Comparison of Clinical Psychologist and Physician Beliefs and Practices Concerning Malingering: Results from a Mixed Met
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Comparison of Clinical Psychologist and Physician Beliefs and Practices Concerning Malingering: Results from a Mixed Methods Study Stephen L. Aita 1,2 & Nicholas C. Borgogna 1 & Lilah J. Aita 1 & Melissa L. Ogden 3,4 & Benjamin D. Hill 1 Received: 3 November 2019 / Accepted: 18 March 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract 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. Keywords Malingering . Effort . Validity . Survey . Medicine . Psychology
Introduction Malingering refers to the intentional production of feigned or exaggerated symptoms for secondary gain. Malingering is differentiated from fictitious disorder and somatoform disorders as clear external incentive is absent in these conditions (Aronoff, Mandel, Genovese, Maitz, Dorto, Klimek, & Staats, 2007; Bass
* Stephen L. Aita [email protected] 1
Department of Psychology, University of South Alabama, 75 South University Blvd., Mobile, AL 36688, USA
2
Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
3
Private Practice, Mobile, AL, USA
4
Department of Neurology, University of South Alabama, Mobile, AL, USA
& Wade, 2018). For example, the manifestation of ph
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