Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses are made after considering as many as five different sources of information collected by the evaluating doctor at the time of the examination. These sources of information are: the patient’s life history and their presenting complaints or symptoms, the doctor’s report of their face-to-face Mental Status Examination, the objective psychological testing data, the patient’s medical records and any collateral sources of information in the form of interviews with the patient’s friends, relatives and/or co-workers. By no means whatsoever should a DSM diagnosis be arrived at by simply considering the psychological testing data. In fact, a review of page xxxii of the DSM-IV-TR explicitly states, “Assessments that rely solely on psychological testing not covering the criteria content (e.g., projective testing) cannot be validly used as the primary source of diagnostic information.” Thus, if you encounter a psychological evaluation report where the diagnostic conclusions were arrived at solely based on psychological testing data, you should ask the doctor where in their report they considered the patient’s life history and their presenting complaints, the face-to-face Mental Status Examination data, the patient’s medical records or the contents of page xxxii of the DSM-IV-TR.
Tuesday, August 15, 2017
Psychiatrist v. Psychologist when considering patient’s credibility - Cross-Examining Psych Doctors, Tip #93
Psychologists typically are trained and have more experience in administration, scoring and interpretation of psychological tests than psychiatrists. This may be an important factor to consider in medical-legal cases where psychological test data is often the only form of objective information that can be presented for public inspection in open court and is useful in determining the patient’s credibility. Point in case, a recent deposition transcript reveals a psychiatrist’s response to a question about the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). This is approximately what the doctor said during his/her depo, “I really don’t know much about the MMPI-2. I’m not a specialist in testing or I would have interpreted the results. Maybe what you should do is have somebody else provide you with that information, I don’t.” The MMPI-2, of course, is a version of the Minnesota Multiphasic Personality Inventory, a test that is the gold standard of psychological test batteries for medical-legal examinations. In fact, the principal method for assessing the patient’s credibility is an objective psychological test battery containing such instruments as the MMPI that are capable of generating objective test scores that can be presented to the court to provide information both about the patient's credibility and any possible psychopathology. For the reasons described above, considering the use of a psychologist for your medical-legal evaluations is strongly recommended.
The Millon Clinical Multiaxial Inventory-III (MCMI-III) is the most recently revised version of the Millon Clinical Multiaxial Inventory devised by Dr. Theodore Millon, a specialist and pioneer in the area of Personality Disorders. The MCMI-III contains a variety of scales which include four validity scales. The Debasement Scale is a validity scale that measures an individual’s “inclination to deprecate or devalue oneself by presenting more troublesome emotional and personal difficulties than are likely to be uncovered upon objective review.” On the MCMI-III a BR score of 75 or more is sufficient to conclude that the individual was attempting to simulate symptoms, fake or malinger. It also should be noted that when an individual is found to be attempting to fake that all further interpretation of the psychological meaning of their scores on the MCMI-III must cease and nothing further can be said about their psychological status beyond the fact that they were trying to appear to have symptoms that do not exist.