Article summary of Syndromes associated with deception by Vitacco - Chapter

What are some important features of deception?

Individuals can have different motivates for deception at different times. A few important features about deception need to be kept in mind:

• Deception is a multidimensional construct that manifests differently across situations and settings.
• Deception is not taxonic - it is a dimensional construct that can change in direction and intensity.
• Deception is frequently adaptive.
• Individuals who deceive are not always aware of their motives for the deception.

What conceptual issues exist regarding feigning and related response styles?

• Individual’s motivations need to be carefully considered. Factitious disorders are usually viewed as existing on a continuum, and symptoms of malingering and factitious disorder can be difficult to disentangle.
• Isolated test results cannot be equated with a classification of feigning or malingering. Clinicians should use a multimodal approach that integrates information from behavioral observations, health history, criminal history, and objective psychological testing.
• Behaviors associated with malingering are not taxonic.
• There can be multiple determinants of motivations related to feigning and deceptive behaviors. Behaviors can span more than one explanatory model.
• Clinicians should use empirically validated terms.

Which types of malingering can be distinguished?

Resnick, West, and Payne subtyped malingering by the level of fabrication and exaggeration and distinguished three types of malingering:

• False imputation: symptoms are attributed to an etiologically unrelated cause.
• Partial malingering: exaggerating symptoms that individuals do not longer have.
• Full malingering: intentionally fabricating and exaggeration of symptoms for external incentives.

In which ways can deception be manifested as part of psychopathology?

Many clinicians think that any form of deception is an indicator of malingering, even though several DSM diagnoses include deception as an important aspect. There is also a difference between syndromes in which deception is planned and voluntary, and syndromes where deception is much less under control of the patient. In the following section you find an overview of disorders associated with various types of deception.

What are disruptive, impulse-control, and conduct disorders?

Oppositional Defiant Disorder (ODD) and Conduct Disorders (CD), diagnosed during childhood, are seen as precursors of developing more antisocial behavior later on in life. ODD and CD interfere with the development of positive family and peer relationships. In both disorders, deceitfulness is a core part of the diagnostic criteria. Researchers have highlighted that early engagement in conduct problems which are less severe, like lying, often develop more severe types of violent behavior in adulthood. In both ODD and CD, the deception is conscious as well as voluntary.

What is reactive attachment disorder?

Reactive Attachment Disorder (RAD) is defined by the DSM as a developmentally inappropriate social relatedness in most contexts, starting before the age of 5. The disorder is associated with much pathological care. It is a distortion in the early attachment, because of which the child often shows sociopathic behavior, including deception. Adolescents and adults who have a history of attachment problems are at higher risk of developing antisocial behaviors like cheating, lying and vandalism. Clinicians should pay attention to early home environments in order to be able to make a distinction between ODD, CD and RAD. Children with RAD try to overcome the abuse they experienced during their childhood through the use of superficial charm and manipulation.

What is a factitious disorder imposed on self?

Factitious Disorder (FD) is described as intentionally producing or feigning grossly exaggerated or false psychological or physical symptoms motivated by assuming the sick role. The presence of external motivation excludes this diagnosis. The symptoms can become apparent because they only present when the individual is observed, there is an atypical or dramatic presentation of the symptoms, covert use of substances etc. The presentation of the symptoms vary according to the disorder that is feigned, and a wide range of symptoms have been suggested to be associated with FD. Unfortunately, patients with FD are most often unwilling to cooperate with diagnostic procedures, which makes it difficult to effectively diagnose the disorder.

What is a factitious disorder imposed by another?

Factitious Disorder imposed by another (FDIA) is a variant of factitious disorder in which caregivers fabricate, exaggerate or make up physical or psychological symptoms in others, most often their children. When there is evidence suggesting the illness of a child is caused by a parent, a distinction has to be made between illness because of neglect and illness because of purposeful efforts to fabricate or induce a disorder. It is still unclear why people develop FDIA, but some explanatory models suggest motivations.

• The pathogenic model suggests over-attachment with the child or a rigid, defensive style.
• The criminological model suggests psychopathy and previous criminal convictions as explanations.
• Motivations of financial gain or attempts to resolve family conflict are presented by the adaptational model.

What role does deception play in a substance abuse disorder?

Substance abuse (SA) is often the cause of frequent lying, minimizing and denying in order to hide and be able to continue the abuse. De DSM states that in order to be diagnosed with SA, a great amount of time must be spent on obtaining, using, hiding and recovering from substance abuse, and deception is used to conceal these behaviors. The different explanatory models also have different explanations for developing these behaviors. Awareness for all kinds of reasons to deceive is necessary when dealing with SA. Multiple motivations are applicable.

• The pathogenic model may partially apply to people who are depending on highly addictive drugs
• The criminological model fits a broader pattern of antisocial behavior.
• The adaptational model may explain how substance abusers cope with adversarial circumstances, like getting medication for simulated pain when the actual problem is an Axis II disorder.

What role does deception play in eating disorders?

Eating Disorders like anorexia and bulimia include several deceptive manners in order to enable obsessive and compulsive behavior regarding their weight and body image. In these disorders, deception is often used to maintain having a feeling of control. In these cases, family deceptiveness is often identified as a factor in the etiology.

What are paraphilias?

Sexual abuse and Paraphilias are, according to the DSM, sexual deviations or perversions with behaviors or sexual urges focusing on unusual objects, activities or situations: in short, maladapted sexual behavior. These behaviors are deviant and illegal, and therefore may lead to imprisoning. Defensiveness, minimization and lying are key features of paraphilias and sexual abuse. Individuals may also develop cognitive distortions, which may present characteristic patterns of thinking that are potentially less voluntary. There are several motivations for deception among sexual offenders. They may use deceptive techniques regarding victims, but also to avoid being sentenced. Some people have suffered from abuse themselves and because of that have been unable to develop appropriate social skills and the ability to form age-appropriate interpersonal relationships.

What are personality disorders?

Personality Disorders and Psychopathy. People with a personality disorder show chronic, maladaptive patterns of thoughts and behaviors. They have a tendency to lie and behave in deceptive manners, which is most obvious in the antisocial personality disorder (APD). Other Axis II disorders like borderline also contain deception as an important feature. Psychopathy is a syndrome associated with the APD. It is a collection of behavioral and personality traits in conjunction with antisocial behavior. It seems that some psychopaths are excellent liars, but nevertheless most psychopaths are no more effective than other offenders at malingering. Psychopathy is unrelated to malingering, and using it as a criteria would lead to high levels of misdiagnoses. Psychopathy is related to deception, but is not a symptom or predictor for malingering.

Which other syndromes are related to deception?

What is parental alienation syndrome?

Child Custody and Parental Alienation Syndrome (PAS) occurs in custody cases in which a parent tries to maximize his/her own qualities and likeability, and minimize everything that’s positive about the other parent and make him/her appear less fit. Defensiveness is a regular feature of custody cases. PAS is a controversial, quite unaccepted clinical construct. It occurs when the dominant parent pressures the child to choose his/her side, and the child can deceive by complying with these expectations. It can also be the dominant parent lying about the other parent to limit access. Unfortunately, the validity of PAS remains far from settled.

What is false-memory syndrome?

False-Memory Syndrome focuses on the degree to which the trauma-based memories remain present in the absence of any objective evidence and the degree to which these memories define the individual’s life, leading to an inability to handle adult responsibilities. Such repressed memories have been the subject of several lawsuits. Clinicians should continue to consider the possibilities when dealing with sudden-onset memories, including potential for malingering and factitious disorder.

What is chronic fatigue syndrome?

Chronic Fatigue Syndrome (CFS) is characterized by exhaustion and extreme fatigue which makes everyday tasks extremely difficult to accomplish. There are many mental health symptoms that can co-occur with CFS, including malingering and factitious disorder. Many researchers warn of the association of malingering with CFS, because it can create unhealthy mistrust between patients and doctors. Because of the possible incentives, deception is definitely possible but clinicians should be careful with their judgement.

Which models can be used to decide whether deception is voluntary or not?

It is very difficult to decide whether deception is voluntary or not. In order to help make this decision, two models can be used.

• The threshold model functions as a screen for identifying potential cases of dissimulation that require further evaluation. The criteria are low in order to minimize missing individuals engaged in a specific response style.
• The clinician-decision model represents a definite conclusion about the presence of a specific response style or general deception. A definitive conclusion with this model cannot be reached without substantial evidence to support it.