Abstract
We investigated how scores from the Rorschach task and self-reports of psychotic-like disturbance distinguish individuals attempting to appear insane (i.e., feigning) from patients with psychotic disturbances or nonpatient controls. We also evaluated whether Rorschach scores provide incremental validity over self-reported symptoms. The study used 50 nonpatients asked to feign (F; age M = 19.5, SD = 1.5), 88 incarcerated forensic inpatients deemed not guilty by reason of insanity or incompetent to stand trial (P; age M = 40.8, SD = 13.5), and 47 standard nonpatient controls (S; age M = 19.8, SD = 2.2). Participants responded to the Rorschach Performance Assessment System (R-PAS), the Magical Ideation Scale (MIS), and the Perceptual Aberration Scale (PAS). We compared each pair of groups (i.e., F vs. P, P vs. S, and F vs. S) with separate predetermined hypotheses addressing the multimethod assessment of feigning or psychosis and ran logistic regressions including Rorschach and self-reported scores to predict group membership (e.g., F vs. P). Primary analyses found validity for Critical Contents and a revised version of it, the Thought and Perception Composite (TP-Comp), a variable we call Breaking the Card Boundary (BCB), and self-reported symptoms. In supplementary analyses, we document validity for subcomponents of TP-Comp alone and in combination with BCB. We also found it was easier to feign self-reported symptoms than R-PAS assessed characteristics and that R-PAS variables had incremental validity over self-reports on the MIS-PAS. Finally, we note limitations and suggest future paths, such as evaluating the generalizability of the results when considering attempts to feign severe mental illness on the trauma spectrum and creating a feigning composite using cross-validated logistic regression equations.
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Notes
Sewell and Helle (2018) organized their review in a summary table indicating whether the feigners scored higher, lower, or no differently than the comparison group across 15 variables. In our version of the table, which is available from the authors, we made corrections to some of their entries. Based on the text in Easton and Feigenbaum (1967) and Feldman and Graley (1954), we changed the direction of three effects. We also added missing effects provided in (n = 8) Batchelder (1994), Easton and Feigenbaum (1967), Feldman and Graley (1954), and Seamons et al. (1981), or computable from (n = 6) Netter and Viglione (1994). Given the small samples, we also noted the direction of effects when they were close to significant (i.e., p < .10).
Researchers defined dramatic content in overlapping ways. Relative to Critical Content, two studies omitted Anatomy (Ganellen et al., 1996; McDougall, 1996), though the two scales correlate highly in the R-PAS norms (r = .89). Overton (1984) studied Blood, Fire, Explosion, and Sex separate from Anatomy and did not study Morbid or Aggressive Movement. His four-variable composite has an r with Critical Content of just 0.69, which may explain why he had the only null dramatic content result. (Null results may also be due to small samples [10 feigners, 10 controls] and instructions to use five strategies to fake the Rorschach.) Seamons et al. (1981) defined dramatic content as “themes of depression, sex, blood, gore, mutilation, confusion, hatred, fighting, and decapitation” (p. 132). Perry and Kinder (1992) and Spana (1992) slightly expanded that to add themes of negative emotion or evil.
CritCont2% encompasses almost all the sub-features of dramatic contents that others have studied. However, it does not assess confusion, as used by G. G. Perry and Kinder (1992), Seamons et al. (1981), and Spana (1992) or negative emotions that do not qualify for the MOR code, as used by G. G. Perry and Kinder (1992) and Spana (1992).
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Joni L. Mihura and Gregory J. Meyer are members of a company that sells the manual for the Rorschach Performance Assessment System (R-PAS) and associated products, which establishes a financial conflict of interest.
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Kiss, A., Mihura, J.L., Meyer, G.J. et al. Comparing Committed Forensic Inpatients to Nonpatients Instructed to Feign Insanity or Not Using Scores from the Rorschach Task and Self-Report. Psychol. Inj. and Law 16, 141–157 (2023). https://doi.org/10.1007/s12207-023-09473-5
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DOI: https://doi.org/10.1007/s12207-023-09473-5