How is noncredible presentation defined by the DSM-IV-TR?

The DSM-IV-TR uses two different labels for noncredible presentation. Malingering is used when the feigning of symptoms seems to be motivated by external gain, such as money, resources, medication, or others. The label factitious disorder is used when the feigning is motivated by an internal reason, such as wanting to act out the role of patient. This version of the DSM also states that feigning means that a patient has intentional control over their symptoms. However, it appears their is not such a clear difference between malingerers and those with factitious disorder. Secondly, some people are so involved with pretending to have a certain disorder that they practice it unconsciously. People may really come to believe they are ill and mistake their fake symptoms for 'real ones'.

The current study looks at whether fake symptoms can be mistaken for real ones when people are instructed to feign them. A second thing this research studies is whether self-deception may be the basis of this effect. Self-deception is a trait where people lack introspective ability.

How did the first experiment go?

The first experiment had two groups. Both groups read a story explaining a defendant entering a building illegally, stones falling down as a result, and a girl getting killed because of it. The groups were instructed to imagine that they were the defendant and had to undergo an evaluation. One of the groups was instructed to feign symptoms to make them less criminally responsible, whereas people from the other group were instructed to fill out the evaluation honestly. After some time had passed both groups filled in the same scale again, but were both instructed to respond honestly this time. The researchers examined whether those that were first instructed to feign and then to respond honestly reported more symptoms than those that were asked tor espond honestly both times. This would support the idea that people who feign symptoms can become less conscious of the way they report them.

Participants did what was asked of them and it was found that the group that first feigned and then had to respond honestly reported more symptoms in both cases. This may have been because people 'forget' that they fabricated their symptoms.

How did the second experiment go?

Participants were asked to fill in a certain psychiatric symptom scale, the SCL-90. Following this, they were asked to solve two sudoku puzzles. While the participants solved the puzzles, one of the experimenters manipulated two items of their psychiatric symptom scale and increased their score on it by two points. After solving the puzzles, the experimenter showed them the manipulated answers and some control ones and asked them to explain why they had filled out the scores as they did. This was to test whether participants could detect the mismatches between what they actually answered and what the experimenter turned their answer into. After this was done, the participants filled out another short version of the SCL-90. Through this it was tested whether participants that did not notice the score change by the experimenter would fill out their scoring in the direction of the manipulation while filling in the SCL-90 this second time.

Many participants were blind to the changes the experimenter made in their answer sheets and accepted tham as their own answers. As a result of this, they changed their answers in the direction of the manipulation when filling out the scale a second time. This means that participants do not monitor symptoms they report very well introspectively. However, people do differ on this character trait. Important for this is self-deceptive enhancement, a bias where you see yourself as a powerful agency, which goes together with a poor insight into symptoms and distortion of memory.

How did the third experiment go?

This experiment was set up to check whether self-deceptive enhancement (a poor insight into what causes your own behavior) could be related to feigning and seeing your own made up symptoms as real. Participants were asked to read a story about a worker who had practiced the same factory job for 25 years, but after a conflict tried to call in sick and complain of symptoms he did not have. The participants were asked to imagine they were the worker and feign the symptoms he was having on a test. After this test, the participants were given sudoku's to solve. After this, the participants got new tests and were now asked to forget the story about the worker and instead respond honestly.

It was found that individuals who scored high on self-deceptive enhancement showed greater residual effects of feigning. Thus, having poor introspective abilities could possibly be related to forgetting your symptoms are made up, and instead seeing them as real.

Are there limitations to the three experiments?

A few limitations to the research above can be stated:

• The research was done with small, nonclinical samples made up of students.
• The samples consisted mainly of females.
• No interviews were done after the experiments to see whether participants had actually consciously feigned symptoms when given the second test or whether they had answered honestly.
• It is unknown whether the effects found with this research are short- or long-term effects. This is because both tests were administered in one session.