Psychiatric Disorders That May Be Mistaken for Malingering

Factitious disorders and somatoform disorders share common elements with malingering (Cunnien 1997 Eisendrath 1996). Thus, clinicians should be familiar with these conditions when examining suspected cases of malingering. Both malingering and factitious disorders involve the intentional production of physical or psychological symptoms (American Psychiatric Association 2000, p. 513). However, the motivation for behavior associated with factitious disorders is a desire to assume the sick role in...

Case Vignette

J, a 36-year-old chief financial officer of a large corporation, was returning home aboard a jet aircraft when it skidded off the runway in a snowstorm. The aircraft entered a bordering harbor and came to a stop in 5 feet of icy water. Ms. J was momentarily dazed when her head struck the seat in front of her. She was terrified that she would drown, as she had never learned to swim. She escaped the aircraft by sliding down an emergency chute and was able to walk ashore. Ms. J twisted her...

Contracting With Clients

Utilizing business practices common to attorneys minimizes problems involved with collecting fees. Psychiatrists are generally unfamiliar with writing contracts for their services. In contrast, attorneys typically work on a contractual basis. Psychiatrists undertaking forensic work should be familiar with comparable acceptable and desirable billing practices that facilitate the ethical provision of forensic psychiatric services. Mr. W, the gentleman who contacted Dr. M to contract for a...

Subject Index

Page numbers printed in boldface type refer to tables or figures. fellowships in forensic psychiatry and, 64 forensic psychiatry for children and adolescents, 484 recognition of forensic psychiatry as subspecialty, 4 Achievement tests, 625, 628-629 Act for the Safe Keeping of Insane Persons Charged With Offences (1800), 18 Actuarial measures, and risk assessment, 384, 540 Actuarial prediction, and forensic evaluations in correctional settings, 398, 404 Actuarial risk assessment instruments...

Anxiety Disorders

A particular event or accident may not affect some individuals much at all, whereas it may cause others to become quite anxious. The individual who responds with anxiety can develop an anxiety disorder, the signs and symptoms of which are elucidated in DSM-IV-TR. The history of a plaintiff's responses to prior stress with anxiety can be helpful in determining whether a current anxiety disorder exists or is impairing. A plaintiff who has no history or no significant history of responding to...

Vignette 1 Malingered PTSD

A Vietnam-era veteran was admitted to a PTSD partial hospitalization program upon referral from an outpatient clinician. Shortly after entering the program, he reported symptoms such as hearing the voice of his dead comrades during group therapy sessions. However, psychologists conducting group therapy sessions began to be concerned about the patient berating other veterans in the program. In group sessions, he chided the other patients as follows Y'all aren't here to get help like me because...

Role of Psychiatrists

The guidelines of the National Council of Negotiation Associations advise that negotiation teams consider establishing a consultative relationship with a mental health professional. The mental health professional should serve as a team advisor and not as a negotiator, participate in negotiation team training, respond to team call outs as requested, focus on behavioral assessment of the subject and assist in team debriefing after a critical incident (National Council of Negotiation Associations...

Dimensional Diagnosis in Litigation Subthreshold Posttraumatic Stress Disorder

Subthreshold PTSD is an example of a disorder with dimensional features that has not received official diagnostic recognition yet clearly exists and frequently causes significant functional impairment. Subthreshold PTSD can be conceptualized as a dimensional entity that manifests categorical characteristics (defined symptoms causing impairment) and is a good example of such a model (Frank et al. 1998 Maser and Patterson 2002 Ruscio et al. 2002). The diagnosis of PTSD may present clinically with...

The Concept of Scatter

In IQ testing, most persons show relative strengths and weaknesses, indicated by higher and lower scores. However, in the absence of psychopathol-ogy, cognitive impairments, and learning disabilities, the difference in scores is generally not statistically significant. That is, the subtests do not vary by more than 3 points, and the differences across domains vary no more than 10 points. When the variation between scores is larger, the variation is referred to as scatter. There are three...

The Value of a Business Plan

Most business schools advocate developing a formal business plan when getting started in any business. For complex forensic practices, for example, those that involve a partnership or employment relationship between forensic service providers from multiple disciplines as well as support staff, a formal business plan may be useful and necessary (Granacher 2004). In contrast, a formal business plan is probably not going to be of assistance in achieving practice goals for a solo practitioner who...

References

Allen JP, Maisto SA, Connors GJ Self-report screening tests for alcohol problems in primary care. Arch Intern Med 155 1726-1730, 1995 American Academy of Child and Adolescent Psychiatry Practice parameters for the assessment and treatment of children and adolescents with conduct disorder. J Am Acad Child Adolesc Psychiatry 36 122S-139S, 1997a American Academy of Child and Adolescent Psychiatry Practice parameters for child custody evaluation. J Am Acad Child Adolesc Psychiatry 36 57S-68S, 1997b...

Psychological Tests for Malingering

Malingering tests, more properly termed feigning tests (Table 23-1), are specific psychological tests used to assess the credibility of symptoms and disabilities. There is no psychological test for global malingering tests are designed to assess the quality and the nature of symptoms in reference to usual manifestations of illness. They are designed around the assumptions that each major mental disorder has common presentations of major signs and symptoms and that the severity of the illness...

Case Vignette 2

In 2003, James Pacenza Sr., an IBM employee, was fired for accessing cybersex chats on company computers during business hours. Pacenza sued IBM, alleging that his termination was wrongful discrimination under the Americans with Disabilities Act (Pacenza v. IBM Corp. 2009). Pacenza claimed that his use of the chats was related to posttraumatic stress disorder (PTSD) he had developed from service in the Vietnam War and that his PTSD manifests itself through a variety of addictive behavior...