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.     

Mental health professionals in forensic arenas

The authors discuss a variety of forensic matters using cases in which they have been involved as experts. Pertinent issues are illustrated in cases in which the offender is charged with homicide. The need for a comprehensive evaluation, the importance of corroboration of the offender's statements, and the value of preparing a thorough report are discussed.     

Dangerously antisocial youths who kill their parents

Adolescent parricide offenders are typically presented in the popular and professional literature as prosocial youths in fear of their lives, often killing to protect themselves or others from death or serious physical injury or to end the chronic abuse they and other family members suffer. There are, however, dangerously antisocial youths who kill their parents for selfish, instrumental reasons. The trial of Lyle and Eric Menendez, two affluent youths accused of the first degree murder of their parents, captured worldwide attention. The question “Were they abused kids or did they kill for the money” is addressed in terms of the author’s typology of parricide offenders. Pertinent case facts are examined in relation to her synthesis of the literature on adolescent parricide offenders. Close study of this case indicates that the brothers did not fit the profile of “the severely abused child”. An alternative explanation that more closely fits the established facts is presented. Pertinent questions that need to be addressed by mental health professionals examining adolescent parricide offenders are addressed.     

Medical aid as protest: acts of citizenship for unauthorized im/migrants and refugees

This article examines organized efforts by citizens to provide medical aid to unauthorized migrants in Germany. A case study of an activist organization in Berlin highlights how prevailing forms of governance through citizenship are disrupted. Three major themes are explored. First, historical contingencies and policy realities explain why, given examples of grassroots protest by migrants in other settings, efforts in Germany have been driven primarily by citizens. Second, migrants' biolegitimacy shapes specific ideas of relative deservingness. As a result, advocacy for some groups, such as survivors of torture or refugees from specific geopolitical settings, is more highly valued than that which addresses needs of unauthorized labor migrants. Finally, although their sustained efforts have resulted in challenges to policy and called into question prevailing notions of citizenship, medical activist organizations have become increasingly institutionalized, which may jeopardize their goals. As this case illustrates, the distinctive ethics associated with providing medical care has the ability to disrupt the scaling of citizenship by the state by treating noncitizens – especially ‘illegal’ noncitizens – ostensibly as citizens, thus protesting citizenship as the exclusive organizing principle of German society.     

Female juvenile murderers: Biological and psychological dynamics leading to homicide

The increasing involvement of girls under 18 in violent crime has been a matter of growing concern in the United States in recent years. This article reviews the arrests of female juveniles for violent crime and then focuses specifically on their involvement in homicide. Arrests of girls for murder, unlike arrests for assault, have not risen over the last 30 years, suggesting that the dynamics that propel female juveniles to engage in lethal violence differ from those contributing to assaultive behavior by this same group. A review of the literature indicates that theories as to why female adolescents kill do not take into account recent scientific findings on brain development and the biological effects of early trauma in explaining serious violent behavior by girls. Three cases, evaluated by the authors, involving female adolescents charged with murder or attempted murder, are presented. The authors focus on the biological and psychological dynamics that help explain their violent behavior. They discuss the effects of insecure attachment and child maltreatment, and trace a critical pathway between these early experiences and future risk of violent behavior. The dynamics of child maltreatment in fostering rage and violence are discussed thereafter in terms of offender accountability. The article concludes with a discussion of treatment and recommendations for future research.     

Musci preferences as data in assessing and treating offenders and victims

Contemporary music has been criticized for promoting violence, hatred, misogyny, sexual excess, drug and alcohol abuse, suicide, narcissism, and self-pity. The authors, a criminologist licensed as a mental health counselor and a clinical psychologist, have found that exploring individuals' music preferences can often provide invaluable assistance in understanding how offenders and victims fulfill existential needs common to both of them. These insights can be useful in setting appropriate therapeutic goals, assessing violence potential toward self and others, and making recommendations regarding the need for placement in a secure facility. Notes Paper delivered at the 1998 Annual Meeting of the Academy of Criminal Justice Sciences, Albuquerque, New Mexico, March.     

Male and female child murderers: an empirical analysis of U.S. arrest data

Recent U.S. cases of murders by children below age 11 have captured national headlines. A review of the literature reveals that little is known about this population of juvenile homicide offenders (JHOs). Most studies on juvenile murderers have used small clinical samples, focused on adolescents, and concentrated on male offenders. Studies that have used Supplementary Homicide Report (SHR) data have found significant gender differences among juveniles below 18 years arrested for murder. This study investigated gender differences among 226 juvenile murderers ages 6 through 10 involved in single-victim incidents using bivariate and multivariate statistical techniques. Consistent with previous research, bivariate analyses revealed gender differences with respect to the type of weapon used, age of the victim, relationship to the victim, and circumstances of the crime. Logistic regression analysis identified female JHOs as more likely to use a knife, kill a family member, and kill a victim below age 5, when compared with male JHOs. From these findings, profiles of young male and female JHOs can be drawn. The article concludes with a discussion of the study's implications for prevention and treatment. The authors recommend that future research in gender differences among young children focus on examining psychological, neurological, and sociological variables not included in the SHR data set.     

The biology of trauma: implications for treatment

During the past 20 years, the development of brain imaging techniques and new biochemical approaches has led to increased understanding of the biological effects of psychological trauma. New hypotheses have been generated about brain development and the roots of antisocial behavior. We now understand that psychological trauma disrupts homeostasis and can cause both short and long-term effects on many organs and systems of the body. Our expanding knowledge of the effects of trauma on the body has inspired new approaches to treating trauma survivors. Biologically informed therapy addresses the physiological effects of trauma, as well as cognitive distortions and maladaptive behaviors. The authors suggest that the most effective therapeutic innovation during the past 20 years for treating trauma survivors has been Eye Movement Desensitization and Reprocessing (EMDR), a therapeutic approach that focuses on resolving trauma using a combination of top-down (cognitive) and bottom-up (affect/body) processing.