Overlooking Feigning Behavior May Result in Potential Harmful Treatment Interventions: Two Case Reports of Undetected Malingering

Clinicians tend to overestimate their ability to recognize feigning behavior in psychiatric patients, especially if it concerns patients who have been admitted for observation. Feigning can be either externally motivated (e.g., for financial compensation, known as malingering) or internally motivated (e.g., to assume the “sick role,” known as factitious disorder). Persistent presentation of severe symptoms is usually associated with the factitious disorder. We present two patients with strong external incentives who consistently and convincingly feigned severe psychiatric symptoms during a protracted period of inpatient observation in a specialized center; both were engaged in a procedure for medical asylum. The first case presented with the clinical picture of a psychotic depression with severe motor symptoms, and the second case showed symptoms of a chronic post-traumatic stress disorder with secondary psychotic symptoms. Both cases were thoroughly investigated but feigning was overlooked, and unnecessary and harmful treatment interventions were given. To prevent iatrogenic damage, we recommend a critical attitude that takes malingering as an option into account in settings where patients are often involved in high stake legal procedures. A clinical sign that might indicate feigning is therapy-resistant symptoms. To rule out feigning a comprehensive, multimethod approach is required, but an active stance toward collateral information is essential. Specialized psychological tests may be useful for preliminary screening, but for their use in culturally diverse populations as in refugee mental health more research is needed.     

Examination of Hacking and Blunt Force Skeletal Trauma

Hacking trauma is prevalent in forensic cases involving genocide and dismemberment, but research into the identification of this type of trauma is lacking. The present study examines characteristics of hacking and blunt force skeletal trauma in order to determine if there is a point at which blunt force trauma becomes distinguishable from hacking trauma. Ten implements with a range of blade angles (i.e., the striking surface of the implement) were used in conjunction with a controlled-force hacking device to impact 100 limb bones of white-tailed deer (Odocoileus virginianus). Observations of the trauma included the occurrence and degree of fragmentation, the entrance widths of the impacts, and composite scores of six hacking characteristics, especially the distinctive V-shaped kerf. ANOVA tests and regression analyses were used to assess the relationships between these characteristics and the blade angles. A significant relationship (p-value = 0.011) was found between the composite hacking scores and the blade angles, indicating that blunt force and hacking trauma can be distinguished. The entrance widths of the impacts exhibited a significant relationship with the blade angles (p-value = 0.037). There was also a significant relationship between the visibility of a V-shaped kerf in the bones (p-value = 0.003), with visibility decreasing around the 60° blade angle. These data should assist in establishing guidelines to differentiate hacking and blunt force skeletal trauma in cases where the implement is on a spectrum between sharp and blunt.     

Evaluating the Potential for Unintentional Occupational Exposure to Fentanyl and Fentanyl Analogues Among Medicolegal Death Investigators and Autopsy Technicians

Recent increases in deaths in the United States from synthetic opioids such as fentanyl and fentanyl analogues (fentanyls) have raised concerns about possible occupational exposures to these potent agents. Medicolegal death investigators and autopsy suite staff might perform job tasks involving exposure to fentanyls. The potential for exposure to fentanyls among medicolegal death investigators and autopsy technicians at a state medical examiner's office was evaluated through review of caseload characteristics, injury and illness logs, and procedures and policies and discussions with management and employee representatives. The evaluation showed that this medical examiner's office had low potential for work-related exposure to fentanyls; its standard operating procedures and personal protective equipment requirements should reduce the potential for occupational exposure. Medicolegal death investigation agencies can develop and implement guidance to control exposures and provide workforce education and training to reduce the potential for work-related exposure to fentanyls.     

The Scharff technique: training military intelligence officers to elicit information from small cells of sources

ABSTRACT

Studies have demonstrated the efficacy of the Scharff technique for gathering human intelligence, but little is known about how this efficacy might vary among different samples of practitioners. In this training study we examined a sample of military officers (n?=?37). Half was trained in the Scharff technique and compared against officers receiving no Scharff training. All officers received the same case file describing two sources holding information about a terrorist attack. University students (n?=?74) took the role of the semi-cooperative sources. Scharff-trained officers adhered to the training as they (1) aimed to establish the ‘knowing-it-all’ illusion, (2) posed claims as a means of eliciting information, and (3) asked fewer explicit questions. The ‘untrained’ officers asked many explicit questions, questioned the reliability of the provided information, pressured the source, and displayed disappointment with the source's contribution. Scharff-trained officers were perceived as less eager to gather information and left their sources with the impression of having provided comparatively less new information, but collected a similar amount of new information as their untrained colleagues. The present paper both replicates and advances previous work in the field, and marks the Scharff technique as a promising technique for gathering human intelligence.     

Types of Malingering in PTSD: Evidence from a Psychological Injury Paradigm

Psychological Injury and Law - The extent to which persons may feign or malinger psychological symptoms is an important concern for civil litigation, specifically in the context of personal injury....     

Can We Make Accurate Long-term Predictions About Patterns of De-escalation in Offending Behavior?

This study consists of a comparative analysis of patterns of de-escalation between ages 17–18 and 32, based on data from two well-known prospective longitudinal studies, the Cambridge Study in Delinquent Development (a study of 411 working-class males in London) and the Montreal Two Samples Longitudinal Study (a sample of 470 adjudicated French-Canadian males). Analyses focus on within-individual change, with individuals serving as their own controls. In this regard, the magnitude of measured change is relative to the past degree of involvement in offending. These results are contrasted with predictors of between-individual differences in offending behavior at age 32. We investigate the respective roles of cognitive predispositions and social bonds in the prediction of patterns of de-escalation, and assess whether it is possible to make relatively long-term predictions (over a 15-year period) about offending in adulthood. Findings suggest that traditional measures of social bonds and cognitive predispositions measured at age 17–18 are generally weak predictors of de-escalation up to age 32. However, these measures are stronger predictors of between-individual differences in offending gravity. These findings highlight the difficulties in making accurate long-term predictions about changes in individual offending patterns early in the criminal career.

Childhood and Adolescent Predictors of Late Onset Criminal Careers

This study explores the emergence of a criminal career in adulthood. The main hypothesis tested is that late criminal onset (at age 21 or later) is influenced by early factors that delay antisocial manifestations. The Cambridge Study in Delinquent Development (CSDD) was used to examine early determinants of criminal behavior. 400 Inner London males were followed from ages 8–10 to 48–50, and were classified as follows: 35 late onsetters who were first convicted at age 21 or later, and did not have high self-reported delinquency at ages 10–14 and 15–18; 129 early onsetters first convicted between ages 10 and 20; and 236 unconvicted males. Odds ratios and logistic regression analyses revealed that the best predictors of late onset offenders compared with early onset offenders included nervousness, having few friends at ages 8–10, and not having sexual intercourse by age 18. The best predictors of late onset offenders compared with nonoffenders included teacher-rated anxiousness at ages 12–14 and high neuroticism at age 16. It is concluded that being nervous and withdrawn protected boys against offending in adolescence but that these protective effects tended to wear off after age 21. These findings show that adult offending can be predicted from childhood, and suggest that early intervention might prevent a variety of maladjustment problems and difficulties in adult life.

Parents, Friends, and Romantic Partners: Enmeshment in Deviant Networks and Adolescent Delinquency Involvement

Adolescent networks include parents, friends, and romantic partners, but research on the social learning mechanisms related to delinquency has not typically examined the characteristics of all three domains simultaneously. Analyses draw on data from the Toledo Adolescent Relationships Study (n = 957), and our analytic sample contains 51% male and 49% female as well as 69% white, 24% African-American, and 7% Latino respondents. Parents,’ peers,’ and partners’ deviance are each related to respondents’ delinquency, and affiliation with a greater number of deviant networks is associated with higher self-reported involvement. Analyses that consider enmeshment type indicate that those with both above average romantic partner and friend delinquency report especially high levels of self-reported involvement. In all comparisons, adolescents with deviant romantic partners are more delinquent than those youths with more prosocial partners, regardless of friends’ and parents’ behavior. Findings highlight the importance of capturing the adolescent’s entire network of affiliations, rather than viewing these in isolation, and suggest the need for additional research on romantic partner influences on delinquent behavior and other adolescent outcomes.

The Intergenerational Transmission of Values in National and Immigrant Families: The Role of Zeitgeist

Correspondence in value orientation between parents and their offspring may be due to actual transmission processes between generations, but it may also be due to influences from the general value context in society that are common to parents and their offspring. This common value context is referred to as Zeitgeist. The present study deals with one family relationship value (i.e., parents’ and adolescents’ obligations toward the family). Participants were 1,252 immigrant and 726 national adolescent–parent dyads from 10 Western countries. There were significant relationships between the value placed on family obligations among parents and offspring, and these were independent of gender. Zeitgeist effects, both intergenerational and intragenerational, were found. The strength of these Zeitgeist effects depended on the basis for defining Zeitgeist, either a person’s own ethnic group or the wider community including both nationals and immigrants. For explaining national adolescents’ acceptance of their family obligations, both the ethnic and the national Zeitgeist played a role, whereas in the immigrant groups only the ethnic Zeitgeist played a significant role. In short, in an immigration context it makes sense to distinguish the influence of a person’s own ethnic group from the influence of the wider community, including other ethnic groups. Explanations are suggested and implications are discussed.

Perceptions of Problem Behavior in Adolescents’ Families: Perceiver,Target, and Family Effects

Considerable research has focused on the reliability and validity of informant reports of family behavior, especially maternal reports of adolescent problem behavior. None of these studies, however, has based their orientation on a theoretical model of interpersonal perception. In this study we used the social relations model (SRM) to examine family members’ reports of each others’ externalizing and internalizing problem behavior. Two parents and two adolescents in 69 families rated each others’ behavior within a round-robin design. SRM analysis showed that within-family perceptions of externalizing and internalizing behaviors are consistently due to three sources of variance; perceiver, target, and family effects. A family/contextual effect on informant reports of problem behavior has not been previously reported.