rather than bored, in a chemically altered state, etc). I often wondered how many of the vets I saw for testing had tbi/ptsd issues and tanked the vailidity/malingering measures because they were trying to play up their sx due to the convoluted benefits system vs those that were truly just lying for secondary gain.

While "sub-optimal effort" is the nomenclature (euphemism?) commonly used, in many (most?) cases, it's not technically accurate. The kind of faking bad and malingering done by these patients isn't "sub-optimal effort." On the contrary, it's actually quite effortful to intentionally perform poorly and exaggerate symptoms, especially if they are trying to do so in a subtle, cagey way to get what they want without arousing suspicion that they are doing so.

Oh, I agree that it invalidates the data and the tests are useless is helping determine their case. The question I have is whether malingering on a given day should invalidate the benefits claim all together. IDK, I guess that is beyond the scope of what is being asked and we can really only speak to the results that are in front of us. I just remember the heated battles between neuropsych and treatment teams on this when I was an intern and it left a bad taste in my mouth.

As WisNeuro pointed out, that's not really within the scope of the assessment. Let's take a hypothetical example. A chronic pain patient comes in for an evaluation that will be used for C&P/SSDI/litigation, they claim that they are having cognitive problems as well. They fail the PVTs and are likely exaggerating their cognitive problems, if they even have any at all. Does this mean that they shouldn't get benefits and/or a favorable judgment? Does failing the PVTs invalidate their other problems, e.g., the chronic pain?

 

[Sanman]

While "sub-optimal effort" is the nomenclature (euphemism?) commonly used, in many (most?) cases, it's not technically accurate. The kind of faking bad and malingering done by these patients isn't "sub-optimal effort." On the contrary, it's actually quite effortful to intentionally perform poorly and exaggerate symptoms, especially if they are trying to do so in a subtle, cagey way to get what they want without arousing suspicion that they are doing so.


As WisNeuro pointed out, that's not really within the scope of the assessment. Let's take a hypothetical example. A chronic pain patient comes in for an evaluation that will be used for C&P/SSDI/litigation, they claim that they are having cognitive problems as well. They fail the PVTs and are likely exaggerating their cognitive problems, if they even have any at all. Does this mean that they shouldn't get benefits and/or a favorable judgment? Does failing the PVTs invalidate their other problems, e.g., the chronic pain?

I would argue that sub-optimal effort is the conservative assertion. To assume it is effortful is to assign intention to that performance. What I am questioning is whether failing a PVT can truly be interpreted as intentional faking bad or simply a performance that can not (or should not) be interpreted past it being an invalid measure of performance. If several PVTs are failed by a couple of standard deviations (or a perfect failure on a single test). I would feel comfortable with a statement of intentional malingering. However, I didn't feel comfortable with the assumption based on a single PVT failure.

 

[PsyDr]

I would argue that sub-optimal effort is the conservative assertion. To assume it is effortful is to assign intention to that performance. What I am questioning is whether failing a PVT can truly be interpreted as intentional faking bad or simply a performance that can not (or should not) be interpreted past it being an invalid measure of performance. If several PVTs are failed by a couple of standard deviations (or a perfect failure on a single test). I would feel comfortable with a statement of intentional malingering. However, I didn't feel comfortable with the assumption based on a single PVT failure.

That depends on the pvt. Binomial theorem based 1000 item home brew? Yeah, I can tell a trier of fact that you could blindfold all of the states of Minnesota, New Hampshire, and Oregon and you still wouldn’t get such a performance.

 

[psych.meout]

I would argue that sub-optimal effort is the conservative assertion. To assume it is effortful is to assign intention to that performance. What I am questioning is whether failing a PVT can truly be interpreted as intentional faking bad or simply a performance that can not (or should not) be interpreted past it being an invalid measure of performance. If several PVTs are failed by a couple of standard deviations (or a perfect failure on a single test). I would feel comfortable with a statement of intentional malingering. However, I didn't feel comfortable with the assumption based on a single PVT failure.

That's kind of my point, "sub-optimal effort" is used more broadly than it should be. It's used both appropriately as a indicator that the tests were not valid indicators of true optimal performance due to less than maximal effort and inappropriately as an euphemism for malingering/exaggerating/lying/etc. My problem is with the latter usage, as true malinger/faking bad/etc. is the opposite of low effort.

 

[WisNeuro]

I would argue that sub-optimal effort is the conservative assertion. To assume it is effortful is to assign intention to that performance. What I am questioning is whether failing a PVT can truly be interpreted as intentional faking bad or simply a performance that can not (or should not) be interpreted past it being an invalid measure of performance. If several PVTs are failed by a couple of standard deviations (or a perfect failure on a single test). I would feel comfortable with a statement of intentional malingering. However, I didn't feel comfortable with the assumption based on a single PVT failure.

If someone who is working, drove to my appointment from two hours away, and can bathe and feed themselves independently, performs well below a normative group of people with moderate to severe dementia and require 24-hour skilled nursing care, I am just fine assuming that someone is intentionally performing poorly.

 

[Justanothergrad]

I would argue that sub-optimal effort is the conservative assertion. To assume it is effortful is to assign intention to that performance. What I am questioning is whether failing a PVT can truly be interpreted as intentional faking bad or simply a performance that can not (or should not) be interpreted past it being an invalid measure of performance. If several PVTs are failed by a couple of standard deviations (or a perfect failure on a single test). I would feel comfortable with a statement of intentional malingering. However, I didn't feel comfortable with the assumption based on a single PVT failure.

I would agree with you that you need multiple sources of evidence to conclude malingering (pretty sure that's consistent with best practices anyway). I'm fine using it to conclude less harsh terms about low effort and describing it as such (as well as providing a comparison of how they performed in the report). Applying the malingering label based on one bit of evidence is generally a bad idea. It drives me nuts when I see feigning studies that use 1 PVT to group an individual into malingering/not-malingering categories.

 

[boomshakalaka]

That depends on the pvt. Binomial theorem based 1000 item home brew? Yeah, I can tell a trier of fact that you could blindfold all of the states of Minnesota, New Hampshire, and Oregon and you still wouldn’t get such a performance.

I've also heard one very prominent psychologist describe the likelihood of these kinds of results as, "As likely as finding spit in the ocean." One of my favorites!

We could probably start an entire thread on terrible TOMM results.

 

[cara susanna]

FWIW, my Clinical Assessment professor said that we'd get an automatic failure in the course if we ever used the term "malingering" just based on test data. He said that refers to motive, which we can never assume from a validity instrument. We had to say "overreporting" or "underreporting."

 

[erg923]

FWIW, my Clinical Assessment professor said that we'd get an automatic failure in the course if we ever used the term "malingering" just based on test data. He said that refers to motive, which we can never assume from a validity instrument. We had to say "overreporting" or "underreporting."

Thats very nice, but does not reflect reality of what needs to occur to make psychological testing (and you) useful, valued, and respected in the healthcare system. By far the biggest complaint I have heard about psychological testing is that either doesn't tell people what they didn't already strongly suspect or just "muddies the waters" and/or sends back a bunch of rule-outs and equivocal statements that don't really help anyone.

Of course malingering shouldnt be test bound decision. So...talk about them in context of everything else and make actual conclusion/opinion. Otherwise, it looks like what we are doing is just wasteful and not valuable.

 

[Justanothergrad]

FWIW, my Clinical Assessment professor said that we'd get an automatic failure in the course if we ever used the term "malingering" just based on test data. He said that refers to motive, which we can never assume from a validity instrument. We had to say "overreporting" or "underreporting."

Yeh, that makes sense since a criteria for malingering is secondary gains and you can't assess that on PVT/SVT- you can only describe performance. I wouldn't extend that thinking about interpretation into a testing situation though since that additional information is part of the referral/eval.