Brechje Dandachi-FitzGerald

Validity tests are widely used to detect distorted symptom presentation but offer little guidance on why such distortions occur. In an explorative qualitative study, we examined how forensic inpatients (n = 36) described antecedents of their response patterns during a collaborative feedback interview. Patients were classified as inattentive responders (n = 8), overreporters (n = 7), underreporters (n = 14), or comparison patients (n = 7) based on stand-alone validity measures administered during routine assessment. Transcripts were primarily coded on 11 literature-derived antecedent themes. Inattentive responders emphasized comprehension/scale-use problems, attention lapses, and disengagement. Overreporters described emotion-processing difficulties, needs for social attention, external incentives, and comprehension issues. Underreporters referred to self-presentational concerns, stigma, reactance-related disengagement, forensic stakes, autonomy/control motives, and mistrust/fear of disclosure. Accounts often highlighted modifiable treatment targets (e.g., interoception, stigma, mistrust, reactance). Overall, collaborative discussion of poor validity may inform case formulation and treatment planning in high-stakes forensic settings.

Symptom overreporting is often considered to be moderated by external incentives, such as financial or legal advantages, although other factors may also play a role. Preliminary studies have suggested a connection between symptom overreporting and alexithymia, that is, trait-like difficulties in recognizing and describing internal sensations. This study aimed to further clarify the relationships among external gain expectations, alexithymia, and symptom overreporting. Specifically, we examined whether alexithymia is related to overreporting in patients without self-reported external gain expectations. Using a cross-sectional design, patients referred for psychological assessments in a hospital setting completed a questionnaire about external gain expectations (e.g., regarding work, housing, legal issues). We differentiated between those with self-reports of external gain expectations (n = 73) and those without (n = 84). Both subsamples were administered the Toronto Alexithymia Scale-20 (TAS-20), the Structured Inventory of Malingered Symptomatology (SIMS), and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF). Across the full sample, alexithymia showed a positive and statistically significant association with symptom overreporting on the SIMS and the Infrequent somatic responses scale (Fs) of the MMPI-2-RF: r = 0.44 and r = 0.31, respectively. These positive associations were also evident in the subgroup without self-reported external gain expectations (i.e., r = 0.35, 95% CI [0.14, 0.52] and r = 0.35, 95% CI [0.15, 0.53], respectively). Regression analysis indicated that self-reported external gain expectations did not account for the relationship between symptom overreporting and alexithymia. These findings suggest that alexithymia is associated with symptom overreporting independently of self-reported external gain expectations. More broadly, the results raise the possibility that alexithymic traits may compromise the accuracy of symptom reporting itself. If so, this has implications not only for the interpretation of symptom validity tests, but also for the broader use of self-report measures in clinical assessment.

Ondanks dat jongeren hun klachten kunnen overdrijven, zijn er voor deze doelgroep geen opzichzelfstaande instrumenten beschikbaar om deze vorm van symptoomvaliditeit te meten. Wij onderzochten bij 88 Nederlandstalige jongeren, in de leeftijd van 12 tot en met 17 jaar, uit de algemene populatie of de Self-Report Symptom Inventory (SRSI) voldoende onderscheidend vermogen heeft om respondenten die hun klachten eerlijk invullen te onderscheiden van respondenten die geïnstrueerd zijn depressie of pijn te veinzen. Daarnaast beoordeelden we de interne consistentie en test-hertestbetrouwbaarheid van de SRSI. Bijkomend onderzochten we de impact van het slordig invullen op de SRSI. Aan het onderzoek namen 88 jongeren deel met een gemiddelde leeftijd van 13,93 jaar (SD = 1,47), waarvan de helft vrouw was. De SRSI werd tweemaal ingevuld: de eerste keer eerlijk (N = 88) en de tweede keer volgens een van de vier rollen: eerlijk invullen (n = 24), depressie veinzen (n = 23), pijn veinzen (n = 22) of slordig invullen (n = 19). Resultaten tonen aan dat de SRSI effectief onderscheid maakt tussen eerlijke invullers en geïnstrueerde veinzers. De specificiteit van de SRSI bij het standaard afkappunt bedroeg ,90 en de sensitiviteit ,91. Voor de plausibele en pseudosymptoomschaal zijn de interne consistentie (Cronbach’s alpha = ,91 en ,81, respectievelijk) en de test-hertestbetrouwbaarheid voldoende (n = 24; r = ,93 en ,88, respectievelijk). Bij slordige invullers scoort ongeveer de helft van de deelnemers boven het afkappunt van de SRSI. Exploratief onderzoek suggereert dat het positief beantwoorden van meer dan één consistentie-item na het falen op de SRSI, eerder wijst op slordig invullen dan op klachtoverdrijving. Concluderend zijn deze eerste bevindingen bemoedigend voor de toepasbaarheid van de SRSI bij jongeren. Verder onderzoek is echter nodig alvorens de SRSI ingezet kan worden om klachtenoverdrijving bij jongeren in de klinische praktijk op te sporen. Abstract Although adolescents may exaggerate their complaints, no standalone instrument exists to assess the validity of their self-reported symptoms. We examined 88 adolescents, aged 12 to 17 years, from the Dutch-speaking general population to assess whether the Self-Report Symptom Inventory (SRSI) demonstrates sufficient discriminative power to distinguish between honest responders and instructed feigners of depression and pain and also shows satisfactory internal consistency and test-retest reliability. Additionally, we explored the impact of careless responding on the SRSI. The sample consisted of 88 adolescents participated in the study, with a mean age of 13.93 years (SD = 1.47), half of whom were female. The SRSI was administered twice, the first time responding honestly (N = 88) and the second time according to one of four roles: responding honestly (n = 24), feigning depression (n = 23), feigning pain (n = 22), or responding carelessly (n = 19). Results indicate that the SRSI effectively discriminates between honest responding and instructed feigning. The specificity of the SRSI at the standard cutoff point was .90, and the sensitivity was .91. For the plausible and pseudosymptom scales, internal consistency (Cronbach’s alpha = .91 and .81, respectively) and test-retest reliability were sufficient (n = 24; r = .93 and .88, respectively). Among careless responders, approximately half of the participants scored above the SRSI cutoff point. Exploratory research suggests that positively endorsing more than one consistency item after failing the SRSI is indicative of careless responding rather than symptom exaggeration. In conclusion, these initial findings are promising for the applicability of the SRSI in adolescents. However, further research is needed before the SRSI can be employed to detect symptom exaggeration in adolescents in clinical practice. Bijsluiter voor de praktijk Klachtoverdrijving kan de validiteit van de uitkomsten op zelfrapportagevragenlijsten beïnvloeden. Wij onderzochten of de SRSI een betrouwbaar instrument is om klachtoverdrijving op te sporen bij jongeren van 12 tot en met 17 jaar uit de algemene Nederlandse populatie. Resultaten tonen aan dat de SRSI succesvol onderscheid maakt tussen eerlijke invullers en degenen die symptomen van depressie of pijn veinzen. Bij de groep die de SRSI slordig invulde, scoorde de helft boven het afkappunt. Exploratief onderzoek suggereert dat de consistentieschaal van de SRSI behulpzaam kan zijn bij het onderscheiden van invaliditeit veroorzaakt door klachtoverdrijving of slordig invullen. Verder onderzoek bij jongeren met mentale en/of lichamelijke klachten is nodig voordat de SRSI gebruikt kan worden in de klinische praktijk.

This study evaluated the reliability and validity of the Self-Report Symptom Inventory (SRSI) in adolescents, aiming to determine whether the SRSI effectively distinguishes between valid and distorted symptom reports under different instructed response conditions. Eighty-eight adolescents, aged 12 to 17 years, from the Dutch-speaking general population completed the SRSI twice: once under honest instructions, and once under one of four randomly assigned conditions: honest (n = 24), feigning depression (n = 23), feigning pain (n = 22), or careless responding (n = 19). Internal consistency, test-retest reliability, and discriminative validity were analyzed. Exploratory analyses examined the impact of careless responding on SRSI scores and the utility of consistency items (i.e., positive health items) in differentiating between careless and feigned responding. The SRSI demonstrated high discriminative validity between honest and feigned responses, with specificity of .90 and sensitivity of .91 at the standard cutoff (> 9). When careless responses were combined with feigned responses - both reflecting distorted symptom presentations - sensitivity decreased to .80. Internal consistency was high for both the genuine (α = .91) and pseudosymptoms (α = .81) scales, and test-retest reliability was high (n = 24; r = .93 and .88, respectively). Among careless responders, approximately 50% scored above the SRSI pseudosymptoms standard cutoff. Exploratory findings suggest that endorsement of multiple consistency items after failing the SRSI may reflect careless rather than feigned responding. These initial findings support the potential utility of the SRSI as a symptom validity measure for adolescents. The lower specificity at the standard cutoff than that found in experimental feigning studies in adults (.90 vs. ≥ .95) suggests that the cutoff may need to be raised in youth samples. Further validation in clinical populations is necessary before recommending its use in applied settings.

Leonhard and Leonhard (2025) argue that Symptom Validity Tests (SVTs) and Performance Validity Tests (PVTs) constitute a form of junk science. This qualification stands in sharp contrast to the breadth and depth of the scientific work on validity tests. Leonhard and Leonhard treat these tests as if they were equivalent to polygraph evidence, a move that betrays a fundamental misunderstanding of the conceptual and empirical foundations of these instruments. More than a year ago, we invited Leonhard and Leonhard to provide case law examples —if only a few— demonstrating that SVTs and/or PVTs contributed to risky legal decisions. So far, they have not been willing or able to cite a single instance. We therefore reiterate our invitation: show us the cases.

Steven J. Lynn (1946–2024) was a prolific researcher who explored a wide array of topics in clinical psychology. He and his co‐authors emphasized the importance of researching the side effects of psychological interventions. In the current studies (Study 1, N = 58; Study 2, N = 64), we examined clinicians' perspectives on side effects. A slight majority of clinicians in both studies reported familiarity with the topic (Study 1: n = 30, 51%; Study 2: n = 39, 61%). Those who claimed familiarity were more likely to discuss side effects with their patients compared with those who acknowledged a lack of knowledge. In Study 2, we found significant variation among clinicians regarding what constitutes avoidable, unavoidable or nonexistent side effects, and their views did not align with those of patients. This divergence may explain why a considerable number of clinicians refrain from discussing side effects with patients, despite patients' right to be fully informed about the potential benefits and risks of their treatment. Our findings underscore the need for clear guidelines that define the full spectrum of side effects and offer strategies for effective communication with patients. The first step in developing such guidelines is to raise awareness among professionals about the topic, which can be effectively achieved by engaging in the work of Steven J. Lynn and his co‐authors, whose insights remain highly relevant.

SUMMARY: Validity tests are used in both forensic and clinical settings, but their application in clinical practice is often hindered by misconceptions. These include the assumptions that validity tests imply a medico-legal dimension, primarily detect feigning or malingering, and provide minimal actionable information to clinicians. The authors critically discuss these misconceptions and argue that validity tests may offer significant value in clinical practice by assessing whether patients can describe their symptoms, complaints and impairments with reasonable accuracy, which has important implications for diagnosis and treatment planning. Importantly, in clinical practice, when interpreting validity tests, neutral terminology such as ‘over-reporting’ and ‘underperformance’ is often preferable to – and better to substantiate than – terms like ‘feigning’ and ‘malingering’, which can evoke moral judgements, creating an unnecessary barrier to using these valuable clinical tools.

Most performance validity tests (PVTs) are memory-based which might lead to an underestimation of performance validity issues in other cognitive domains. Accordingly, the Groningen Effort Test (GET) was developed as an attention-based PVT to detect noncredible attentional performance. This study aimed to examine the utility of the GET performance validity measures—the GET index score (GET _I ) and the number of errors (GET _E )—in a civil forensic setting. Archival data were drawn from neuropsychological assessments of 132 individuals seeking early retirement in Austria. Performance on the Word Memory Test (WMT) and Reliable Digit Span (RDS) served as an external performance validity criterion. Additionally, correlations between all PVTs and two cognitive ability tests (i.e., the Cognitrone and Test of Attentional Performance) were calculated. GET performance was substantially better for individuals exhibiting valid performance than for individuals exhibiting invalid performance, with moderate (GET _I d = 0.73) and large (GET _E d = 2.20) effect sizes. The GET _I showed sensitivity of 71.0% and specificity of 81.8%. The GET _E showed sensitivity of 77.4% and specificity of 89.1%. Correlations between the PVTs and the cognitive ability tests were in the small-to-medium range among participants with valid performance. The GET proved valuable in assessing performance validity in early retirement claimants. Of the two GET measures, the GET _E was slightly superior to the GET _I and should be preferred for clinical use. While the findings indicate that the GET is relatively easy to pass for most individuals, further investigation into its cognitive demands is desirable.