Differentiating Factitious from Malingered Symptomatology: the Development of a Psychometric Approach

Psychometric symptom validity assessment is becoming increasingly part and parcel of psychological and neuropsychological assessments. An unresolved and rarely addressed issue concerns the differentiation between factitious and malingered symptom presentations: present-day symptom validity tests can assess whether an examinee presents with noncredible symptomatology, but not why an examinee does so. We explored this issue by developing the Symptom and Disposition Interview (SDI); a symptom validity test that incorporates strategies intended to gauge internal incentives associated with factitious disorder. The merits of the SDI were explored and compared to a traditional symptom validity test (the Structured Inventory of Malingered Symptomatology) in two analogue studies, each with factitious and malingering conditions (n = 24–30 per condition) and a clinical control group (n = 34, n = 40). Overall, the results were positive: The SDI was as effective in detecting feigned symptom presentations as a traditional symptom validity test and superior in differentiating factitious from malingered symptom presentations. We conclude that the SDI is not ready for clinical use, but that psychometric approaches to the assessment of factitious symptomatology, such as the SDI, appear sufficiently promising to warrant future research.     

Pilot Study of a Group-Based Psychosocial Trauma Recovery Program in Secure Accommodation in Scotland

The current study is the first to implement and evaluate a group-based trauma-specific program for adolescents in a secure accommodation facility in Scotland. A randomized control and qualitative pilot study compared an intervention group (n = 10), who received Teaching Recovery Techniques, to a waitlist control group (n = 7). Measures included subjective units of disturbance (SUDs), standardized trauma symptom questionnaires, and analysis of behavior monitoring logs. Adolescent interviews (n = 10) and a presenter focus group (n = 4) assessed program experience and views on future development. Sessions were videoed and analyzed for program adherence. Analysis involved MANOVA, and a quasi-qualitative thematic approach for participant views. Adolescents reported high SUDs and a range of trauma symptoms. A large effect size was found for reduced SUDs (d = 1.10) and positive trends were identified for symptoms and behavior change in the intervention group. Program adaptations included smaller groups, the use of visual materials and liaison with care staff to facilitate generalization. Recommendations are made for program development and large scale evaluation.     

“Give me some space”: exploring youth to parent aggression and violence

A small scale qualitative project, undertaken by an interdisciplinary domestic violence research group involving academic researchers and research assistants, with colleagues from Independent Domestic Abuse Services (IDAS), investigated youth aggression and violence against parents. Following the literature review, data was generated through several research conversations with young people (n = 2), through semi-structured interviews with mothers (n = 3) and practitioners (n = 5), and through a practitioner focus group (n = 8). Thematic analysis and triangulation of the data from parents, practitioners and young people, elicited interconnected and complex overarching themes. Young people could be both victim and perpetrator. The witnessing or experiencing of domestic aggression and violence raised the concept of ‘bystander children’. The impact of young people experiencing familial violence was underestimated by parents. For practitioners, the effects of working with domestic violence was shown to be significant - both positively and negatively.     

Malingered Posttraumatic Stress Disorder (PTSD) and the Effect of Direct Versus Indirect Trauma Exposure on Symptom Profiles and Detectability

Posttraumatic stress disorder (PTSD) is arguably prone to malingering due to its subjective and heterogeneous nature. Various factors can influence PTSD symptom profiles including trauma type and trauma exposure. However, it is unknown whether trauma exposure influences malingered PTSD symptom profiles. We used a malingering simulation design with trauma type controlled to compare (1) PTSD symptom profiles (Posttraumatic Stress Checliklist-5; PCL-5) at the syndrome, symptom cluster, and individual symptom levels and (2) symptom validity profiles (Structured Inventory of Malingered Symptomatology; SIMS) at the overall and subscale level, as a function of direct and indirect trauma exposure. Seventy-three participants were randomly assigned to either the direct (“witnessed” trauma) or indirect (“learned about” trauma) condition. Participants were coached about symptoms and instructed to simulate PTSD. PCL-5 profile analyses revealed that simulators in the direct exposure group reported greater overall PTSD severity. Significant differences were found on cluster D (changes in cognition and mood) and individual symptoms including intrusive thoughts, amnesia, difficulty experiencing positive emotions, and risk-taking. No differences were identified for any other symptom scores nor for the symptom validity profile, except for the SIMS total score (direct: M?=?33.0, SD?=?12.8, indirect: M?=?26.5, SD?=?13.9, t(71)?=?2.06, p?=?.043, d?=?.48). These findings indicate that trauma exposure can influence malingered PTSD profiles at the syndrome, symptom cluster, and individual symptom levels (small effects), but, with one exception for a summary score, it does not produce a detectable difference on symptom validity testing. This study may provide insight for clinicians into the how malingered PTSD profiles can manifest as a result of direct and indirect trauma exposure; however, further research is strongly indicated.     

Cultural Cognition and Public Policy: The Case of Outpatient Commitment Laws

What explains controversy over outpatient commitment laws (OCLs), which authorize courts to order persons with mental illness to accept outpatient treatment? We hypothesized that attitudes toward OCLs reflect “cultural cognition” (DiMaggio, P. Annl Rev Sociol 23:263–287, 1997), which motivates individuals to conform their beliefs about policy-relevant facts to their cultural values. In a study involving a diverse sample of Americans (N = 1,496), we found that individuals who are hierarchical and communitarian tend to support OCLs, while those who are egalitarian and individualistic tend to oppose them. These relationships, moreover, fit the cultural cognition hypothesis: that is, rather than directly influencing OCL support, cultural values, mediated by affect, shaped individuals’ perceptions of how effectively OCLs promote public health and safety. We discuss the implications for informed public deliberation over OCLs.     

Victimization and Poly-Victimization in Adolescent Outpatients from Mental Health Centers: A Case-Control Study

The aims of the present study were to establish interpersonal victimization rates in a clinical sample and to analyze this sample’s risk of victimization relative to the general population. The sample was composed of 472 adolescents (12–17 years of age): 118 outpatients from public mental health centers and 354 students who were matched by age and sex. Following previous studies, this research defined poly-victimization as four or more victimization types occurring during the previous year. The clinical group was more likely to report sexual victimization (OR = 9.540), conventional crime (OR = 3.120), caregiver victimization (OR = 3.469), witnessing and indirect victimization (OR = 3.466), electronic victimization (OR = 2.809), and poly-victimization (OR = 4.319) compared with the control group. Clinical samples present an increased risk of interpersonal poly-victimization compared with the general population. The influence of poly-victimization on mental health should be considered in the evaluation and treatment of adolescent outpatients.     

‘My Eyes Were Open’: Awakened Maternal Identity and Leaving Violent Relationships for the Infant/Children

A qualitative secondary analysis explored stories of mothers (n = 49) who left violent relationships (VRs) through a lens of maternal identity. Constant comparative method identified a theory of Awakened Maternal Identity (AMI) and Leaving VR for the Infant/Children. Mothers described how the VR diminished their maternal identity (DMI). Partners controlled the VR though unrealistic infant care expectations, criticisms of infant care, harsh parenting, and control over mothering decisions. DMI lowered the mother’s capacity to provide emotionally nurturing infant care. Over time, mothers experienced AMI- as their ‘eyes were opened’ they experienced a stronger sense of mothering responsibility, focused more on the infants and children, and eventually prioritized their relationship with the infants and children over the partner. AMI seemed a turning point that led to leaving the VR for the infants/children. Recommendations offered for professionals to foster AMI as potential means to initiate the leaving VRs.     

Assessing the Feasibility and Acceptability of Narrative Exposure Therapy to Address IPV-related Mental Health in Parenting and Pregnant Adolescents

Many urban, low-income adolescents experience violence, often resulting in posttraumatic stress disorder (PTSD) and depression. Narrative Exposure Therapy (NET) facilitates therapeutic processing of traumatic memories. This purpose of this study is to examine the feasibility of NET among adolescents at-risk for PTSD and depression. Two community-based agencies hosted five focus groups with adolescents (n = 28), aged 18–21, predominantly African- American (71 %) and female (61 %) and one with adolescent service providers (n = 11). Pope’s coding framework (2000) and the Socio-Ecological Model for violence prevention (Krug et al. in The Lancet, 360(9339), 1083–1088, 2002) elicited perceived barriers and facilitators to NET. Individual, relationship, and community level barriers and facilitators to NET therapy engagement were identified. The findings indicate participants have favorable attitudes about NET and the provision of the therapy within trusted community agencies. The results will inform the next steps of NET implementation, training, and psychoeducation.     

Sex Offenders of East Asian Heritage Resemble Other Canadian Sex Offenders

Although there is considerable research on Caucasian sexual offenders, there has been much less research on sex offenders of Asian heritage. The current study compared East Asian (e.g., Chinese, Japanese, and Korean) sex offenders in British Columbia (B.C.), Canada, and other B.C. sex offenders on items and total score of Static-99R. This study included all provincially sentenced adult male sexual offenders (n = 4580) supervised in the community by B. C. Corrections (including 122 East Asian sex offenders). Sexual, violent, any crime, and any recidivism (including technical violations) data were collected with an average follow-up 4.3 years. The total scores of Static-99R were similar between East Asian sex offenders and other ethnic groups (M = 2.0 vs. M = 2.4). East Asian offenders scored significantly lower than other ethnic offenders on several items measuring general criminality (e.g., prior non-sexual violence, prior sentencing dates, and any prior sex offenses). In contrast, Asian offenders appeared to be more paraphilic (e.g., any convictions for non-contact sex offenses). Lastly, Static-99R significantly predicts sexual, violent, and criminal among sex offenders of East Asian heritage.     

Predictable Policing: Measuring the Crime Control Benefits of Hotspots Policing at Bus Stops

Objectives

A fairly robust body of evidence suggests that hotspots policing is an effective crime prevention strategy. In this paper, we present contradictory evidence of a backfiring effect.

Methods

In a randomized controlled trial, aimed at reducing crime and disorder, London’s ‘hottest’ 102 bus-stops were targeted. Double patrol teams of Metropolitan Police Service uniformed officers visited the stops three times per shift (12:00–20:00), 5-times per week, for a duration of 15 min, over a 6 month period. Crucially, officers arrived and departed the bus stop on a bus, with significantly less time spent outside the bus stop setting. Outcomes were measured in terms of victim-generated crimes reported to the police and bus driver incident reports (DIRs), within targeted and catchment areas. We used adjusted Poisson-regression models to compare differences in pre- and post-treatment measures of outcomes and estimated-marginal-means to illustrate the treatment effect.

Results

DIRs went down significantly by 37 % (p = 0.07) in the near vicinity of the bus stops (50 m), by 40 % in the 100 m catchment area (p = 0.04) and marginally and non-significantly in the farthest catchment (10 %; p = 0.66), compared to control conditions. However, victim-generated crimes—the primary outcome measured in previous experiments—increased by 25 % (p = 0.10) in the near vicinity, by 23 % (p = 0.08) and 11 % (p ≤ 0.001) within the 100–150 m catchment areas, respectively.

Conclusions

These findings illustrate the role of bounded-rationality in everyday policing: reductions in crime are predicated on an elevated perceived risk-of-apprehension. Previous studies focused on clusters of addresses or public facilities, with police moving freely and unpredictably within the boundaries of the hotspot, but the patrol areas of officers in this experiment were limited to bus stops so offenders could anticipate their movements. Hotspots policing therefore backfires when offenders can systematically and accurately predict the temporal and spatial pattern of long-term targeting at a single location.

     

Recalling an Unfair Experience Reduces Adolescents’ Dishonest Behavioral Intentions: The Mediating Role of Justice Sensitivity

Injustice experiences are likely to have a strong impact on—adolescents' life. However, individuals differ in how they perceive and respond to injustice depending on their justice sensitivity. Whereas several studies analyzed the relationships between justice sensitivity and antisocial behaviors in adult samples, little is known about this relationship among adolescents. The aim of the present experimental study is to expand knowledge on the antecedents and effects of justice sensitivity from the Victim (i.e., JS-Victim) and Others (i.e., JS-Observer, Perpetrator, and Beneficiary) perspective, particularly with regard to its relationship to willingness to act in dishonest behavioral intentions (e.g., stealing money or objects from classmates, teachers, or strangers). The study involved 369 Italian students (52% males; M _age = 16.64, SD = 1.78). We examined the role of justice sensitivity in the relationship between the recall of unfair, fair, or neutral episodes, and the consequent willingness to perform dishonest behaviors. Results demonstrate that recalling unfair (vs. fair or neutral) episodes leads to an increase in JS-Others, which in turn decreased willingness to behave dishonestly. Conversely, JS-Victim did not mediate the relationship between the recall of unfair episodes and intentions to behave dishonestly. The present findings suggest that during adolescence JS-Others might act as a protective factor against dishonest behaviors.     

Campus Sexual Violence Elimination Act: SaVing Lives or SaVing Face?

The purpose of this study is to examine colleges’ and universities’ compliance with the criteria presented by the Sexual Assault and Violence Education Act (SaVE). Using a stratified random sample of postsecondary institutions (n = 435), we examined university websites in spring 2015 to determine whether schools were meeting each criterion of the SaVE Act. Additionally, we also examined what types of programs were offered for prevention, the accessibility of the information (by number of separations from universities main website). Lastly, we examined how university resources and programs, as well as institutional and student characteristics, were related to overall compliance and the availability of online information on sexual violence programs that institutions offered. Findings showed that only 11 % of schools within the sample were fully compliant with the requirements of the SaVE Act and on average, each school met ten of the eighteen criteria for compliance. Most resources were available within websites that were three to four separations from the main university page. Student population and region were positively associated with whether any programs on sexual violence programs were offered and schools with women’s centers were more likely to offer program/s on dating/domestic violence. Additionally, ROTC programs and larger student populations were positively associated with compliance, while being located in the south was negatively associated.     

The Gains of Greater Granularity: The Presence and Persistence of Problem Properties in Urban Neighborhoods

Objectives

This study applies the growing emphasis on micro-places to the analysis of addresses, assessing the presence and persistence of “problem properties” with elevated levels of crime and disorder. It evaluates what insights this additional detail offers beyond the analysis of neighborhoods and street segments.

Methods

We used over 2,000,000 geocoded emergency and non-emergency requests received by the City of Boston’s 911 and 311 systems from 2011–2013 to calculate six indices of violent crime, physical disorder, and social disorder for all addresses (n = 123,265). We linked addresses to their street segment (n = 13,767) and census tract (n = 178), creating a three-level hierarchy that enabled a series of multilevel Poisson hierarchical models.

Results

Less than 1% of addresses generated 25% of reports of crime and disorder. Across indices, 95–99% of variance was at the address level, though there was significant clustering at the street segment and neighborhood levels. Models with lag predictors found that levels of crime and disorder persisted across years for all outcomes at all three geographic levels, with stronger effects at higher geographic levels. Distinctively, ~15% of addresses generated crime or disorder in one year and not in the other.

Conclusions

The analysis suggests new opportunities for both the criminology of place and the management of public safety in considering addresses in conjunction with higher-order geographies. We explore directions for empirical work including the further experimentation with and evaluation of law enforcement policies targeting problem properties.

     

Justice Concerns Can Feed Nationalistic Concerns and Impede Solidarity in the Euro Crisis: How Victim Sensitivity Translates into Political Attitudes

We investigated how victim sensitivity and news media exposure conjointly contribute to the formation of political attitudes in the context of the euro crisis. Study 1 (N = 208) showed that observer-sensitive individuals were more likely and victim-sensitive individuals were less likely to support solidarity with countries in need of financial support. These correlations were mediated by affective components of political attitudes, namely nationalistic concerns, resentment about and empathic concerns with debtor countries. In Study 2 (N = 51), using a pre–post within-subjects design, we showed that framing the euro crisis in an ‘exploitation frame” (compared to a ‘solidarity frame’) in news media reports was more likely to trigger nationalistic concerns and, consequently, decrease support of solidarity in victim-sensitive individuals compared to their less victim-sensitive counterparts. These results are in line with the SeMI model and previous findings that victim sensitivity is linked to fear of being exploited in intergroup relations.     

Evaluating an Online Program to Help Children Exposed to Domestic Violence: Results of Two Randomized Controlled Trials

The current study reports the results of two randomized controlled trials investigating effects of an online program (Change A Life) designed to educate individuals about children’s exposure to domestic violence (DV), and to increase individuals’ self-efficacy for providing support to children exposed to DV. In both a community sample (n = 110) and a college student sample (n = 146), participants who completed Change A Life, compared to those who completed a control program, reported increased knowledge about children’s exposure to DV. In the community sample, but not the college student sample, those who completed Change A Life also reported increased self-efficacy for helping children exposed to DV. Neither participant sex nor history of exposure to domestic violence moderated intervention effects.     

Some Remarks on the Genesis of Central Yogācāra-Vijñānavāda Concepts

The present paper is a kind of selective summary of my book The Genesis of Yogācāra-Vijñānavāda (2014). [1.–2.] It deals with questions of origin and early development of three basic concepts of this school, viz., the ‘idealist’ thesis that the whole world is mind only (cittamātra) or manifestation only (vijñaptimātra), the assumption of a subliminal layer of the mind (ālayavijñāna), and the analysis of phenomena in terms of the “Three Natures” (svabhāvatraya). [3.] It has been asserted (H. Buescher) that these three basic concepts are logically inseparable and therefore must have been introduced conjointly. [4.] Still, from Vasubandhu onward treatises have been written in which only one of the three concepts is advocated or demonstrated to be indispensable, without any reference to the other two being made. Likewise, in most of the earlier Yogācāra treatises, the three concepts occur in different sections or contexts, or are even entirely absent, as vijñaptimātra in the Yogācārabhūmi (except for the Sa?dhinirmocanasūtra quotation) and ālayavijñāna in the Mahāyānasūtrāla?kāra and Madhyāntavibhāga. [5.] It is therefore probable that the three concepts were introduced separately and for different reasons. [5.1.] As regards the concept of the “Three Natures”, I very hypothetically suggest that it was stimulated by the Tattvārthapa?ala of the Bodhisatvabhūmi. [5.2.1.] In the case of ālayavijñāna, I still think that my hypothesis that the concept (term + idea) originated from a problem emerging in connection with the “attainment of cessation” (nirodhasamāpatti) holds good and has not been conclusively refuted, but I admit that Prof. Yamabe?s hypothesis is a serious alternative. [5.2.2.] An important point is that in the Yogācārabhūmi we come across two fundamentally different concepts of ālayavijñāna, the starting point for the change being, probably, the fifth chapter of the Sa?dhinirmocanasūtra. [5.3.] As for ‘idealism’, we may have to distinguish two strands, which, however, tend to merge. [5.3.1.] The earlier one uses the concept cittamātra and emerges as early as in the Pratyutpanna-buddha-sa?mukhāvasthita-samādhi-sūtra in connection with an interpretation of visions of the Buddha Amitāyus. [5.3.2.] The later strand introduces the concept vijñaptimātra and seems to have originated in the eighth chapter of the Sa?dhinirmocanasūtra in connection with a reflection on the images perceived in insight meditation. [5.3.3.] In texts like the Mahāyānasūtrāla?kāra, concepts from other Mahāyānasūtra strands (like abhūtaparikalpa) become prominent in this connection, and it is only in the Mahāyānasa?graha that the use of vijñaptimātra is finally established.     

The Development of a Reduced-Item Structured Inventory of Malingered Symptomatology (SIMS)

Effort assessment is a relevant area in neuropsychological assessment. There are well-established self-report measures, such as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) FBS Symptom Validity Scale (FBS; Lees-Haley, English & Glenn, Psychological Reports 68: 203-210, 1991) and MMPI-2 Response Bias Scale (RBS; Gervais, Ben-Porath, Wygant & Green, Assessment 14: 196, 2007). However, there is also a need for brief measures of symptom exaggeration. The Structured Inventory of Malingered Symptomatology (SIMS) appears to be a promising self-report measure of symptom validity (e.g., Smith & Burger, Academy of Psychiatry and the Law 25: 183-189, 1997). In order to understand the psychometric properties of the SIMS, a comprehensive item analysis was performed with the questionnaire. Items were removed due to invariable response or lack of relationship with the total SIMS. Receiver operating characteristics (ROC) curve analyses were completed using RBS and FBS Symptom Validity Scale (FBS) of the MMPI-2 with items grouping from the SIMS indices. The results found that limiting the number of items did not affect overall utility. The abbreviated indices on the SIMS had excellent discrimination with the neurologic impairment (NI) and affective disorder (AF) scales and good discrimination with psychosis (P) and amnesic disorder (AM) scales of the SIMS. The briefer measure allows for less time required to administer the measure, while still maintaining the integrity of the SIMS.     

Standard Symptom Inventories for Asylum Seekers in a Psychiatric Hospital: Limited Utility Due to Poor Symptom Validity

We examined symptom validity in two samples (Ns = 27 and 35) of asylum seekers who had been admitted to a psychiatric facility. Considerable proportions over-endorsed atypical symptoms (63 and 83%, respectively) and underperformed on a simple forced-choice task requiring the identification of basic emotions (41 and 71%, respectively). Over-endorsement and underperformance were unrelated to Dutch language proficiency but were related to raised scores on standard symptom inventories commonly used to assess psychiatric symptoms of asylum seekers. This pattern of findings casts doubts on attempts to monitor symptom severity and treatment progress in psychiatric asylum seekers without taking symptom validity into account.     

Relationship Between Motivation to Lead,Mental Health Status,and Job Satisfaction of Male and Female Civil Police Constables

The purpose of the study was to examine the differences in perceptions of motivation to lead, mental health, and job satisfaction of male and female police constables. Police constables (N = 203, male = 144, female = 59) were surveyed at four districts (Varanasi, Mirzapur, Allahabad and Lucknow) in the state of Uttar Pradesh, Republic of India. Participants’ responses were obtained on questionnaires which measured demographic characteristics, motivation to lead (Dubrin, 1998), psychological well-being, psychological distress (Heubeck & Neill Psychological Reports, 87:431–440, 2000), and job satisfaction (Dantzker’s Journal of Crime and Justice 16:171–181, 1993). Results of t test analysis indicated that job experience, salary, education, motivation to lead, and psychological well-being were significantly different among the male and female police constables. Motivation to lead was a significantly positive correlate of job satisfaction among male participants only while psychological well-being was significantly, positively correlated with job satisfaction of both male and female participants. Psychological well-being also exercised partial mediator effects on the positive relationship between “motivation to lead” and job satisfaction in male police constables only. However, psychological distress was negatively correlated with job satisfaction of male police constables. The findings have significant implications for increasing job satisfaction in the police department. Findings indicate that the government should concentrate on removing anomalies in the job conditions of the female police constables so as to promote psychological well-being. Simultaneously, the police department should also pay attention to conditions which can increase motivation to lead among its female police constables.