When Harry Met Sally

Detecting Detecting Malingering On The Malingering On The StreetStreet

Felicia ByarsFelicia Byars

Master’s Forensic PsychologyMaster’s Forensic PsychologyAdjunct Professor Holy Names University, Adjunct Professor Holy Names University, Oakland CAOakland CAPatrol Officer, Menlo Park Police DepartmentPatrol Officer, Menlo Park Police Department

What is Malingering?What is Malingering?

You can fool some of the people all of You can fool some of the people all of the time, and all of the people some the time, and all of the people some of the time, but you cannot fool all of the time, but you cannot fool all of the people all of the timeof the people all of the time.”.”

Abraham LincolnAbraham Lincoln

Acceptance of a LieAcceptance of a Lie

Truth White lie Lie

The whole truth and The whole truth and nothing but the nothing but the truth so help me truth so help me God…God…

One of the One of the “great “great sins”sins”

Spare a person pain Spare a person pain or discomfort…or discomfort…

Police can lie to get Police can lie to get to the truth…to the truth…

The “I” disease…The “I” disease…

Types of MalingererTypes of Malingerer

Traditional – to avoid responsibility/punishmentTraditional – to avoid responsibility/punishment

Hierarchical – to place responsibility for Hierarchical – to place responsibility for actions away from indindividualactions away from indindividual

Safety – company “fidges” results to enable Safety – company “fidges” results to enable product releaseproduct release

Health – pretends to be healthier than they Health – pretends to be healthier than they really arereally are

Superiority – to make ones self better in Superiority – to make ones self better in appearanceappearance

Iatrogenic – blame symptomsIatrogenic – blame symptoms

By proxy – adult <> childBy proxy – adult <> child

Goals of MalingeringGoals of Malingering

1)1) Avoid Avoid responsibility/punishment/dangerresponsibility/punishment/danger

2)2) Receive protection/compensation not Receive protection/compensation not otherwise availableotherwise available

3)3) Achieve retaliation against Achieve retaliation against person/entity for real/perceived injury person/entity for real/perceived injury or illnessor illness

Hospital vs Prison

To Malinger…To Malinger… or Not To Malinger or Not To Malinger

Faking BadFaking Bad– Get out of trouble Get out of trouble

(NGRI)(NGRI)– Special treatmentSpecial treatment– $$$$$$– Avoid a jobAvoid a job

Faking GoodFaking Good– Prevent Prevent

detentiondetention– Early ReleaseEarly Release– Avoid StigmaAvoid Stigma– Obtain a job Obtain a job

Willful Deceit vs Altered Mental Willful Deceit vs Altered Mental StateState

Liar believes the lieLiar believes the lie– Cannot/will not be exposedCannot/will not be exposed

Does not understand the lieDoes not understand the lie– Truth is internalTruth is internal

How do they (re)act?How do they (re)act?

Malingering StylesMalingering Styles

OffensiveOffensive– DeceptionDeception– Created Created

symptomssymptoms– problem problem

solving skillssolving skills– Seeks controlSeeks control– Challenge Challenge

provokes angerprovokes anger

DefensiveDefensive– ProtectionProtection– Remove Remove

symptoms/problesymptoms/problemsms

– problem problem solving skillssolving skills

– Seeks to get awaySeeks to get away– Challenge Challenge

provokes fearprovokes fear

How does “I don’t know” move How does “I don’t know” move from being a lie to malingering?from being a lie to malingering?

Is it a lie or is it Is it a lie or is it Malingering?Malingering?

Proposes a false explanationfor an event

Seeks to be excused fromany responsibility

Malingerers Tend To….Malingerers Tend To….

Repeat or answer questions slowlyRepeat or answer questions slowly

Repeat words exactly when asked to recount Repeat words exactly when asked to recount eventevent

Show concentrationShow concentration

Seldom remember things correctly/completelySeldom remember things correctly/completely

Quick to admit their “problem”Quick to admit their “problem”

Attempt to control the interviewAttempt to control the interview

FBI CluesFBI Clues

VerbalVerbal– Gives clear and articulate description of being Gives clear and articulate description of being

confusedconfused Non-VerbalNon-Verbal

– Physical doesn’t match verbalPhysical doesn’t match verbal– Reports hallucinations, while undistractedReports hallucinations, while undistracted

Comparison to Norms of psychotic behaviorComparison to Norms of psychotic behavior– Over/Under actingOver/Under acting– Absurd or inconsistent thoughtsAbsurd or inconsistent thoughts– Sudden onset of delusionSudden onset of delusion– Confused description of hallucinationsConfused description of hallucinations– Eager to expose their symptomsEager to expose their symptoms– Offered as excuse for blamelessnessOffered as excuse for blamelessness

Over/Under ActingOver/Under Acting

Think “made for television”Think “made for television”

In a prison study…In a prison study…– more frightening and abusive, more frightening and abusive, – more uncontrollable, more uncontrollable, – unbearably distressing, unbearably distressing, – less predictable, and less predictable, and – less context-dependentless context-dependent

Absurd or Inconsistent Absurd or Inconsistent ThoughtsThoughts

Delusional “Norms”Delusional “Norms”

Often associated with hallucinationsOften associated with hallucinations Complexity of delusion correlates Complexity of delusion correlates

with sophistication of individualwith sophistication of individual Takes weeks to develop and longer Takes weeks to develop and longer

to disappearto disappear Individual exhibits corresponding Individual exhibits corresponding

paranoid behaviorparanoid behavior Individual reluctant to discuss Individual reluctant to discuss

delusiondelusion

““Norms” of Norms” of HallucinationHallucination

Hallucinations are usually associated Hallucinations are usually associated with delusions (88%)with delusions (88%)**

Intermittent rather than continuousIntermittent rather than continuous Can be interrupted by activityCan be interrupted by activity 56% of real psychotics agree 56% of real psychotics agree

hallucination could be due to hallucination could be due to imaginationimagination**

*Lewinsohn  PM. 

““Norms” of Auditory Norms” of Auditory HallucinationHallucination

Clear, NOT vagueClear, NOT vague Can distinguish between men and womenCan distinguish between men and women Real psychotics can identify

Sex, race, age, and emotional state of the voice (sometimes the person)

The tone, volume, and rate of the voice Most auditory hallucinations ask for an

interaction or a response from the person Usually originates outside the head (88%)Usually originates outside the head (88%) Can be malevolent or benevolentCan be malevolent or benevolent

Goodwin  DW,  Anderson  P,  Rosenthal  R

““Norms” of Visual Norms” of Visual HallucinationsHallucinations

Only occur between 24% to 30%, only Only occur between 24% to 30%, only reported about 4% of time by people reported about 4% of time by people with diagnosed psychosiswith diagnosed psychosis

Normal sized people Normal sized people Bright colorsBright colors Psychotic hallucinations do not change Psychotic hallucinations do not change

when eyes are closedwhen eyes are closed– drug induced more readily seen when eyes drug induced more readily seen when eyes

closed/in darkclosed/in dark

Command Command HallucinationsHallucinations Usually present with Usually present with

noncommand hallucinations and noncommand hallucinations and delusionsdelusions

Individual does not always obey Individual does not always obey command, esp if dangerouscommand, esp if dangerous

““Norms” of Olfactory Norms” of Olfactory HallucinationsHallucinations They Stink!They Stink!

I don’t remember… I don’t remember…

Feeling of knowingFeeling of knowing– How likely would you be to How likely would you be to

remember…remember… With more time?With more time? With hints?With hints? With a recognition task?With a recognition task?

Indirect Memory TestsIndirect Memory Tests What is this word kn_ _ _?What is this word kn_ _ _?

……it must be AMNESIA it must be AMNESIA

MiscMisc

Faking “dumb”Faking “dumb” Use of the terms “probably”, “I Use of the terms “probably”, “I

don’t know” don’t know” Mixed symptom profileMixed symptom profile Repeats question as answerRepeats question as answer Gets angry when challengedGets angry when challenged

The ProfileThe Profile

Non- MalingererNon- Malingerer– Seldom has a partnerSeldom has a partner– Seldom planned crimeSeldom planned crime

MalingererMalingerer– Non-psychotic alternative motiveNon-psychotic alternative motive

Let’s PracticeLet’s Practice

Group Breakout…Group Breakout…