Multiple Feigning Strategies Used in Competence (CST) Evaluations
When CST examinees feign psychiatric symptoms, it is likely they will also engage in additional feigning regarding their lack of legal knowledge. This is the bottom line of a recently published article in International Journal of Forensic Mental Heath. Below is a summary of the research and findings as well as a translation of this research into practice.
Featured Article | International Journal of Forensic Mental Health | 2017, 1-11
The Relationship between Feigned Psychiatric Symptoms and Feigned Lack of Legal Knowledge among a Multi-Site Sample of Forensic Inpatients
Emily D. Gottfried, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
Michael J. Vitacco, Department of Psychiatry and Health Behavior, Augusta University
Jennifer A. Steadham, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
The accurate assessment of feigning is a cornerstone of forensic evaluations. This study examined two feigning strategies defendants may use for the purpose of being found not competent to stand to trial: feigning psychiatric symptoms and feigning lack of legal knowledge. Participants included 203 forensic inpatients undergoing competency to stand trial assessments at two state hospitals. Each participant was administered the Miller Forensic Assessment of Symptoms Test and the Inventory of Legal Knowledge. Results indicated that there was a significant relationship between these two types of feigning (manual cut scores: x2 (1, 203) D 23.02, p < .001) and the presence of one feigning strategy increased his or her risk for engaging in the other feigning strategy (e.g., using the manual cut scores, participants shown to be feigning psychiatric symptoms were 2.23 times more likely to feign lack of legal knowledge than those not feigning psychiatric symptoms). This article provides evidence of an increased risk of defendants employing a second feigning strategy when it is determined they are already using one strategy. These results encourage forensic evaluators to be cognizant of the nature of feigning and various strategies employed by individuals undergoing evaluations of competency.
Psychiatric feigning, feigning lack of legal knowledge, malingering, M-FAST, ILK
Summary of the Research
“Within the criminal forensic realm, competency to stand trial (CST) evaluations are the most common type of mental health referral (Melton, Petrila, Poythress, & Slobogin, 2007)… One hypothesis warranting consideration is the potential a defendant is malingering or feigning impairment” (p. 1).
“The Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001) has gained popularity for its ability to quickly detect possible feigned psychiatric symptoms and may be most useful for the brief assessment of screening for individuals in need of a more comprehensive assessment of feigning … The M-FAST has been investigated for use with specific groups of individuals, including certain diagnostic classifications (Guy et al., 2006), literacy abilities (Miller, 2005), and race (Guy & Miller, 2004; Miller, 2005). … its performance was most effective at discriminating feigned from genuine schizophrenia (Guy et al., 2006), likely due to the psychotic-focused content of the items” (p. 3).
“Cognitive feigning can take different forms, including memory impairment, intellectual deficits (Bender, 2008; Rogers, Salekin, Sewell, Goldstein, & Leonard, 1998), or fabricated perceptual-motor deficits (Greiffenstein, 2007)… As with assessing psychiatric feigning, specific detection strategies are employed when cognitive feigning is suspected. Such strategies fall into two broad categories: unlikely presentation and excessive impairment” (p. 3).
“Recently, the concept of feigned legal knowledge deficits has been i nvestigated with a measure that employs excessive impairment as a strategy. The Inventory of Legal Knowledge (ILK; Otto, Musick, & Sherrod, 2010)… is an instrument which utilizes excessive impairment detection strategies, namely symptom validity testing based on a forced-choice model” (p. 3).
“Available evidence suggests pre-trial defendants undergoing competency to stand trial evaluations may feign (a) psychotic symptoms, (b) cognitive deficits, or (c) both (Gottfried & Glassmire, 2015, Rogers, 2008)… The purpose of the current study was to examine how frequently defendants exaggerate or fabricate psychiatric symptoms and feign deficits in competency, such as legal knowledge, individually and simultaneously” (p.4).
“This study utilized two inpatient forensic samples of defendants who had either been adjudicated incompetent to stand trial and were receiving competency restoration treatment or were undergoing a pretrial inpatient competency evaluation at two state forensic psychiatric facilities in the southeastern U.S… Participants included 203 forensic patients who had been administered the ILK and the M-FAST during the same assessment” (p.4)
“Protocols were classified as “psychiatric feigning” if they obtained a total score of six or greater on the M-FAST. They were classified as “conservative psychiatric feigning” if they obtained a total score of 16 or greater on the M-FAST. Protocols were classified as “feigning lack of legal knowledge” if they obtained a total score of 47 or less on the ILK and were classified as “conservative feigning lack of legal knowledge” if they obtained a total score of 35 or less on the ILK (p. 6).
“Given that we employed instruments more suitable for screening, we used both the manual recommended score, as well as a more conservative cut score derived from the literature to minimize the likelihood of false positives that occur when using screening instruments… Defendants who met the basic cut score on the M-FAST (6) were 2.23 times more likely to be feigning lack of legal knowledge on the ILK. Using the more conservative score for both measures indicated pretrial defendants meeting the higher threshold on the M-FAST were 4.18 times more likely to feign legal knowledge deficits on the ILK. Similar results were found for the likelihood of feigning psychiatric symptoms on the M-FAST after finding feigned legal knowledge on the ILK.” (p. 7).
“This article provides clear direction to appropriately evaluating the possibility of feigned presentation on CST evaluations. The current findings, taken together with extant research showing the overlap on approaches to feigning, should heighten evaluators’ sensitivity to the likelihood that if an evaluee is engaging in one type of feigning to appear impaired, there is some possibility they are feigning other domains” (p. 8).
Translating Research into Practice
“The current results map well onto other findings of feigning with forensic patients and should inform strategies for the clinical assessment of response styles… Forensic evaluators should routinely use instruments designed to screen for feigning, especially in light of their effectiveness at identifying individuals in need of additional testing (Miller, 2005; Vitacco et al., 2007). In that vein, forensic evaluators are most effective when properly evaluating psychiatric and cognitive aspects of feigning” (p. 8).
Other Interesting Tidbits for Researchers and Clinicians
“Future research would benefit from using the SIRS-2 to identify psychiatric feigning or the Validity Indicator Profile (VIP; Frederick, 1997) for cognitive feigning to allow for stronger conclusions…. The subsequent development of feigning measures that encapsulate both psychiatric and cognitive feigning certainly warrants exploration, especially given data on feigning in CST evaluations indicating that approximately 20% of individuals undergoing a forensic evaluation of competency to stand trial are feigning” (p. 9.
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Authored by Sara Hartigen
Sara Hartigan is a second year Forensic Psychology Master’s student at John Jay and hope to obtain a Ph.D. in Clinical Forensic Psychology in the future. My main areas of interest include clinical evaluations and developing treatment interventions within the forensic population.