Comparison of Clinical Psychologist and Physician Beliefs and Practices Concerning Malingering: Results from a Mixed Methods Study

• Published in: Psychological injury and law 2020-09, Vol.13 (3), p.246-260
• Main Authors: Aita, Stephen L., Borgogna, Nicholas C., Aita, Lilah J., Ogden, Melissa L., Hill, Benjamin D.
• Format: Article
• Language: English
• Subjects: Attention deficit hyperactivity disorder; Base rates; Behavioral Science and Psychology; Clinical assessment; Clinical psychologists; Clinical Psychology; Clinical research; Compensation; Deception; Estimates; Health care; High risk; Law and Psychology; Litigation; Malingering; Medical personnel; Mixed methods research; Neuropsychology; Physicians; Polls & surveys; Post traumatic stress disorder; Psychological assessment; Psychologists; Psychology; Somatoform disorders; Traumatic brain injury; Validity
• ISSN: 1938-971X; 1938-9728
• DOI: 10.1007/s12207-020-09374-x

Malingering, or intentional feigning of impairment for an external incentive, has been the topic of extensive psychological research in recent decades. The emphasis on symptom validity assessment in training, practice, and research in clinical psychology is not echoed across other health professions. While past surveys of clinical psychologists revealed positive beliefs and attitudes toward validity assessment, much less is known about physicians in this area, particularly in regard to how they identify suspected malingering. To address this gap, we surveyed a sample of demographically similar clinical psychologists ( n  = 57) and physicians ( n  = 54) regarding their beliefs and practices about malingering. Unique to this study was the use of a mixed survey and mixed methods approach to analyzing quantitative and qualitative data. Broadly, survey findings indicated that more clinical psychologists reported documenting malingering in their careers compared with physicians (65.0% vs. 33.0%). Consistently, more clinical psychologists endorsed “always” or “often” being able to recognize malingering compared with physicians (73.7% vs. 22.2%). Clinical psychologists indicated that they ask patients or evaluees about potential external incentives (e.g., current involvement in litigation) much more often than physicians (70.0% vs. 16.0%). On average, clinical psychologists estimated higher base rates of malingering in six high-risk malingering diagnostic categories compared with physicians, with greatest estimation difference noted for mild traumatic brain injury (19.9% vs. 5.9%). Qualitative examination of respondent data generally converged with quantitative findings and provided additional insights to how conceptualizations of malingering differ across healthcare disciplines. Implications for practice and study limitations are discussed.