The Cry for Help in Psychological Injury and Law: Concepts and Review

Clinical Consultation in the Workplace: Are There Implications for Response Attitudes?

The clinical-organizational context (where clinical psychology services are provided in the individuals' professional setting) has still been insufficiently approached in research, namely the influence it may have on the response attitudes of individuals undergoing psychological assessment. Our main goal is to find out if, when psychological assessment occurs in the workplace context, patients being assessed present specific response bias that may have implications for the clinical results and correlative decisions. Five hundred and ten adult participants grouped in two samples of ambulatory patients - Clinical-Organizational Sample (COS n = 238) and Clinical Sample (CS n = 272) - were assessed with the Minnesota Multiphasic Personality Inventory-2-RF validity and substantive scales. Under-reporting is five times more frequent in the COS, which presents Defensiveness (11%), and Desirability (5%). In the CS, under-reporting is residual and over-reporting is more prevalent than in the COS. Clinical record information of COS participants presenting under vs. over-reporting also reveal differences concerning their circumstances, and type of clinical conditions. Comparing participants with under-reporting in each sample, the COS had lower clinical profiles, and tended to present excessively low psychopathology and symptomology values, suggesting higher defensiveness. Finally, the fact that 33% of the COS present biased response attitudes (i.e., 15% presented under-reporting and 18% presented over-reporting) has implications for both clinical and career decision making processes. In conclusion, there are relevant differences in response attitude and psychopathology features between outpatients assessed in a traditional clinical setting and in a clinical-organizational one, suggesting the professional context of the patients may influence motivations to disclosure psychological symptoms and problems.

Interpreting symptom validity test fails in forensic disability and related assessments: When the cry for help for one fail makes sense

Dandachi-FitzGerald et al. (2022), published the article "Cry for help as a root cause of poor symptom validity: A critical note," in Applied Neuropsychology: Adult [Advance Online], arguing that the cry for help in forensic disability and related assessments is not a valid interpretation for poor symptom validity test results. This rebuttal contests the criticisms of the use of the cry for help in this context, as presented in Young (2019); "The Cry for help in a psychological injury and law: Concepts and review" that appeared in Psychological Injury and Law, Vol. 12, pp. 225-237. It calls for more programmatic research, for example, based on the cry for help questionnaire suggested by the author. In particular, it indicates, for example, that one SVT test failure in a test battery constitutes an assessment result that could allow for attributing the cry for help, everything else being equal. It suggests that the adaptational theory explains the cry for help as much as malingering. It suggests practice and court recommendations that will allow better rebuttals of unethical assessors who overuse/misuse/abuse the cry for help interpretation of poor symptom validity test results in forensic disability and related assessments.

Cry for help as a root cause of poor symptom validity: A critical note

When patients fail symptom validity tests (SVTs) and/or performance validity tests (PVTs), their self-reported symptoms and test profiles are unreliable and cannot be taken for granted. There are many well-established causes of poor symptom validity and malingering is only of them. Some authors have proposed that a cry for help may underlie poor symptom validity. In this commentary, we argue that cry for help is a (1) metaphorical concept that is (2) difficult to operationalize and, at present, (3) impossible to falsify. We conclude that clinicians or forensic experts should not invoke cry for help as an explanation for poor symptom validity. To encourage conceptual clarity, we propose a tentative framework for explaining poor symptom validity.

Detection of Feigning of Different Symptom Presentations With the PAI and IOP-29

This study examined the effectiveness of the negative distortion measures from the Personality Assessment Inventory (PAI) and Inventory of Problems-29 (IOP-29), by investigating data from a community and a forensic sample, across three different symptom presentations (i.e., feigned depression, posttraumatic stress disorder [PTSD], and schizophrenia). The final sample consisted of 513 community-based individuals and 288 inmates (total N = 801); all were administered the PAI and the IOP-29 in an honest or feigning conditions. Statistical analyses compared the average scores of each measure by symptom presentation and data source (i.e., community vs. forensic sample) and evaluated diagnostic efficiency statistics. Results suggest that the PAI Negative Impression Management scale and the IOP-29 are the most effective measures across all symptom presentations, whereas the PAI Malingering Index and Rogers Discriminant Function generated less optimal results, especially when considering feigned PTSD. Practical implications are discussed.

Objective Cognitive Outcomes and Subjective Emotional Sequelae in Litigating Adults with a Traumatic Brain Injury: The Impact of Performance and Symptom Validity Measures

OBJECTIVE

This study examined the relative contribution of performance and symptom validity in litigating adults with traumatic brain injury (TBI), as a function of TBI severity, and examined the relationship between self-reported emotional symptoms and cognitive tests scores while controlling for validity test performance.

METHOD

Participants underwent neuropsychological assessment between January 2012 and June 2021 in the context of compensation-seeking claims related to a TBI. All participants completed a cognitive test battery, the Personality Assessment Inventory (including symptom validity tests; SVTs), and multiple performance validity tests (PVTs). Data analyses included independent t-tests, one-way ANOVAs, correlation analyses, and hierarchical multiple regression.

RESULTS

A total of 370 participants were included. Atypical PVT and SVT performance were associated with poorer cognitive test performance and higher emotional symptom report, irrespective of TBI severity. PVTs and SVTs had an additive effect on cognitive test performance for uncomplicated mTBI, but less so for more severe TBI. The relationship between emotional symptoms and cognitive test performance diminished substantially when validity test performance was controlled, and validity test performance had a substantially larger impact than emotional symptoms on cognitive test performance.

CONCLUSION

Validity test performance has a significant impact on the neuropsychological profiles of people with TBI, irrespective of TBI severity, and plays a significant role in the relationship between emotional symptoms and cognitive test performance. Adequate validity testing should be incorporated into every neuropsychological assessment, and associations between emotional symptoms and cognitive outcomes that do not consider validity testing should be interpreted with extreme caution.

Assessing Negative Response Bias Using Self-Report Measures: New Articles, New Issues

In psychological injury and related forensic evaluations, two types of tests are commonly used to assess Negative Response Bias (NRB): Symptom Validity Tests (SVTs) and Performance Validity Tests (PVTs). SVTs assess the credibility of self-reported symptoms, whereas PVTs assess the credibility of observed performance on cognitive tasks. Compared to the large and ever-growing number of published PVTs, there are still relatively few validated self-report SVTs available to professionals for assessing symptom validity. In addition, while several studies have examined how to combine and integrate the results of multiple independent PVTs, there are few studies to date that have addressed the combination and integration of information obtained from multiple self-report SVTs. The Special Issue of Psychological Injury and Law introduced in this article aims to help fill these gaps in the literature by providing readers with detailed information about the convergent and incremental validity, strengths and weaknesses, and applicability of a number of selected measures of NRB under different conditions and in different assessment contexts. Each of the articles in this Special Issue focuses on a particular self-report SVT or set of SVTs and summarizes their conditions of use, strengths, weaknesses, and possible cut scores and relative hit rates. Here, we review the psychometric properties of the 19 selected SVTs and discuss their advantages and disadvantages. In addition, we make tentative proposals for the field to consider regarding the number of SVTs to be used in an assessment, the number of SVT failures required to invalidate test results, and the issue of redundancy when selecting multiple SVTs for an assessment.

Remote Forensic Psychological Assessment in Civil Cases: Considerations for Experts Assessing Harms from Early Life Abuse

The COVID-19 pandemic has brought to the fore the question of whether psycho-legal assessments can be executed remotely in a manner that adheres to the rigorous standards applied during in-person assessments. General guidelines have evolved, but to date, there are no explicit directives about whether and how to proceed. This paper reviews professional, ethical, and legal challenges that experts should consider before conducting such an evaluation remotely. Although the discussion is more widely applicable, remote forensic psychological assessment of adults alleging childhood abuse is used as an example throughout, due to the complexity of these cases, the ethical dilemmas they can present, and the need to carefully assess non-verbal trauma-related symptoms. The use of videoconferencing technology is considered in terms of potential benefits of this medium, as well as challenges this method could pose to aspects of interviewing and psychometric testing. The global pandemic is also considered with respect to its effects on functioning and mental health and the confounding impact such a crisis has on assessing the relationship between childhood abuse and current psychological functioning. Finally, for those evaluators who want to engage in remote assessment, practice considerations are discussed.

Civil Forensic Evaluation in Psychological Injury and Law: Legal, Professional, and Ethical Considerations

Psychologists who work as therapists or administrators, or who engage in forensic practice in criminal justice settings, find it daunting to transition into practice in civil cases involving personal injury, namely psychological injury from the psychological perspective. In civil cases, psychological injury arises from allegedly deliberate or negligent acts of the defendant(s) that the plaintiff contends caused psychological conditions to appear. These alleged acts are disputed in courts and other tribunals. Conditions considered in psychological injury cases include posttraumatic stress disorder, depression, chronic pain conditions, and sequelae of traumatic brain injury. This article outlines a detailed case sequence from referral through the end of expert testimony to guide the practitioner to work effectively in this field of practice. It addresses the rules and regulations that govern admissibility of expert evidence in court. The article provides ethical and professional guidance throughout, including best practices in assessment and testing, and emphasizes evidence-based forensic practice.

Do You Know People Who Feign? Proxy Respondents About Feigned Symptoms

We asked students, clinicians, and people from the general population attending a public university lecture (n = 401) whether they knew others who (had) feigned symptoms. We also asked about the type of symptoms and the motives involved. A slight majority of proxy respondents (59%) reported that they knew a person who (had) feigned symptoms, and 34% knew a person who had admitted to them having feigned symptoms. According to our respondents, the most often feigned symptoms were headache/migraine, common cold/fever, and stomachache/nausea, and the most important reasons for doing so were sick leave from work, excusing a failure, and seeking attention from others. We conclude that feigning is part of the normal behavioral repertoire of people and has little to do with deviant personality traits and/or criminal motives. Also, the current emphasis in the neuropsychological literature on malingering, i.e., feigning motivated by external incentives, might be one-sided given that psychological motives, notably seeking attention from others and excuse making, seem to be important determinants of everyday feigning.