Researchers implant false symptoms

An intriguing study just published in the Journal of Clinical and Experimental Neuropsychology has found that we can be convinced we reported symptoms of mental illness that we never mentioned and, as a result, we can actually start believing we have the symptom itself.

The faking and exaggerating of psychiatric and neurological symptoms is a big problem in the medical world, not because it is difficult to see when symptoms are inconsistent with the person’s medical history, but because they can also be arise unconsciously without any intent to deceive.

For example, imagine someone experiences a minor car crash but afterwards reports that their legs are paralysed. Of course, they could be outright faking, but they could also be experiencing what is now diagnosed as conversion disorder, where they have no neurological damage that would prevent them moving their legs but where they also have no conscious control over their movements.

It is probably true to say that the condition is not well understood, but it seems that the paralysis occurs through problems in the organisation of activity patterns in the brain, rather than through ‘damaged wiring’.

In terms of the medical diagnosis, however, the distinction can often rely on making a difficult judgement about the person’s intentions and motivations – whether they are deliberately faking, have no control or are somewhere in between.

These issues become even more tricky when the reported symptoms are psychological in nature – e.g. memory loss, emotional disturbance, difficulty concentrating – because it can be even harder to make the distinction between genuine, exaggerated or outright faked symptoms.

This is also a legal problem, because patients making insurance or compensation claims have a financial incentive to report more symptoms.

Psychologists have developed numerous tests and evaluations to assess the genuineness of symptoms and whether someone is putting their full effort into ability tests, but this new study shows that the line between conscious and unconscious exaggeration can be quite blurry.

The research team, led by psychologist Harald Merckelbach, asked two groups of student participants to read a description of a legal case where the defendant had illegally entered a medieval building and accidentally dislodged some stones which had fatally wounded a young girl.

They were then told to imagine they were the defendant and to fill in a medical assessment questionnaire. One group was told to fill it in honestly, and other was told to fake a serious psychological condition in a credible way to minimise their criminal responsibility.

The twist came when, after an hour of doing unrelated puzzles and quizzes, the participants in the dishonest group were told they had been detected as fakers, and were asked to fill in the medical questionnaire again – but this time honestly. Those in the honest group were simply told that sometimes people can change their mind and were asked to complete the assessment again.

The group asked to ‘fake’ the first time around showed much higher levels of symptom exaggeration and faking on the second assessment – even though they were told to complete the questionnaire honestly.

In an interesting parallel to a recent study showing that just wearing counterfeit designer clothes led by higher levels of deception, just having experience of earlier deliberate faking led to unconscious exaggeration later on.

But perhaps the most interesting part came in their second experiment. Participants were asked to complete a checklist of symptoms, to report, honestly, on their mental health.

After handing in the questionnaires, the researchers secretly altered a couple of the participants responses – for example, when the participant answered a question about concentration difficulties with 0 (“not at all”), this score was surreptitiously changed to a 2 (“occasionally”).

One of the research team then went through the questionnaire and asked each participant to explain why they answered the way they did.

During the interview, more than two-thirds of the participants gave justification for why a faked item was true, without realising it had been manipulated, and over half were completely blind to the fact that both items had been changed.

The researchers described how “participants would say that they occasionally or rather often experienced concentration difficulties because they had been drinking a lot of coffee lately or because they were going through a difficult time in life with a lot of exams”.

Afterwards, the participants were given the same questions again and those who had justified the faked responses tended to change their answers – having seemingly come to believe more strongly that they really did experience the symptoms ‘given’ to them by the researchers. The effect was not dramatic, but still a significant shift.

In some ways, the study is an extension of the many studies that have found how easy it is to implant fictitious experiences into the memories of everyday folk. But it also shows that there is no cut and dry line between deliberate faking and unconscious motivation and that we can give exaggerated answers even when we’re trying to be brutally honest.

Link to PubMed entry for study.