Psychopathology Concealment

Both clinical and forensic psychiatrists recognize that individuals whom they evaluate may be unreliable historians. Clinical psychiatrists are diligent in attending to the possibility that patients may not be forthcoming with all of their symptoms, beliefs, or personal history. For example, consider a clinician’s skepticism about the claims of a delusional paranoid schizophrenic brought to a clinic by his concerned family members or about the denials of suicidal intent of a depressed patient brought to the emergency room for a drug overdose. Clinicians approach cases such as these recognizing that patients may withhold critical information about their psychopathology, whether because of paranoid fears, in response to voices they hear, covert suicidal intent, desires to appear “normal,” or other motives. Forensic practitioners approach evaluations with a somewhat different focus, colored chiefly by inclusion of strategies to detect the possibility of malingering. It is certainly reasonable to be skeptical of a forensic evaluee’s...