The place of validity tests in psychiatric diagnosis: beyond common misconceptions

Validity tests are used in both forensic and clinical settings, but their application in clinical practice is often hindered by misconceptions. These include the assumptions that validity tests imply a medico-legal dimension, primarily detect feigning or malingering, and provide minimal actionable information to clinicians. The authors critically discuss these misconceptions and argue that validity tests may offer significant value in clinical practice by assessing whether patients can describe their symptoms, complaints and impairments with reasonable accuracy, which has important implications for diagnosis and treatment planning. Importantly, in clinical practice, when interpreting validity tests, neutral terminology such as 'over-reporting' and 'underperformance' is often preferable to - and better to substantiate than - terms like 'feigning' and 'malingering', which can evoke moral judgements, creating an unnecessary barrier to using these valuable clinical tools.