Biased Symptom Reporting And Antisocial Behavior In Forensic Samples

20 Pages·2016·0.34 MB·English

Psychiatry, Psychology and Law
ISSN: 1321-8719 (Print) 1934-1687 (Online) Journal homepage: http://www.tandfonline.com/loi/tppl20
Biased Symptom Reporting and Antisocial
Behaviour in Forensic Samples: A Weak Link
Alfons van Impelen, Harald Merckelbach, Isabella J. M. Niesten, Marko
Jelicic, Benno Huhnt & Joost á Campo
To cite this article: Alfons van Impelen, Harald Merckelbach, Isabella J. M. Niesten, Marko
Jelicic, Benno Huhnt & Joost á Campo (2016): Biased Symptom Reporting and Antisocial
Behaviour in Forensic Samples: A Weak Link, Psychiatry, Psychology and Law
To link to this article: http://dx.doi.org/10.1080/13218719.2016.1256017
Published online: 12 Dec 2016.
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Download by: [Maastricht University Library] Date: 15 December 2016, At: 01:55
Psychiatry,PsychologyandLaw,2016
http://dx.doi.org/10.1080/13218719.2016.1256017
BiasedSymptomReportingandAntisocialBehaviourinForensicSamples:
AWeakLink
AlfonsvanImpelena,HaraldMerckelbacha,IsabellaJ.M.Niestena,MarkoJelicica,Benno
HuhntbandJoost(cid:1)aCampoc
aDepartmentofClinicalPsychologicalScience,MaastrichtUniversity,TheNetherlands;bBerlin,
Germany;cRadixForensicPsychiatricHospital,Heerlen,TheNetherlands
In two studies (one with 57 forensic inpatients and one with 45 prisoners) the connection
betweenbiasedsymptomreportingandantisocialbehaviourisexplored.Thefindingsareas
follows: 1) the association between symptom over-reporting and antisocial features is a)
present in self-report measures, but not in behavioural measures, and b) stronger in the
punitivesettingthaninthetherapeuticsetting;and2)participantswhoover-reportsymptoms
a) are prone to attribute blame for their offence to mental disorders, and b) tend to report
heightened levels of antisocial features, but the reverse is not true. The data provide little
support for the inclusion of antisocial behaviour (i.e. antisocial personality disorder) as a
signalofsymptomover-reporting(i.e.malingering)intheDiagnosticandStatisticalManual
of Mental Disorders – Fifth Edition (DSM-5). The empirical literature on symptom over-
reportingandantisocial/psychopathicbehaviourisdiscussedanditisarguedthattheutility
ofantisocialbehaviourasanindicatorofbiasedsymptomreportingisunacceptablylow.
Keywords:antisocialpersonalitydisorder;malingering;psychopathy;responsebias;symp-
tomvalidity.
Introduction incentives’ (American Psychiatric Associa-
Antisocial behaviour and deceptive tenden- tion,2013,p.726).
Precisely because malingering is a form
cies are considered to be core characteristics
of deception – and because such behaviour
of both antisocial personality disorder
infringes social norms – the idea that malin-
(ASPD; American Psychiatric Association,
gering is strongly associated with ASPD and
1980, 2000, 2013) and psychopathy (Cleck-
psychopathy has great intuitive appeal.
ley, 1941, 1988; Hare, 1991, 2003; Hare,
Forth, & Hart, 1989). A specific variant of Accordingly,theDSM–fromitsthirdedition
deceptive behaviour is referred to in the onwards – assumes that antisocial behaviour
Diagnostic and Statistical Manual of Mental is intimately linked to malingering. Indeed,
theDSM-5liststhepresenceofASPDamong
Disorders – Fifth Edition (DSM-5;American
theindicationsthatwarrantheightenedsuspi-
Psychiatric Association, 2013) as malinger-
cion of malingering. However, in contrast to
ing: ‘The intentional production of false or
itsprimafacieplausibility,theempiricalsup-
grossly exaggerated physical or psychologi-
port for this idea is weak. In fact, early
cal symptoms, motivated by external
Correspondence:AlfonsvanImpelen,ForensicPsychologySection,DepartmentofClinicalPsychological
Science, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. Tel. C31 43 388
1264.Email:[email protected]
(cid:1)2016TheAustralianandNewZealandAssociationofPsychiatry,PsychologyandLaw
2 A.vanImpelenetal.
reviews (Clark, 1997; DeMatteo & Edens, principally deceptive and manipulative in
2006) concluded that there is a paucity of nature. Hence, itstands toreason thatifanti-
studies demonstrating the link between anti- social and psychopathic traits predispose to
social behaviour and malingering. More symptom over-reporting (i.e. malingering),
recently, Niesten, Nentjes, Merckelbach, and these features may also predispose to symp-
Bernstein (2015) conducted a systematic tomunder-reporting.
search by means of several databases and The extant literature about the relation
confirmed the mixed findings in this domain: between symptom under-reporting and social
of the seven studies found that explore desirability, on the one hand, and antisocial
whether psychopathic and antisocial behav- and psychopathic traits, on the other, is even
iour are related to symptom over-reporting, scarcer than that on symptom over-reporting
fourfoundanassociation–albeitarelatively and antisocial or psychopathic traits. The
weak one – (e.g. Heinze & Vess, 2005; investigation of Niesten et al. (2015) only
Kucharski, Duncan, Egan, & Falkenbach, yielded two studies that are directly relevant:
2006), one did not find a relation (Pierson, Cima, van Bergen, and Kremer (2008), who
Rosenfeld, Green, & Belfi, 2011), and two found no association, and Freeman and Sam-
produced conflicting results (Cima & van son (2012), who found psychopathy to be
Oorsouw, 2013; Sumanti, Boone, Savodnik, associated with less symptom under-reporting.
& Gorsuch, 2006). Furthermore, a recent Additionally, the meta-analysis of Ray et al.
meta-analysis of the relation between dis- (2013)showedthattheantisociallifestylefac-
torted response styles and self-reported psy- tor (95% CI of weighted mean effect size:
chopathic traits revealed a medium [¡.25, ¡.06]), but not the manipulative, cal-
association between symptom over-reporting lous personality factor (95% CI: [¡.06, .05])
(i.e. malingering) and the antisocial lifestyle of psychopathy is negatively related to symp-
factor(95%CIofweightedmeaneffect size: tomunder-reportingandsocialdesirability.
[.23, .40]), but not the manipulative, callous One explanation for the conflicting find-
personalityfactor(95%CI:[.00,.14])ofpsy- ings in this research domain is that the links
chopathy(Rayetal.,2013). between biased symptom reporting and anti-
Some authors (e.g. MacNeil & Holden, social features are context dependent. Thus,
2006) have speculated that high levels of psy- prison inmates may feign psychiatric symp-
chopathy are associated with greater profi- toms in an attempt to be transferred from
ciency in successful (i.e. undetected) faking. prison to the relatively mild conditions of a
Even if psychopathic traits would confer no forensic psychiatric hospital. Once in a psy-
aptitude for malingering directly, they could chiatric hospital, they may exaggerate their
still lead to gains in proficiency through prac- mentalfitnesstoreducemandatorytreatment.
tice,astheymaypromptindividualstoengage Similarly,defendantsmayfeignsymptomsin
in malingering more frequently. However, an attempt to reduce their criminal responsi-
there is hardly any support for the hypothesis bility, yet employ symptom under-reporting
thatantisocialandpsychopathictraitsfosterthe and social desirability post-conviction to
abilitytomalinger(e.g.Marionetal.,2013;for obtain privileges, probation, or parole. Like-
anoverview,seeNiestenetal.,2015). wise,plaintiffsmayfeignparticularsymptom
Distortedsymptomreportsduringclinical constellations (e.g. post-traumatic stress,
assessmentarenotlimitedtotheexaggeration burnout, chronic pains) in the service of a
ofsymptoms;they may alsotake theform of compensation claim, while simultaneously
the denial of such symptoms, as well as the denying genuine problems (e.g. substance
exaggeration of positive qualities or indica- use, impulsivity, compulsivity) to make a
tors of good health (i.e. social desirability). favourable impression on judicial decision-
Much like malingering, symptom under- makers (e.g. Cima & van Oorsouw 2013;
reporting and social desirability are Niestenetal.,2015).
BiasedSymptomReportingandAntisocialBehaviour 3
The idea – as endorsed by the DSM-5 – punishment, but not mandatory; patients can
that antisocial behaviour is associated with opt for incarceration in a penitentiary (and
symptom over-reporting is further examined alsooptforthisduringtheirstay).Allpatients
in two studies. Unlike other studies in this undergopsychologicalandneuropsychological
field, symptom under-reporting (Study 1) and assessment upon admission to establish diag-
socialdesirability(Study2)arealsoexamined, noses as laid out in the DSM-5. In addition to
because such behaviour is no less deceptive individually tailored treatment for their psy-
than symptom over-reporting, and thus – at chopathology, patients are obliged to partake
face value – it is equally plausible for it to be ingrouptherapiesaimedatresocialisationand
related to antisocial and psychopathic behav- recidivism risk reduction. Patients remain in
iour. To explore the idea that the relations treatment until theyare ready to re-enter soci-
betweenbiasedsymptomreportingandantiso- etyoruntiltheirprisontermends.
cial features are context dependent, a thera- Treatment supervisors provided the
peutic forensic setting (Study 1) is contrasted names of patients they deemed fit to partici-
withapunitiveforensicsetting(Study2). pate and these patients were then invited to
take part in the study. Exclusion criteria (as
determined by treatment supervisors)
Study1 included insufficient command of the Dutch
language, extreme symptoms of drug with-
The aim of Study 1 is to investigate the rela-
drawal, severe mental instability due to psy-
tionship between biased symptom reporting
chosis, or deficient mental abilities owing to
(i.e. over-reporting and under-reporting) and
severe intellectual disability. On these
antisocial behaviour (measured by institu-
grounds, 25 patients were not approached.
tional misbehaviour and ASPD diagnoses) in
The majority of these patients were found to
a forensic psychiatric context. Given the
be unfit to participate because of substance
mixed findings in the literature mentioned
withdrawalsymptoms,severeintellectualdis-
earlier, it was expected that little to no rela-
ability, or psychosis. Furthermore, as partici-
tionship between antisocial behaviour and
pation was voluntary and did not yield any
biased symptom reporting would be found.
rewards,13eligiblepatientschosenottopar-
The therapeutic environment of the psychiat-
ticipate.Another3patientsabscondedbefore
ric hospital (in which treatment progress
behavioural observations were completed,
leads to privileges such as furloughs and
and1patientchosetoterminatehisparticipa-
access to accommodation for recreational
tionshortlyafterstartingthefirsttest.
activities)createdtheanticipationofahigher
In total, 57 male inpatients aged 19 to
rate of symptom under-reporting than symp-
54years(MD40.0,SDD9.1)completedthe
tom over-reporting. Prior to data collection,
study. The mean IQ was 88.2 (SD D 14.6,
ethical approval was obtained from the Ethi-
range D 61–140; IQ scores are missing for 2
cal Committee of the Faculty of Psychology
participants). IQ data were gathered from
andNeuroscience,MaastrichtUniversity,and
patient records, which contained Wechsler
from Radix Forensic Psychiatric Hospital,
Adult Intelligence Scale – Fourth Edition
Heerlen,TheNetherlands.
(WAIS-IV; Wechsler, 2008) protocols. The
majority of participants are Caucasian (79%,
nD45)andallexceptone(98%,nD56)had
Method
been diagnosed with one or multiple sub-
Participants
stance disorders. Furthermore, 28% (n D 16)
Participants were recruited from Radix, a had received a diagnosis of other specified
medium security forensic psychiatric hospital personality disorder, 16% (n D 9) had been
in the Netherlands that admits patients post- diagnosedwithASPD,14%(nD8)hadbeen
trial. Confinement there is in lieu of regular diagnosedwithautismspectrumdisorder,7%
4 A.vanImpelenetal.
(n D 4) had been diagnosed with attention- my problems under full control’, and an
deficit hyperactivity disorder (ADHD), 7% example of a social desirability item is ‘I try
(nD4)hadbeen diagnosed withschizophre- to help everybody who has problems’.
nia, and 19% (n D 11) received no diagnosis Endorsement of supernormality and social
otherthansubstancedisorder. desirabilityitemsissummedsoastoobtaina
totalSSscore.Whiletheinternalconsistency
(Cronbach’salphaD.86)andtest–retestreli-
Measures ability(rD.90)oftheSSaresatisfactory,the
TheStructuredInventoryofMalingeredSymp- diagnostic accuracy indices are meagre, with
tomatology(SIMS). TheSIMS(Smith&Bur- the sensitivity and specificity being .74 and
ger,1997;seeMerckelbach&Smith,2003for .42 for a >14 cut-off score, .58 and .67 for a
the Dutch translation) is a symptom validity >17 cut-off score,and .28 and .93for a>21
test that assesses a broad spectrum of feigned cut-off score, respectively (Cima et al.,
andexaggeratedsymptoms.TheSIMSconsists 2003). However,the SS does possess moder-
of 75 true–false items, which constitute five ate predictive validity, as undergraduate stu-
subscales that target feigned depression, psy- dents instructed to imagine that they were
chosis, neurologic impairment, memory dys- offenders who opted for parole and who
function, and low intelligence. The items therefore engaged in faking good exhibited
mostlyrefertobizarreexperiencesandatypical statisticallyhigherscorescomparedtocontrol
symptoms such as ‘I have difficulty recognis- individuals(Cimaetal.,2003).
ing written and spoken words’ and ‘When I
can’tremembersomething,hintsdonothelp’. The Levenson Self-Report Psychopathy Scale
Thenumberofendorsedsymptomsissummed (LSRPS). The LSRPS (Levenson, Kiehl, &
so as to obtain a total SIMS score. The SIMS Fitzpatrick, 1995) is a 26-item self-report
does not require a high reading level (i.e. instrumentthatassessestraitsassociatedwitha
Flesch–Kincaid Scale 5.3 suffices; Smith, callous and manipulative orientation towards
2008).TheinternalconsistencyoftheSIMSis others (i.e. primary psychopathy) and with a
reasonable (Cronbach’s alpha coefficients of disinhibitedandantisociallifestyle(i.e.second-
.72foundbyMerckelbach&Smith,2003,and ary psychopathy). Items are scored on four-
.92 to .94 by Rogers, Robinson, & Gillard, point Likert scales (where 1 D strongly dis-
2014). Both studieswith experimental simula- agree and 4 D strongly agree). A total score
tors and studies with identified malingerers (i. that is reflective of psychopathic traits can be
e. known-groups studies) haveyieldedaccept- calculated by recoding some items and then
ablediagnosticaccuracyparameters,withsen- summing all scores. Total scores of >57 are
sitivity circling around .91 and specificity considered to be ‘high’ (Brinkley, Schmitt,
around.65foracut-offof>16(foradetailed Smith, & Newman, 2001). A representative
overview,seevanImpelen,Merckelbach,Jeli- itemfromtheprimarypsychopathysubscaleis
cic,&Merten,2014). ‘[i]ntoday’sworld,Ifeeljustifiedindoingany-
thingIcangetawaywithtosucceed’,whereas
The Supernormality Scale (SS). The SS an illustrative item from the secondary psy-
(Cimaetal.,2003)isaself-reportinstrument chopathyscaleis‘Ihavebeeninalotofshout-
thathasbeendevelopedasaresearchtoolfor ing matches with other people’. While the
assessing symptom under-reporting. It con- LSRPS was originally designed to assess psy-
sistsof37true–falseitems,ofwhich21items chopathic traits in non-institutionalised sam-
comprise a supernormality subscale (measur- ples,ithasbeenemployedsuccessfullyinlarge
ing minimisation of mild psychopathological forensic samples (Brinkley et al., 2001; Wal-
phenomena), 11 items comprise a social ters, Brinkley, Magaletta, & Diamond, 2008).
desirability subscale, and 5 items are bogus. The internal consistency of the total and
Anillustrativesupernormalityitemis‘Ihave primary psychopathy scale is adequate
BiasedSymptomReportingandAntisocialBehaviour 5
(Cronbach’salphaD.82–.84),whereasthatof Malingering Scale (Schretlen & Arkowitz,
the secondary psychopathy scale is moderate 1990), which are cognitive paper-and-pencil
(Cronbach’salphaD .63–.68;Levensonetal., tasks that measure underperformance. After
1995;Lynam,Whiteside,&Jones,1999). participants had completed the test battery,
their engagement in institutional misbeha-
The Social Dysfunction and Aggression viour was monitored for a period of six
Scale-11 (SDAS-11). The SDAS-11 (Wis- weeks. The monitoring of participants was
tedt et al., 1990) is an 11-item behavioural achieved through the close examination of
observation scale that was developed to mea- patient records, which were maintained on a
sure social dysfunction and aggression in psy- daily basis by nursing staff, therapists, psy-
chiatric inpatients. The SDAS-11 is scored chologists,physicians,andtreatmentsupervi-
over a longer time interval, with one-week sors. The patient records that were used for
intervals between successive ratings. It con- the present study contain reports of daily
sists of 9 items covering outward aggression activities and detailed accounts of clinically
and social dysfunction (e.g. irritability, nega- relevant activities and behaviour, such as
tivism, verbal and physical aggression) and 2 social functioning, treatment progress, and
items covering inward aggression (i.e. self- physical and emotional well-being. As such,
harm), with each item including a five-point thepatientrecordscontainampleinformation
scoringscale(rangingfrom0Dnotpresentto for completing the SDAS-11 items. For each
4 D severe). The outward and inward items participant,thescoresonthetestbatterywere
arenotinter-correlatedandtheinternalconsis- calculated only after scores on the SDAS-11
tency is acceptable (Cronbach’s alpha D .79; had been obtained, thus reducing experi-
Wistedt et al., 1990). In the current study, menter bias during the evaluation of patient
SDAS-11 items were used to evaluate the recordswithSDAS-11items.
dailynurseobservationrecordsofeachpartici-
pant. More specifically, for each participant,
Results
all records of a six-week period were selected
andscoredintermsofindicationsforthepres- Table 1 summarises the mean scores on the
ence of SDAS-11 items. To explore the reli- psychometric instruments and also gives the
ability of this procedure, a random set of ten proportion of patients who scored above cut-
one-week records from 10 patients were off points, as well as the prevalence of the
selected and evaluated by the first author and most frequent diagnoses among these
another rater who was alsoblind to the symp- patients. As can be seen, symptom under-
tom validity status associated with each reporting(asindexedbytheSS)ismorethan
record. The Spearman rank order correlation twiceasprevalentassymptomover-reporting
betweenthetworatersis.79. (asindexedbytheSIMS).
The most frequent diagnoses among par-
ticipantswhofailedtheSIMScut-offscore(n
Procedure
D 5, 9%) are an IQ of <75 (60%) and other
Seated in a small therapy room on their own specified personality disorders (OSPDs;
ward,participantsfirstgavewritteninformed 40%). Among participants who failed the SS
consentthatwasalsoverballycommunicated cut-off score (n D 13, 23%), the most fre-
tothem.Next,participantscompletedthetest quentdiagnoses are OSPDs (38%)andan IQ
battery, which included – in counterbalanced of <75 (23%). Furthermore, two participants
order–theSIMS,theSS,andforasubsample produced a significantly outlying score (>2
(n D 25) also the LSRPS. The test battery SDs) on the LSRPS; they were diagnosed
also included an instrument that is not with ASPD and autism spectrum disorder,
addressed in the current study: the Vocabu- respectively. The group of participants who
lary and Abstraction subtests of the scoredbeyond1.5SDsontheSDAS-11(nD
6 A.vanImpelenetal.
Table1. Summaryofmeans,SDs,95%confidenceintervalsandprevalenceratesofdiagnosesandcut-
offfailuresintheforensicpatientsample(nD57).
Percentageofmost
frequentdiagnoses
Percentageexceeding ofpatients
M(SD) 95%CI cut-off scoring>cut-off
SIMS 8.6(6.6) [6.8,10.3] 9%(5outof57)>16 60%IQ<75,40%OSPD
SS 16.4(6.5) [14.7,18.2] 23%(13outof57)>21 38%OSPD,23%IQ<75
LSRPS 52.6(9.6) [48.6,56.6] 28%(7outof25)>57 Nodiagnoseswithacount>1
SDAS-11 17.1(12.5) [13.8,20.4] 16%(8outof57)>1.5SDs 38%IQ<75,25%OSPD
Note:LSRPSDLevensonSelf-ReportPsychopathyscale;OSPDDotherspecifiedpersonalitydisorder;SDAS-11D
SocialDysfunctionandAggressionScale-11;SIMSDStructuredInventoryofMalingeredSymptomatology;SSD
SupernormalityScale.
8, 14%) is diverse with regard to diagnoses: psychopathictraits;LSRPSscores>57,insti-
three participants (38%) had an IQ of <75 tutional misbehaviour; SDAS-11 scores >
andtwo(25%)hadanOSPDdiagnosis.There 1.5 SDs above the mean, and ASPD diagno-
is no overlap between the group of partici- ses) and biased symptom reports (i.e. symp-
pants who exceeded the cut-off score of the tom over-reporting; SIMS scores >16, and
SIMS and the group who exceeded the cut- symptom under-reporting; SS scores >21).
offscoresoftheSSortheLSRPS.Ofthethir- Fisher’sexacttestsindicatethatbiasedsymp-
teen participants who scored above the cut- tom reporting is not associated with psycho-
off on the SS, three (23%) have SDAS-11 pathic traits, institutional misbehaviour, or
scores of 1.5 SDs above the mean and two ASPDdiagnoses(allps>.05).
have an LSRPS score that surpasses the cut- As another approach to data analysis,
offof>57.Interestingly,themeanSDAS-11 Pearsonproduct–momentcorrelationsamong
scoreofASPDpatientsdoesnotdifferstatis- the various measures were calculated
ticallyfromthatoftheotherpatients(15.4vs (Table 2). Neither self-reported psychopathic
17.3), t(55) D 0.3, p D .75, a result that traits(LSRPS)norinstitutionalmisbehaviour
squareswiththerecentfindingofEdens,Kel- (SDAS-11)were found tobestronglyrelated
ley, Lilienfeld, Skeem, and Douglas (2015) tosymptomover-reporting(SIMS)orunder--
thatASPDhasnopredictivevalueforinstitu- reporting (SS). Institutional misbehaviour
tionalmisconduct. (SDAS-11) was found to be unrelated to
To examine the relation between antiso- symptom over-reporting (SIMS) or under-
cial features and biased symptom reporting, reporting(SS),whereasself-reportedpsycho-
binary contingency tables were computedfor pathic traits (LSRPS) seem to be moderately
all antisocial behaviour indices (i.e. associated with symptom over-reporting
Table2. Pearsonproduct–momentcorrelationsand95%confidenceintervalsfortheStudy1data.
Measure 1SIMS 2SS 3LSRPS
2SS ¡.28(cid:1)[¡.50,¡.02] –
3LSRPSᵃ .31[¡.09,.63] ¡.10[¡.30,.48] –
4SDAS-11 ¡.04[¡.30,.22] .00[¡.26,.26] .27[¡14,.60]
Note:(cid:1)p<.05,two-tailed;ᵃnD25.LSRPSDLevensonSelf-ReportPsychopathyScale;SDAS-11DSocialDysfunc-
tionandAggressionScale-11;SIMSDStructuredInventoryofMalingeredSymptomatology;SSDSupernormality
Scale.
BiasedSymptomReportingandAntisocialBehaviour 7
Table3. Numbersofforensicpatients(nD57)withincreasing,constant,ordecreasingantisocialbehav-
iourwhoover-reportorunder-reportsymptoms.
Over-reporting(SIMS) Under-reporting(SS)
SDAS-11 Belowcut-off((cid:2)16) Abovecut-off(>16) Belowcut-off((cid:2)21) Abovecut-off(>21)
Increasing 21(37%) 2(4%) 18(32%) 5(9%)
Stable 24(42%) 2(4%) 20(35%) 6(11%)
Decreasing 7(12%) 1(2%) 6(11%) 2(4%)
Note:SDAS-11DSocialDysfunctionandAggressionScale-11;SIMSDStructuredInventoryofMalingeredSymp-
tomatology;SSDSupernormalityScale.
(SIMS), but not under-reporting (SS). Age is Discussion
not related to any of the measures; IQ is Theprevalenceofsymptomover-reportingin
related only to symptom under-reporting, this sample of forensic psychiatric inpatients
with those with higher IQs predisposed is relatively low (9%) compared with esti-
towards less under-reporting, r D ¡.30 mates that can be found in the literature (cf.
[¡.52,¡.04],pD.03,two-tailed. 19%:Mittenberg,Patton,Canyock,&Condit,
Consistentwiththecorrelationalanalyses, 2002; 32%: Pollock, Quigley, Norley, &
multiple linear regression analyses indicate Bashford,1997).Theparticipantsinthepres-
that neither self-reported psychopathic traits ent study were recruited from a forensic psy-
(LSRPS) nor institutional misbehaviour chiatric hospital where patients are admitted
(SDAS-11) are predictive of symptom over- oncetheirsentenceshavebeenpassed,andin
reporting (SIMS), F(2, 22) D 1.70, p D .21, which patients have relatively few apparent
orsymptomunder-reporting(SS),F(2,22)D externalincentivestoover-reportsymptoms–
0.40, p D .67. Analyses including the scores in fact, doing so may even result in delayed
onthesubscalesoftheSIMS,SS,andLSRPS furloughs and prolonged stays. This might
did not yield additional information. In sum, explain why symptom under-reporting was
no association was found between institu- more than twice as prevalent as symptom
tionalmisbehaviourandeitherformofbiased over-reportinginthepresentsample (23%vs
symptom reporting, nor is there a relation 9%). Additionally, the prevalence of symp-
between biased symptom reporting and tom over-reporting may have been low
ASPD or self-reported psychopathy (yet the because of selection bias: treatment supervi-
latterisbasedonnD25). sors prohibited the inclusion of patients they
Next, groups were formed based on the deemed too disordered to participate. It may
temporal trends of the SDAS-11 scores; one bethataportionofthesepatientsexaggerated
group had scores that increased over time their pathology (and would have over-
(nD23),onegrouphadscoresthatremained reportedsymptomshadtheyparticipated).
relativelystable(nD26),andonegrouphad TheprevalenceofASPD(16%)andantiso-
scores that decreased over time (n D 8). The cial behaviour is low as well. A large portion
threegroupswerethencomparedwithregard of patients’ SDAS-11 scores are explained by
to biased symptom-reporting (i.e. frequency irritability, negativism, mild resentment, and
of individuals scoring above the SIMS or SS moderateverbalaggression. Thus,participants
cut-offs).Table3showsthepatterns.Fisher’s engaged almost exclusively in mild disruptive
exact tests yielded no significant results (all behaviour; none engaged in serious physical
ps > .05), which implies that institutional violence, self-harm, or severe verbal aggres-
misbehaviour is in no way related to symp- sion.Therelativeabsenceofgravelydisruptive
tomover-reportingorunder-reporting. behaviourislikelyduetoseveralfactors.First,
8 A.vanImpelenetal.
it may have to do with the focus on treatment and invited to participate in two test sessions
and the consequently comprehensive and con- without compensation. Insufficient literacy
stantimplementationofazerotolerancepolicy and command of the German language are
onallwards,whichhaveastafftopatientratio the only exclusion criteria. A total of 65
ofatleast1:6(usually1:4).Second,itmaybe inmates agreed to participate and completed
relatedtotheconsiderableweightoftheconse- the first session, but only 45 of those com-
quences of misbehaviour, which typically pleted the second session, which took place
include delayed or revoked furloughs, pro- two to three weeks later. Reasons for drop-
longed stays, or – in severe cases – relocation ping out included completion of the prison
toapenalinstitution. sentence, relocation to another facility, and
lack of interest in the second session. The
majority of the final sample (n D 45) were
Study2
sentenced prisoners, and 4 (9%) were on
This study examines the relation between remand.Themeanagewas20.7years(SDD
biased symptom reporting and antisocial 1.7,rangeD18–24).
behaviour in a punitive forensic setting.Addi-
tionally,severaltypesofblameattributionand
excuse-making are assessed. Niesten et al. Measures
(2015)reportaninterestingdifferencebetween
Antisocialanddelinquentbehaviourwasmea-
forensicpsychiatricpatientsandprisonerswith
sured with several proxies: length of prison
respect to symptom over-reporting and under-
sentences(inyears),numberofincurreddisci-
reporting. More specifically, they found that
plinary actions (coded as a continuous vari-
both types of distorted symptom reporting are
able),andclassificationas‘intensiveoffender’
higherinthelattergroup,presumablybecause
(yes/no). Intensiveoffender(Intensivta€ter)isa
the incentives to distort symptoms are higher
term used in Germany to designate juveniles
inthatcontext.Withthisinmind,moresymp-
whose delinquency is serious and repetitive.
tom over-reporting was expected in the puni-
Althoughtherearenoformaldefinitionsorcri-
tive setting of Study 2 than in the therapeutic
teria to establish intensive offending, the term
setting of Study 1, yet it was also predicted
iscommonplaceintheGermanjusticesystem.
that the relationship between biased symptom
The SIMS and the LSRPS were used (see
reporting and antisocial behaviour would be
Study 1 for details), along with two other
similarly small. Cima et al. (2003) observe
instruments. The test battery also included a
that symptom under-reporting in a forensic
measure of symptom overreporting that was
sample is related to the tendency to blame
not used in the analyses below (the recently
external conditions or others for their crimes.
developed Self-Report Symptom Inventory;
To extend this work, it was decided to test
SRSI;Merten,Merckelbach,Giger,&Stevens,
whether symptom over-reporting is associated
2016).
with excuse-making and blame attribution to
mentaldisorders.Approvalwasobtainedfrom
the standing Ethical Committee of the faculty The Social Desirability Scale-5 (SDS-5).
of Psychology and Neuroscience, Maastricht The SDS-5 consists of five modified items
University, and the Youth Prison of Berlin from the Social Desirability Scale-17 (SDS-
(JugendstrafanstaltBerlin),Germany. 17; St€ober, 2001). The internal consistency
(Cronbach’salphaD.80)andtest–retestreli-
ability (r D .82) of the SDS-17 are adequate.
Method
The SDS-5 was embedded in the LSRPS.
Participants
Therefore, the original true/false format is
Inmatesofanall-maleyouthprisoninBerlin replacedwithafour-pointscale(where1DI
wereprofferedabriefdescriptionofthestudy donotatallagreeand4DIfullyagree).
BiasedSymptomReportingandAntisocialBehaviour 9
The Revised Gudjonsson Blame Attribution SIMS, the BAI, and the LSRPS with the
Inventory (BAI). The BAI (Gudjonsson & SDS-5 items. Participants were told that the
Singh, 1989; for the German translation, see instrumentsmeasuredpersonalitycharacteris-
Cima et al., 2006) contains 42 items that tap ticsandpsychologicalproblems.
into three independent dimensions of blame
attributionforcriminaloffences:externalattri-
bution (i.e. blaming transgressions on social Results
environments, victims, or society; Cronbach’s
Table 4 presents means scores of the sample
alpha D .77), mental-element attribution (i.e.
on the various measures, as well as the pro-
placing blame on mental disorders or insuffi-
portion of prisoners whose scores exceed the
cient self-control; Cronbach’s alpha D .79),
associatedcut-offs.Ascanbeseen,13%(nD
andguilt-feelingattribution(i.e.feelingremorse
6) of the participants failed the SIMS, which
or regret about offences; Cronbach’s alpha D
is only slightly higher than the failure rate in
.81). Items consist of first-person statements
Study 1 (9%). More than half of the sample
that are evaluated on a five-point scale (where
scored above the cut-off on the LSRPS
0 D I do not at all agree and 4 D I fully
(56%), which is considerably higher than the
agree). Representative items include ‘I did not
proportion with extreme LSRPS scores in
deservetobecaughtforthecrimeIcommitted’
Study1(28%).
(external attribution), ‘I would certainly not
Table 5 displays the correlations among
have committed the crime I did if I had been
thevariousmeasures.Symptomover-reporting
mentally well’ (mental-element attribution),
(SIMS)correlatespositivelywithself-reported
and‘IhavenoseriousregretsaboutwhatIdid’
psychopathictraitsasmeasuredbytheLSRPS
(guilt-feelingattribution).
and negatively with social desirability as
indexed by the SDS-5. Symptom over-report-
ingisalsorelatedtoblameattributiontoexter-
Procedure
nal factors such as social environments,
Two sessions were undertaken, the first con- victims,orsociety(BAIExternal)andtomen-
taining the informed consent form followed tal disorders (BAI Mental). However, symp-
by administration of the SRSI. The second tom over-reporting is not statistically related
session(whichtookplacetwotothreeweeks to behavioural proxies of antisocial behaviour
later) consisted of administration of the (i.e. sentence length, number of incurred
Table4. Summaryofmeans,SDs,95%confidenceintervalsandprevalenceratesofcut-offfailuresinthe
forensicpunitivesample(nD45).
M(SD) 95%CI Percentageexceedingcut-off
SIMS 10.6(5.2) [9.1,12.2] 13%(6outof45)>16
SDS-5 16.7(2.7) [15.9,17.5] N/A
LSRPS 58.9(9.3) [56.1,61.7] 56%(25outof45)>57
BAIExternal 29.5(8.5) [26.9,32.0] N/A
BAIMental 25.0(6.6) [23.0,27.0] N/A
BAIGuilt 54.6(11.7) [51.1,58.2] N/A
Prisonterm(years) 2.5(1.4) [2.1,2.9] N/A
Punitiveactions 0.5(0.9) [0.3,0.8] N/A
Intensiveoffender N/A N/A 22%(10outof45)
Note:BAIDRevisedGudjonssonBlameAttributionInventory;LSRPSDLevensonSelf-ReportPsychopathyScale;
PunitiveactionsDrelativenumberofpunitiveactionstakenagainstparticipants;SDS-5DSocialDesirabilityScale-5;
SIMSDStructuredInventoryofMalingeredSymptomatology.