TY - JOUR
T1 - Experts' Failure to Consider the Negative Predictive Power of Symptom Validity Tests
AU - Niesten, Isabella J.M.
AU - Merckelbach, Harald
AU - Dandachi-FitzGerald, Brechje
AU - Jutten-Rooijakkers, Ingrid
AU - van Impelen, Alfons
N1 - Copyright © 2022 Niesten, Merckelbach, Dandachi-FitzGerald, Jutten-Rooijakkers and van Impelen.
PY - 2022/3/18
Y1 - 2022/3/18
N2 - Feigning (i.e., grossly exaggerating or fabricating) symptoms distorts diagnostic evaluations. Therefore, dedicated tools known as symptom validity tests (SVTs) have been developed to help clinicians differentiate feigned from genuine symptom presentations. While a deviant SVT score is an indicator of a feigned symptom presentation, a non-deviant score provides support for the hypothesis that the symptom presentation is valid. Ideally, non-deviant SVT scores should temper suspicion of feigning even in cases where the patient fits the DSM's stereotypical yet faulty profile of the "antisocial" feigner. Across three studies, we tested whether non-deviant SVT scores, indeed, have this corrective effect. We gave psychology students (Study 1, N = 55) and clinical experts (Study 2, N = 42; Study 3, N = 93) a case alluding to the DSM profile of feigning. In successive steps, they received information about the case, among which non-deviant SVT outcomes. After each step, participants rated how strongly they suspected feigning and how confident they were about their judgment. Both students and experts showed suspicion rates around the midpoint of the scale (i.e., 50) and did not respond to non-deviant SVT outcomes with lowered suspicion rates. In Study 4, we educated participants (i.e., psychology students, N = 92) about the shortcomings of the DSM's antisocial typology of feigning and the importance of the negative predictive power of SVTs, after which they processed the case information. Judgments remained roughly similar to those in Studies 1-3. Taken together, our findings suggest that students and experts alike have difficulties understanding that non-deviant scores on SVTs reduce the probability of feigning as a correct differential diagnosis.
AB - Feigning (i.e., grossly exaggerating or fabricating) symptoms distorts diagnostic evaluations. Therefore, dedicated tools known as symptom validity tests (SVTs) have been developed to help clinicians differentiate feigned from genuine symptom presentations. While a deviant SVT score is an indicator of a feigned symptom presentation, a non-deviant score provides support for the hypothesis that the symptom presentation is valid. Ideally, non-deviant SVT scores should temper suspicion of feigning even in cases where the patient fits the DSM's stereotypical yet faulty profile of the "antisocial" feigner. Across three studies, we tested whether non-deviant SVT scores, indeed, have this corrective effect. We gave psychology students (Study 1, N = 55) and clinical experts (Study 2, N = 42; Study 3, N = 93) a case alluding to the DSM profile of feigning. In successive steps, they received information about the case, among which non-deviant SVT outcomes. After each step, participants rated how strongly they suspected feigning and how confident they were about their judgment. Both students and experts showed suspicion rates around the midpoint of the scale (i.e., 50) and did not respond to non-deviant SVT outcomes with lowered suspicion rates. In Study 4, we educated participants (i.e., psychology students, N = 92) about the shortcomings of the DSM's antisocial typology of feigning and the importance of the negative predictive power of SVTs, after which they processed the case information. Judgments remained roughly similar to those in Studies 1-3. Taken together, our findings suggest that students and experts alike have difficulties understanding that non-deviant scores on SVTs reduce the probability of feigning as a correct differential diagnosis.
KW - BASE
KW - BEHAVIOR
KW - BIAS
KW - DECISION-MAKING
KW - DIAGNOSIS
KW - HEURISTICS
KW - NEUROPSYCHOLOGISTS
KW - OVERCONFIDENCE
KW - PERFORMANCE
KW - PSYCHIATRISTS
KW - antisocial personality features
KW - clinical decision making
KW - debiasing
KW - feigning
KW - malingering
KW - negative predictive power
KW - symptom validity testing
KW - tunnel vision
U2 - 10.3389/fpsyg.2022.789762
DO - 10.3389/fpsyg.2022.789762
M3 - Article
C2 - 35369141
SN - 1664-1078
VL - 13
JO - Frontiers in Psychology
JF - Frontiers in Psychology
M1 - 789762
ER -