Cognitive and personality functioningCognitive and personality functioning

What are meaningful ways to integrate these two What are meaningful ways to integrate these two pieces of information?pieces of information?– What interpretations might one make for high IQ individuals What interpretations might one make for high IQ individuals

relative to low IQ individuals re: personality? relative to low IQ individuals re: personality? Overlap with maturity? Less complex presentations? Overlap with maturity? Less complex presentations? What PD is associated with extremist thinking (splitting), inability to What PD is associated with extremist thinking (splitting), inability to

recognize subtleties?recognize subtleties?

Other implications?Other implications?– Ease of use for clients, alternative test format, wider range of Ease of use for clients, alternative test format, wider range of

responses (variability), alternative approach to detecting responses (variability), alternative approach to detecting pathology, difficult for client to identify socially desirable or pathology, difficult for client to identify socially desirable or undesirable responding, theory basedundesirable responding, theory based

– Defensiveness strategies (see MMPI-2)? Defensiveness strategies (see MMPI-2)?

Projective test/techniqueProjective test/technique

MMPI/MMPI-2 is most frequently used test MMPI/MMPI-2 is most frequently used test in inpatient settingsin inpatient settings

Rorschach & TAT are not too far behindRorschach & TAT are not too far behind Advantages of projectives?Advantages of projectives? Disadvantages of projectives?Disadvantages of projectives?

– Administration and scoring is generally less Administration and scoring is generally less standardized so reliability and validity are standardized so reliability and validity are compromisedcompromised

Minimal criteria for a testMinimal criteria for a test

Standardized administrationStandardized administration– Rorschach has numerous administration procedures Rorschach has numerous administration procedures

(Bleck, Klopfer, Exner, etc.)(Bleck, Klopfer, Exner, etc.) Standardized scoringStandardized scoring

– Rorschach has numerous scoring approaches (Bleck, Rorschach has numerous scoring approaches (Bleck, Klopfer, Exner, etc.)Klopfer, Exner, etc.)

Standard of comparison for interpretations (norm group)Standard of comparison for interpretations (norm group)– Minimal information with regard to representative normsMinimal information with regard to representative norms

Rorschach – ExnerRorschach – Exner

Exner’s (1987) scoring system involves an attempt Exner’s (1987) scoring system involves an attempt to increase validity by objectifying the scoring, to increase validity by objectifying the scoring, increasing the number of responses (14), and increasing the number of responses (14), and standardizing the administrationstandardizing the administration

This has resulted in significant improvements in This has resulted in significant improvements in the test’s reliability and validitythe test’s reliability and validity

In a meta-analysis, Hiller et al. (1999) found the In a meta-analysis, Hiller et al. (1999) found the Rorschach (using Exner’s scoring) to have larger Rorschach (using Exner’s scoring) to have larger validity coefficients than the MMPI-2 for studies validity coefficients than the MMPI-2 for studies using objective criterion variablesusing objective criterion variables

Exner’s scoring systemExner’s scoring system

Location – part of the blot Location – part of the blot – W, D, d, S, (WS)W, D, d, S, (WS)– How common is the location (normative comparisons from How common is the location (normative comparisons from

manual)manual) Determinant – what led to responseDeterminant – what led to response

– Form, Color, FC or CF, Movement, etc.Form, Color, FC or CF, Movement, etc.– Evaluate form quality (normative decision based on manual Evaluate form quality (normative decision based on manual

of responses). Low Fof responses). Low F++% = psychosis/poor reality contact% = psychosis/poor reality contact Content – focus on what specificallyContent – focus on what specifically

– Human or animal, whole or detail, nature, etc.Human or animal, whole or detail, nature, etc. Populars – determines normative responding Populars – determines normative responding

Other projective “tests”Other projective “tests”

TAT (Thematic apperception test, Murray)TAT (Thematic apperception test, Murray)– Stimuli are less ambiguous than the ink blotsStimuli are less ambiguous than the ink blots– Tell a story, though little standardization re: which pictures to be used, Tell a story, though little standardization re: which pictures to be used,

scoring (typically a content analysis), etc.scoring (typically a content analysis), etc.– Used extensively with less literate pops like children (CAT), geriatric pops Used extensively with less literate pops like children (CAT), geriatric pops

(GAT), non-English speaking individuals, etc.(GAT), non-English speaking individuals, etc. Draw-a-figure test (figure drawings)Draw-a-figure test (figure drawings)

– Person, family, house, tree, etc. – all are interpreted as youPerson, family, house, tree, etc. – all are interpreted as you– Minimal standardization for scoringMinimal standardization for scoring

Sentence completionSentence completion– Sentence stems like “Mom is”, “Life”, etc. largely scored for a thematic Sentence stems like “Mom is”, “Life”, etc. largely scored for a thematic

standpointstandpoint Bender-Gestalt (the same test used for neuropsychological screens)Bender-Gestalt (the same test used for neuropsychological screens)

– Copying figures and making personality interpretationsCopying figures and making personality interpretations

Test or technique?Test or technique?

Review articles and come up with an Review articles and come up with an opinion. Come ready to debate/discuss.opinion. Come ready to debate/discuss.

On Tuesday/Thursday?On Tuesday/Thursday?

Assessment of malingeringAssessment of malingering

What is malingering? What must it include?What is malingering? What must it include?– Intentional? Awareness? Personal gain?Intentional? Awareness? Personal gain?

Very complex phenomenon that may change over timeVery complex phenomenon that may change over time– e.g., A lie (or lies) that become “real/true” for the individual over time, or a e.g., A lie (or lies) that become “real/true” for the individual over time, or a

truthful statement that becomes a lie.truthful statement that becomes a lie.– Most statements can’t be categorized as one or the other, and typically Most statements can’t be categorized as one or the other, and typically

involve aspects of bothinvolve aspects of both– Berry et al (1995) suggest that faking good and faking bad are distinct Berry et al (1995) suggest that faking good and faking bad are distinct

constructs (not opposite ends of the same continuum)constructs (not opposite ends of the same continuum)– Harder to detect specific faking vs. general fakingHarder to detect specific faking vs. general faking– Content nonresponsivity (CNR) – random responding, all true or all falseContent nonresponsivity (CNR) – random responding, all true or all false– Content response faking (CRF) – fake good or bad; research suggests that Content response faking (CRF) – fake good or bad; research suggests that

these may be independent dimensions (client may fake good on some parts these may be independent dimensions (client may fake good on some parts and fake bad on others)and fake bad on others)

Should always be considered (in some form) when there are Should always be considered (in some form) when there are contingencies for the patientcontingencies for the patient

Classifications of MisrepresentationClassifications of Misrepresentation

Are symptoms under conscious control? Are physical/psychological Are symptoms under conscious control? Are physical/psychological symptoms motivated by internal or external gains?symptoms motivated by internal or external gains?

Factitious Disorders – Factitious Disorders – intentionalintentional production of symptoms (feigning) production of symptoms (feigning) that are motivated by internal gainsthat are motivated by internal gains– Motivation is to assume the “sick role” as there are Motivation is to assume the “sick role” as there are nono external incentives external incentives

for the behavior (e.g., economic gain, avoiding legal responsibility, etc.)for the behavior (e.g., economic gain, avoiding legal responsibility, etc.) Somatoform disorder – Somatoform disorder – unintentionalunintentional (i.e., unconscious) production of (i.e., unconscious) production of

symptoms for internal gainssymptoms for internal gains Malingering – Malingering – intentionalintentional production or production or exaggerationexaggeration of symptoms (i.e., of symptoms (i.e.,

conscious) motivated by conscious) motivated by externalexternal incentives incentives– Lack of cooperation during the evaluation, presence of ASPD, discrepancy Lack of cooperation during the evaluation, presence of ASPD, discrepancy

between self-reported data and objective findings, medicolegal context for between self-reported data and objective findings, medicolegal context for referral (e.g., attorney, police, etc.)referral (e.g., attorney, police, etc.)

– Note: Exaggeration rather than fabrication makes differential very difficult Note: Exaggeration rather than fabrication makes differential very difficult

Pros and Cons of Malingering DxPros and Cons of Malingering Dx

What are the costs of labeling someone a “malingerer”What are the costs of labeling someone a “malingerer”– Questions all present and future clinical presentationsQuestions all present and future clinical presentations

What are the limits of our measures to make this differential?What are the limits of our measures to make this differential? After weighing the strength of any claim of malingering (relatively weak After weighing the strength of any claim of malingering (relatively weak

given the limits of our measures) and the costs of making an erroneous given the limits of our measures) and the costs of making an erroneous judgment, we need to act very carefullyjudgment, we need to act very carefully

Use converging, independent evidence to make any determinationsUse converging, independent evidence to make any determinations– e.g., objective inventories like the MMPI-2, strong contextual factors (i.e., to e.g., objective inventories like the MMPI-2, strong contextual factors (i.e., to

provide the motive and baserates), interview, low probability baserates for provide the motive and baserates), interview, low probability baserates for responding (e.g., incorrect on all options when this would be well below responding (e.g., incorrect on all options when this would be well below chance responding), and response to the evaluator’s feedback (e.g., chance responding), and response to the evaluator’s feedback (e.g., “Actually, you’re doing quite well” – followed by decrements in “Actually, you’re doing quite well” – followed by decrements in performance)performance)

Mind of a murderer – the Bianchi tapesMind of a murderer – the Bianchi tapes

Identify the circumstances that could be seen as contingencies for Identify the circumstances that could be seen as contingencies for malingering (reinforcers for malingering)malingering (reinforcers for malingering)

Why would that particular malingering behavior be manifested?Why would that particular malingering behavior be manifested? How could client have obtained the information necessary to provide How could client have obtained the information necessary to provide

the malingering profile? Any evidence that this information was the malingering profile? Any evidence that this information was obtained?obtained?

Any indications of malingering in his presentation? (Be objective)Any indications of malingering in his presentation? (Be objective) What are some reasons why he might not be malingering?What are some reasons why he might not be malingering? Predict response sets in advance of testing (vs. scoring in hindsight)Predict response sets in advance of testing (vs. scoring in hindsight) What pattern of responses do you predict for the Rorschach?What pattern of responses do you predict for the Rorschach? What pattern of responses would you predict for the MMPI-2?What pattern of responses would you predict for the MMPI-2?

What’s your call?What’s your call?

Measures of malingering – Berry et alMeasures of malingering – Berry et al

The pasta strainer and photo copy machine “incident”The pasta strainer and photo copy machine “incident” MMPI-2: F, F-K (note: these two indices are MMPI-2: F, F-K (note: these two indices are notnot independent), VRIN independent), VRIN

(random), TRIN (all true or all false), and Fb(random), TRIN (all true or all false), and Fb– Also look for discrepancies between some of your subtle and obvious Also look for discrepancies between some of your subtle and obvious

supplemental scales (though this can also just assess sophistication in supplemental scales (though this can also just assess sophistication in malingering) malingering)

– The D scale has also been used with some success, as the items appear The D scale has also been used with some success, as the items appear to reflect a less sophisticated (popular) view of mental illnessto reflect a less sophisticated (popular) view of mental illness

MCMI – evaluates random responding, low frequency responding, MCMI – evaluates random responding, low frequency responding, willingness to disclose information, debasement (willingness to willingness to disclose information, debasement (willingness to endorse psychological problems), and desirability (unwilling to endorse endorse psychological problems), and desirability (unwilling to endorse psychological problems). Also as with the D scale of the MMPI, the psychological problems). Also as with the D scale of the MMPI, the well-being scale can likewise assess psychopathologywell-being scale can likewise assess psychopathology

Measures of malingering – 2 continuedMeasures of malingering – 2 continued

CPI (Cough, 1957) – intended to assess personality in the normal CPI (Cough, 1957) – intended to assess personality in the normal populationpopulation– Has 3 validity scales: good impression (faking good), communality (items Has 3 validity scales: good impression (faking good), communality (items

with either very high or very low endorsement frequency that assesses with either very high or very low endorsement frequency that assesses random responding), well-being (assesses fake bad)random responding), well-being (assesses fake bad)

Basic personality inventory (BPI: Jackson, 1989) contains 12 scales Basic personality inventory (BPI: Jackson, 1989) contains 12 scales each with 20 T/F items. Research is limited on its utility for this.each with 20 T/F items. Research is limited on its utility for this.– Deviation scale is comparable to the MMPI-2 F scaleDeviation scale is comparable to the MMPI-2 F scale

Personality assessment inventory (PAI: Morey, 1991) is a 344 itemsPersonality assessment inventory (PAI: Morey, 1991) is a 344 items– 4 validity scales: Inconsistency, infrequency, negative impression 4 validity scales: Inconsistency, infrequency, negative impression

management and positive impression managementmanagement and positive impression management NEO-PI-R (Costa & McCrae, 1991) – no effective validity index, so NEO-PI-R (Costa & McCrae, 1991) – no effective validity index, so

should not be used in this contextshould not be used in this context 16 PF also lacks adequate validity measures and should not be used16 PF also lacks adequate validity measures and should not be used

Measures to specifically detect malingeringMeasures to specifically detect malingering

These measures should be administered when the referral question These measures should be administered when the referral question specifically implicates malingering and/or when there are substantial specifically implicates malingering and/or when there are substantial contingencies to suggest that malingering is likely contingencies to suggest that malingering is likely

Structured Interview of reported symptoms (SIRS) Structured Interview of reported symptoms (SIRS) – Has shown some promise, though it is susceptible to acquiescence and Has shown some promise, though it is susceptible to acquiescence and

false positives (claiming malingering when it is not)false positives (claiming malingering when it is not) The M test is a 33 item T/F test with three scales: genuine symptoms The M test is a 33 item T/F test with three scales: genuine symptoms

of schizophrenia, atypical attitudes not characteristic of mental illness, of schizophrenia, atypical attitudes not characteristic of mental illness, and bizarre and unusual symptoms rarely found in mental illnessand bizarre and unusual symptoms rarely found in mental illness– Showed some ability to differentiate patients from directed malingerers and Showed some ability to differentiate patients from directed malingerers and

from suspected malingerers (Note: The problem with using the latter from suspected malingerers (Note: The problem with using the latter criterion group as there is no definitive knowledge about those individuals)criterion group as there is no definitive knowledge about those individuals)

Measures to specifically detect malinger. - 2Measures to specifically detect malinger. - 2

Test battery approach including WAIS-III and the MMPI-2 – the Test battery approach including WAIS-III and the MMPI-2 – the more more tests administered, the harder it is to present a consistent profiletests administered, the harder it is to present a consistent profile

This approach should use baserates for incorrect responses as the This approach should use baserates for incorrect responses as the primary means of classifyingprimary means of classifying– Provide response options (typically no more than two) such that a chance Provide response options (typically no more than two) such that a chance

correct criterion can be calculated (e.g., 50% for a two item version) – this correct criterion can be calculated (e.g., 50% for a two item version) – this should be no lower than 30% to avoid floor effectsshould be no lower than 30% to avoid floor effects

– Track responses over at least 30 trials (the more the better as this Track responses over at least 30 trials (the more the better as this minimizes chance outcomes).minimizes chance outcomes).

– Calculate the probabilities for deviations from .50 correct and apply it to Calculate the probabilities for deviations from .50 correct and apply it to client’s correct response rate (i.e., what are the odds that they would have client’s correct response rate (i.e., what are the odds that they would have missed as many as they did if they were truly guessing)missed as many as they did if they were truly guessing)

– Evaluate responsiveness to your feedback (e.g., “You’re actually not doing Evaluate responsiveness to your feedback (e.g., “You’re actually not doing that bad” vs. “Most people with your type of injury do better”)that bad” vs. “Most people with your type of injury do better”)

– If less sophisticated malingering there will be an immediate and relatively If less sophisticated malingering there will be an immediate and relatively large response to your commentslarge response to your comments

Who is your client?Who is your client?

Why is this question important in addressing the malingering issue?Why is this question important in addressing the malingering issue? If the suspected malingerer is your client who is undergoing therapy If the suspected malingerer is your client who is undergoing therapy

with you (or someone else) to whom is your obligation and what are with you (or someone else) to whom is your obligation and what are the costs/benefits of undertaking an evaluation of malingering?the costs/benefits of undertaking an evaluation of malingering?– Does it help the therapeutic process? Focus on Does it help the therapeutic process? Focus on whywhy one might be one might be

deceptive to better understand client’s behaviordeceptive to better understand client’s behavior

If the “client” is the court, then to whom is your obligation and what are If the “client” is the court, then to whom is your obligation and what are the costs/benefits of undertaking an evaluation of malingering?the costs/benefits of undertaking an evaluation of malingering?– Question now is to determineQuestion now is to determine if if client is being deceptive/evasive. client is being deceptive/evasive.

Assessing psychopathic personalityAssessing psychopathic personality

Psychopathic personality = behavior characterized by remorseful and Psychopathic personality = behavior characterized by remorseful and callous disregard for others and a chronic antisocial lifestyle. Thus, callous disregard for others and a chronic antisocial lifestyle. Thus, most ASPDs are most ASPDs are not necessarilynot necessarily psychopathic. psychopathic.

Drawing data from various sources (at least three)Drawing data from various sources (at least three)– In person interviewIn person interview

– TestingTesting

– Independent historical information (anything that is Independent historical information (anything that is notnot self report – it is self report – it is important to note that other official records are not necessarily based on important to note that other official records are not necessarily based on anything other than self-report)anything other than self-report)

Although all three of the above are important in order to provide Although all three of the above are important in order to provide converging evidence, the test data will be the strongest tool in court converging evidence, the test data will be the strongest tool in court (due to its psychometric strengths)(due to its psychometric strengths)

Assessment (Meloy & Gacono, 1995)Assessment (Meloy & Gacono, 1995)

The Psychopathy checklist – revised (Hare, 1991) – 20 item test with a The Psychopathy checklist – revised (Hare, 1991) – 20 item test with a 4-point Likert scale response format. Largely intended for males (little 4-point Likert scale response format. Largely intended for males (little data on females)data on females)– To be completed by the clinician after a clinical interview and review of To be completed by the clinician after a clinical interview and review of

historical data (includes descriptors falling under a single dimension of historical data (includes descriptors falling under a single dimension of psychopathy) e.g., impulsive, irresponsible, shallow emotions, etc.psychopathy) e.g., impulsive, irresponsible, shallow emotions, etc.

– Items must be scored in a particular sequence, with more structured items Items must be scored in a particular sequence, with more structured items first, followed by the least structured items (with the former contributing to first, followed by the least structured items (with the former contributing to the latter) the latter)

– Cutoff score of 30 or greater to define psychopathy, with higher scores Cutoff score of 30 or greater to define psychopathy, with higher scores denoting more extreme presentationsdenoting more extreme presentations

– Adequate reliability and validity, though note the overlap between some of Adequate reliability and validity, though note the overlap between some of the validity criteria and the info used to determine the score (e.g., extent of the validity criteria and the info used to determine the score (e.g., extent of criminal record is used for both)criminal record is used for both)

Assessment (Meloy & Gacono, 1995) – p. 2Assessment (Meloy & Gacono, 1995) – p. 2

The Rorschach – should still pursue the minimum number of The Rorschach – should still pursue the minimum number of responses (14 or more) as suggested by Exner (1986)responses (14 or more) as suggested by Exner (1986)– Include an assessment of defenses and object relations (both of which Include an assessment of defenses and object relations (both of which

appear to have modest reliability) that suggest more narcissism (self-appear to have modest reliability) that suggest more narcissism (self-references), violations of boundaries, etc. in the psychopathic personality references), violations of boundaries, etc. in the psychopathic personality (specific ratios from Exner’s scoring system are described)(specific ratios from Exner’s scoring system are described)

MMPI-2 – primary focus is on scale 4 (also content subscales drawn MMPI-2 – primary focus is on scale 4 (also content subscales drawn from 4 – be cautious with the latter)from 4 – be cautious with the latter)– If administering scale 4 alone, note that you will not have the benefit of the If administering scale 4 alone, note that you will not have the benefit of the

k correction. Thus, scores will be suppressed.k correction. Thus, scores will be suppressed.– L and F will also predict psychopathy (tendency to be untruthful)L and F will also predict psychopathy (tendency to be untruthful)

Cognitive abilities (e.g., WAIS-III) are unrelated to the presence of Cognitive abilities (e.g., WAIS-III) are unrelated to the presence of psychopathy, but may be informative as to the nature of the psychopathy, but may be informative as to the nature of the presentation (e.g., level of sophistication, concordance with presentation (e.g., level of sophistication, concordance with traditional/normative concepts of intelligence, etc.)traditional/normative concepts of intelligence, etc.)

Integrity testingIntegrity testing

Evaluating integrity as a trait, whereas such behavior may be situation Evaluating integrity as a trait, whereas such behavior may be situation specific (e.g., someone who would not lie in interpersonal settings specific (e.g., someone who would not lie in interpersonal settings might not hesitate to cheat on their taxes).might not hesitate to cheat on their taxes).– Characterological view of integrity downplays situational factorsCharacterological view of integrity downplays situational factors

– Integrity is a very broad concept that can include diverse responses (e.g., Integrity is a very broad concept that can include diverse responses (e.g., passive vs. active lying, cheating vs. theft, etc.)passive vs. active lying, cheating vs. theft, etc.)

Early paper and pencil tests were validated with the polygraphEarly paper and pencil tests were validated with the polygraph Employed in low end entry jobs when people have to interact with Employed in low end entry jobs when people have to interact with

money (retail, financial services, etc.)money (retail, financial services, etc.) Today, such tests attempt to predict a wide range of behaviors Today, such tests attempt to predict a wide range of behaviors

including violations of work rules, fraud, absenteeism, etc.including violations of work rules, fraud, absenteeism, etc.

Integrity testing – p. 2Integrity testing – p. 2

Overt integrity tests – evaluate beliefs about the incidence of theft and Overt integrity tests – evaluate beliefs about the incidence of theft and other counterproductive behaviors, punitive attitudes towards theft, other counterproductive behaviors, punitive attitudes towards theft, endorsement of common rationalizations for theft, and direct questions endorsement of common rationalizations for theft, and direct questions about one’s own involvement in such activities.about one’s own involvement in such activities.

Personality oriented measures – much broader than integrity tests and Personality oriented measures – much broader than integrity tests and tend to have lower face validity (e.g., high conscientiousness on the tend to have lower face validity (e.g., high conscientiousness on the NEO)NEO)

Clinical measures like the MMPI – validity scalesClinical measures like the MMPI – validity scales All are difficult to validate because the behavior we are trying to predict All are difficult to validate because the behavior we are trying to predict

goes largely undetected. So if a test score does not predict it could just goes largely undetected. So if a test score does not predict it could just mean that this is a false positive or someone who was not caughtmean that this is a false positive or someone who was not caught

The polygraph testThe polygraph test

Measures physiological arousal that is presumed to be associated with lying. Measures physiological arousal that is presumed to be associated with lying. e.g., perspiration as indicated by galvanic skin response, brain activity e.g., perspiration as indicated by galvanic skin response, brain activity suggesting arousal, etc. suggesting arousal, etc. to the questionto the question (not answer) (not answer)– Is this assumption reasonable? Is this assumption reasonable? – Confounds? Confounds? – Under what circumstances can lying not be associated with arousal?Under what circumstances can lying not be associated with arousal?

Habituation effect from repeated lying?Habituation effect from repeated lying? Lack of awareness of the lying? (issue of conscious vs. unconscious)Lack of awareness of the lying? (issue of conscious vs. unconscious)

What is the best way to quantify arousal? Should we evaluate this What is the best way to quantify arousal? Should we evaluate this normatively or ipsatively?normatively or ipsatively?

Control Question Test (CQT) – compares relevant questions to control Control Question Test (CQT) – compares relevant questions to control questions which are intended to elicit a strong physiological response from questions which are intended to elicit a strong physiological response from innocent subjects (e.g., “Prior to 1993, did you ever do anything that was innocent subjects (e.g., “Prior to 1993, did you ever do anything that was illegal or dishonest?”)illegal or dishonest?”)– While innocent people know they didn’t commit the crime, they are either While innocent people know they didn’t commit the crime, they are either

uncertain or lying about the CQ. Guilty persons should not respond as much to uncertain or lying about the CQ. Guilty persons should not respond as much to the CQthe CQ

The polygraph test – p. 2The polygraph test – p. 2

Criticisms of the CQTCriticisms of the CQT– Difficult to develop good control questions that will produce similar Difficult to develop good control questions that will produce similar

responses relative to relevant questions for innocent people. This results in responses relative to relevant questions for innocent people. This results in many false positives (Note: Bias for positive outcome is why most of these many false positives (Note: Bias for positive outcome is why most of these tests have artificially high success rates in forensic settings – most are tests have artificially high success rates in forensic settings – most are guilty)guilty)

– CQ are designed for each individual, so standardization is compromisedCQ are designed for each individual, so standardization is compromised Direct Lie Control Test (DLCT) – if person answers truthfully to a Direct Lie Control Test (DLCT) – if person answers truthfully to a

question they are asked the question again and told to lie about it question they are asked the question again and told to lie about it when asked again (a known lie for comparison)when asked again (a known lie for comparison)– Can be standardized and the power of the DLCT is from the instruction Can be standardized and the power of the DLCT is from the instruction

(which is standardized) not the content of the question(which is standardized) not the content of the question– Can reduce the rate of false positives and generally does better than the Can reduce the rate of false positives and generally does better than the

CQTCQT Initially employed absolute standards for arousal = lying and this was Initially employed absolute standards for arousal = lying and this was

not at all effectivenot at all effective

The polygraph test – p. 3The polygraph test – p. 3

The guilty knowledge test (GKT) – not designed to detect deception, The guilty knowledge test (GKT) – not designed to detect deception, rather it tries to differentiate between those who have knowledge about rather it tries to differentiate between those who have knowledge about a particular event (crime) and those who do not (the innocent)a particular event (crime) and those who do not (the innocent)

The concealed information test (CIT) – is similar to the above approach The concealed information test (CIT) – is similar to the above approach and likewise tries to assess familiarity with specific information as and likewise tries to assess familiarity with specific information as opposed to lyingopposed to lying

Both of these approaches have the advantage of asking the exact Both of these approaches have the advantage of asking the exact same questions of all individuals and comparing responses both within same questions of all individuals and comparing responses both within and between subjectsand between subjects

Minimal data on these approaches, as the bulk of the research is on Minimal data on these approaches, as the bulk of the research is on the CQTthe CQT

Does it work?Does it work?

Honts (1994) reviewed the literature on the effectiveness of the Honts (1994) reviewed the literature on the effectiveness of the polygraph and found that it does about as well as chance in polygraph and found that it does about as well as chance in experimental settings. Most of the reviewed research uses the DLCTexperimental settings. Most of the reviewed research uses the DLCT

In real life and experimental settings, the majority of errors are false In real life and experimental settings, the majority of errors are false negatives (saying someone is innocent when they are guilty)negatives (saying someone is innocent when they are guilty)

Most deceptive individuals (up to 95%) are misclassifiedMost deceptive individuals (up to 95%) are misclassified Because the cost of a false positive (saying someone is guilty when Because the cost of a false positive (saying someone is guilty when

really they are innocent) is deemed to be higher in our legal system. really they are innocent) is deemed to be higher in our legal system. Therefore, the cutoff scores (criteria) have been altered so as to make Therefore, the cutoff scores (criteria) have been altered so as to make false negatives more likelyfalse negatives more likely

Why does it fail?Why does it fail?– If high arousal to control questions, then more difficult to discriminateIf high arousal to control questions, then more difficult to discriminate– Idiosyncratic responses to lyingIdiosyncratic responses to lying

Admissibility of the polygraph (Saxe & Ben-Shakhar, Admissibility of the polygraph (Saxe & Ben-Shakhar, 1999)1999)

Courts have almost universally rejected the polygraph, though this Courts have almost universally rejected the polygraph, though this question has been and continues to be litigated extensivelyquestion has been and continues to be litigated extensively

Courts are increasingly being made responsible for evaluating the Courts are increasingly being made responsible for evaluating the merits of test data, despite lacking the expertise to do so.merits of test data, despite lacking the expertise to do so.– Note: The literature has become increasingly discrepant in its view on the Note: The literature has become increasingly discrepant in its view on the

polygraph (disagreement on its validity even in the scientific community)polygraph (disagreement on its validity even in the scientific community)

What criteria should be used to evaluate this information and what What criteria should be used to evaluate this information and what should we tell the courts?should we tell the courts?

HistoryHistory– Marston (1917) used a blood pressure cuff to determine truthfulness Marston (1917) used a blood pressure cuff to determine truthfulness

(arousal) in a defendant (Frye), based on the assumption that while truth (arousal) in a defendant (Frye), based on the assumption that while truth required little or no energy, lies do – rejected by the courtsrequired little or no energy, lies do – rejected by the courts

History of the PolygraphHistory of the Polygraph

Note the courts use of the term “experimental” as “not well established Note the courts use of the term “experimental” as “not well established evidence”evidence”

The Frye ruling adequately reflects the courts treatment of the The Frye ruling adequately reflects the courts treatment of the polygraph even today, though now based on the Federal Rules of polygraph even today, though now based on the Federal Rules of Evidence (FRE) which require that the evidence (polygraph or Evidence (FRE) which require that the evidence (polygraph or otherwise) be relevant and that it aid the jury (i.e., be valid).otherwise) be relevant and that it aid the jury (i.e., be valid).

Daubert (1993) was based on the FRE and highlights 4 considerations Daubert (1993) was based on the FRE and highlights 4 considerations when ruling on evidence:when ruling on evidence:– Testability or falsifiability (see Popper and the method of science)Testability or falsifiability (see Popper and the method of science)– Error rateError rate– Peer review and publicationPeer review and publication– General acceptanceGeneral acceptance

This basically requires juries & judges to evaluate scientific issuesThis basically requires juries & judges to evaluate scientific issues

History of the Polygraph – p. 2History of the Polygraph – p. 2

In trials like Daubert, scientists with opposing views on the polygraph In trials like Daubert, scientists with opposing views on the polygraph present their views and the jury must decide on the merits of their present their views and the jury must decide on the merits of their argumentsarguments

Generally there has been no legal distinction between the concepts of Generally there has been no legal distinction between the concepts of reliability and validity (you can see where this is go, since, from a reliability and validity (you can see where this is go, since, from a scientific standpoint, reliability limits validity)scientific standpoint, reliability limits validity)

An additional problem with these concepts is that the data is collected An additional problem with these concepts is that the data is collected as a series of discrepancy scores and these are then summed to as a series of discrepancy scores and these are then summed to reflect a qualitative assessment of truthful, deceptive, and inconclusive. reflect a qualitative assessment of truthful, deceptive, and inconclusive. Thus, very different discrepancy readings might still result in similar Thus, very different discrepancy readings might still result in similar qualitative assessments.qualitative assessments.

Two accepted approaches for reliability are:Two accepted approaches for reliability are:– Test the same person twice on the same issue using the same polygraph Test the same person twice on the same issue using the same polygraph

technique with 2 different testerstechnique with 2 different testers– Test the person once, but have the chart scored by two different peopleTest the person once, but have the chart scored by two different people

History of the Polygraph – p. 3History of the Polygraph – p. 3

The latter approach deals on with the error involved in chart scoring The latter approach deals on with the error involved in chart scoring and ignores (or equates) administration errorand ignores (or equates) administration error

The real issue is whether the procedure as a whole is reliable (e.g., the The real issue is whether the procedure as a whole is reliable (e.g., the creation and administration of control questions), thereby getting at creation and administration of control questions), thereby getting at internal reliability (do different parts of the test agree), test retest internal reliability (do different parts of the test agree), test retest reliability (different administrations of the test agree), inter-rater reliability (different administrations of the test agree), inter-rater reliability (different test administrators agree as to the outcome)reliability (different test administrators agree as to the outcome)– Note: There are practical limitations to how often the “same” test could be Note: There are practical limitations to how often the “same” test could be

given to the same individual given to the same individual What little data exists on reliability focuses only on the between What little data exists on reliability focuses only on the between

examiners approach (inter-rater reliability), though this reliability is examiners approach (inter-rater reliability), though this reliability is reasonable (not high). Thus, this remains an unevaluated component reasonable (not high). Thus, this remains an unevaluated component of the polygraph (major limitation)of the polygraph (major limitation)

History of the Polygraph – p. 4History of the Polygraph – p. 4

Because the courts do not distinguish between reliability and validity, Because the courts do not distinguish between reliability and validity, the minimal reliability that does exist carries far more weight than it the minimal reliability that does exist carries far more weight than it should. should.

Modern views of validity highlight the integrative component of validity Modern views of validity highlight the integrative component of validity (recall Messick, 1995), though to evaluate it, it is necessary to consider (recall Messick, 1995), though to evaluate it, it is necessary to consider different aspects separately different aspects separately

Different types of validity are more relevant depending on the question Different types of validity are more relevant depending on the question at hand at hand – e.g., predictive validity for integrity testing in job placement/hiring, vs. e.g., predictive validity for integrity testing in job placement/hiring, vs.

criterion validity being more relevant for determining truth/lying criterion validity being more relevant for determining truth/lying Construct validity gets at the theoretical issue of what is a lie. Is it a Construct validity gets at the theoretical issue of what is a lie. Is it a

situational phenomenon or a trait? Can it be represented by situational phenomenon or a trait? Can it be represented by physiological responding? Etc.physiological responding? Etc.– No theory to explain why a stronger response should occur for lies vs. truthNo theory to explain why a stronger response should occur for lies vs. truth

History of the Polygraph – p. 5History of the Polygraph – p. 5

Similar physiological responses to lying appear to occur for Similar physiological responses to lying appear to occur for experiences such as surprise/noveltyexperiences such as surprise/novelty– Note: For the CQT, questions about the crime are expected to be well Note: For the CQT, questions about the crime are expected to be well

rehearsed for the criminalrehearsed for the criminal Thus, they have questionable construct validity (not necessarily Thus, they have questionable construct validity (not necessarily

measuring what they propose to measure)measuring what they propose to measure)– Under-represents the construct of interest and over-represents irrelevant Under-represents the construct of interest and over-represents irrelevant

constructs (surprise, stress, etc.)constructs (surprise, stress, etc.) What criterion can be used?What criterion can be used?

– Outcome of a trial? If the case is dismissed?Outcome of a trial? If the case is dismissed?– Do either of these assure that we know the client’s status re: lying?Do either of these assure that we know the client’s status re: lying?

Note also that a true evaluation of the polygraph would mean that the Note also that a true evaluation of the polygraph would mean that the examiner only has access to the polygraph data (that s never the examiner only has access to the polygraph data (that s never the case). case).

History of the Polygraph – p. 6History of the Polygraph – p. 6

The criterion and predictor are rarely independent.The criterion and predictor are rarely independent.– e.g., if the polygraph is used to get a confession and the confession helps e.g., if the polygraph is used to get a confession and the confession helps

get a conviction, then by definition, the polygraph is part of the criterion get a conviction, then by definition, the polygraph is part of the criterion (polygraphs are frequently used to get confessions)(polygraphs are frequently used to get confessions)

Experimental criteria for the polygraph generally lack external validity Experimental criteria for the polygraph generally lack external validity (is lying in an experiment = to lying in a crime involving yourself? That (is lying in an experiment = to lying in a crime involving yourself? That is, are all types of deception equal?), while real life evaluations of the is, are all types of deception equal?), while real life evaluations of the polygraph lack experimental rigor and control (e.g., only a subset of polygraph lack experimental rigor and control (e.g., only a subset of them will ultimately have a clear outcome regarding deception and this them will ultimately have a clear outcome regarding deception and this may not be representative of all respondents).may not be representative of all respondents).

The CQT assumes that you can create similar “control” questions.The CQT assumes that you can create similar “control” questions. Do deceptions involving different types of crime result in the same Do deceptions involving different types of crime result in the same

physiological response?physiological response?

Issues in assessing alcohol/substance abuseIssues in assessing alcohol/substance abuse

Recognition of dual diagnosis (vs. assuming all other problems are merely secondary Recognition of dual diagnosis (vs. assuming all other problems are merely secondary to the addiction) – to the addiction) – How can we address this?How can we address this?

Timing of assessment remains an important concern as this can dramatically alter the Timing of assessment remains an important concern as this can dramatically alter the outcome- outcome- When is the optimal time to assess?When is the optimal time to assess?

Patterns of use/abuse and general categories (e.g., stimulants, sedatives, etc.) of use Patterns of use/abuse and general categories (e.g., stimulants, sedatives, etc.) of use may be important to assessment and interventionmay be important to assessment and intervention– Also some drugs may be used to offset the deleterious effects of other drugsAlso some drugs may be used to offset the deleterious effects of other drugs

Context in which use typically occurs may help in identifying triggers and high risk Context in which use typically occurs may help in identifying triggers and high risk settings for potential relapse – settings for potential relapse – Examples of assess & tx?Examples of assess & tx?

Motivation for seeking treatment is likewise a critical component to evaluating the Motivation for seeking treatment is likewise a critical component to evaluating the patient – patient – Why? How would you assess and tx differently?Why? How would you assess and tx differently?– e.g., legal motivation, social/family pressure, work requirement, etc.e.g., legal motivation, social/family pressure, work requirement, etc.

May require different test features to identify those still using as opposed to those who May require different test features to identify those still using as opposed to those who have used before but are not now usinghave used before but are not now using

The outcome of research in this area varies greatly as a function of how use is defined The outcome of research in this area varies greatly as a function of how use is defined (any use, quantity/freq, problem behaviors, combos., etc.)(any use, quantity/freq, problem behaviors, combos., etc.)– May identify different pops (e.g., those with liver damage vs. those losing jobs)May identify different pops (e.g., those with liver damage vs. those losing jobs)

Specific measures to assess alcohol and drug abuseSpecific measures to assess alcohol and drug abuse

The MMPI-2 has 2 items (264 “I have used alcohol excessively” & 489 “I The MMPI-2 has 2 items (264 “I have used alcohol excessively” & 489 “I have a drug or alcohol problem”) that directly assess use, but the small have a drug or alcohol problem”) that directly assess use, but the small number of items limits their psychometric properties. number of items limits their psychometric properties.

These items each appear to identify very different groupsThese items each appear to identify very different groups– Sensitivity (how well the test identifies those who abuse alcohol) of approx. Sensitivity (how well the test identifies those who abuse alcohol) of approx.

80% for males and 75% for women 80% for males and 75% for women – Specificity (how well the test identifies those who Specificity (how well the test identifies those who do notdo not abuse alcohol) abuse alcohol)

ranges from 53% to 95% for men and from 76% to 97% for women (varying ranges from 53% to 95% for men and from 76% to 97% for women (varying on the item and race of the respondent) on the item and race of the respondent)

Because the lifetime prevalence base rates for use in the population are Because the lifetime prevalence base rates for use in the population are 8% for women and 16% for men, it is difficult to improve on the base rate 8% for women and 16% for men, it is difficult to improve on the base rate of non-use (84% or more)of non-use (84% or more)

Other measures include the MAST and the CAGE – Other measures include the MAST and the CAGE – what do you know what do you know about these?about these?– Both have problems identifying female substance abusers (they were Both have problems identifying female substance abusers (they were

developed for and validated on, men)developed for and validated on, men)

Specific measures to assess alcohol and drug Specific measures to assess alcohol and drug abuse: MMPI-2 scales – p. 2abuse: MMPI-2 scales – p. 2

MacAndrew Alcoholism scale – (from the MMPI-2) is best for identifying white MacAndrew Alcoholism scale – (from the MMPI-2) is best for identifying white males who have a propensity for polydrug abuse. It has a sensitivity of approx. males who have a propensity for polydrug abuse. It has a sensitivity of approx. 70-75% and 20% false negatives. 70-75% and 20% false negatives. – Very high false positive rate for black males, little data on females and adolescents, Very high false positive rate for black males, little data on females and adolescents,

and lower hit rates for psychiatric patientsand lower hit rates for psychiatric patients Addiction Admission scale (also from the MMPI-2) – acknowledgment or denial Addiction Admission scale (also from the MMPI-2) – acknowledgment or denial

of substance abuse problemsof substance abuse problems– Low reliabilityLow reliability

Addiction Potential scale (also from the MMPI-2) – personality features Addiction Potential scale (also from the MMPI-2) – personality features associated with useassociated with use– Low reliabilityLow reliability

MMPI-2 profiles associated with use: 2/4, 4/2, 2/7, 7/2, 9/4, 4/9, MMPI-2 profiles associated with use: 2/4, 4/2, 2/7, 7/2, 9/4, 4/9, – Just males: 1/2, 2/1Just males: 1/2, 2/1– Just females: 3/4, 4/3, 6/4, 4/6, 8/4, 4/8Just females: 3/4, 4/3, 6/4, 4/6, 8/4, 4/8– Code types account for 25-35% of alcoholics & they don’t differ on tx successCode types account for 25-35% of alcoholics & they don’t differ on tx success

Issues in alcohol/drug assessmentIssues in alcohol/drug assessment

Is there any utility in identify substance abusers who are doing so Is there any utility in identify substance abusers who are doing so covertly or who don’t believe they have a problem?covertly or who don’t believe they have a problem?– Drawbacks: Treatment generally requires the clients willing consent, so why Drawbacks: Treatment generally requires the clients willing consent, so why

bother identifying anyone other than those who acknowledge use? This is bother identifying anyone other than those who acknowledge use? This is consistent with the most widely used model, AA. consistent with the most widely used model, AA.

– Some benefits: Accuracy of other diagnoses, as use can alter presentation of Some benefits: Accuracy of other diagnoses, as use can alter presentation of other symptoms, it can make some medication treatments undesirable due to other symptoms, it can make some medication treatments undesirable due to interaction effects, it could bring a problem to a higher level of awareness for interaction effects, it could bring a problem to a higher level of awareness for the client, etc.the client, etc.

Utility in administering a measure for some clients as it can serve as a Utility in administering a measure for some clients as it can serve as a standard (vs. an opinion) to the lay person, that allows for a normative standard (vs. an opinion) to the lay person, that allows for a normative evaluationevaluation– * Research suggests that exposure to norms can not only help with * Research suggests that exposure to norms can not only help with

assessment, but also recognition of problem drinkingassessment, but also recognition of problem drinking Use, in and of itself is considered problem use for an alcoholic from Use, in and of itself is considered problem use for an alcoholic from

an AA perspective. What factors are relevant from a CD perspective?an AA perspective. What factors are relevant from a CD perspective?

Legal/ethical issues in assessing childrenLegal/ethical issues in assessing children

Three components of “consent” for testingThree components of “consent” for testing– Knowledge – what will be done, why, and howKnowledge – what will be done, why, and how– Voluntariness – absence of coercion; a child alone can’t do this, but they Voluntariness – absence of coercion; a child alone can’t do this, but they

are usually asked for assent are usually asked for assent – Competence – parents must be legally competent and guardians to give Competence – parents must be legally competent and guardians to give

consent for childconsent for child Also you are ethically (though not legally) bound to tell the parents of Also you are ethically (though not legally) bound to tell the parents of

potential risks from testingpotential risks from testing (e.g., what test scores can be used for – (e.g., what test scores can be used for – such as being grounds to deny entry to a special education program)such as being grounds to deny entry to a special education program)

Child is not likely to be the one who asked for testing. Child is not likely to be the one who asked for testing. So are they the So are they the client? If not, who is?client? If not, who is?

Legal issues abound for intelligence testing, but there have been few Legal issues abound for intelligence testing, but there have been few precedents for personality assessment. precedents for personality assessment. Why?Why?

Demers (1986) on testingDemers (1986) on testing

Although there are few legal challenges of personality tests, these Although there are few legal challenges of personality tests, these measures do tend to have more problems with reliability and validitymeasures do tend to have more problems with reliability and validity

Little to no evidence for gender or racial bias in personality testingLittle to no evidence for gender or racial bias in personality testing Also, most personality tests are administered in a voluntary contextAlso, most personality tests are administered in a voluntary context Test validation issues:Test validation issues:

– Tests must be validated for the purpose for which they are being Tests must be validated for the purpose for which they are being usedused

– Tests must be reliable for the pop being used, and appropriate Tests must be reliable for the pop being used, and appropriate norms must exist for that pop.norms must exist for that pop.

– The tests must be capable of generating appropriate decisions for The tests must be capable of generating appropriate decisions for that pop (i.e., validity)that pop (i.e., validity)

Providing feedback to clientsProviding feedback to clients

APA requires that feedback be provided after testing, but it must be in APA requires that feedback be provided after testing, but it must be in a form that they can understand (varies depending on the client)a form that they can understand (varies depending on the client)– This can be best accomplished through an overview of the findings and This can be best accomplished through an overview of the findings and

then a Q & A session.then a Q & A session. The feedback should provide a clear path to treatment goalsThe feedback should provide a clear path to treatment goals Consider anything that is assessed as representing a continuum, such Consider anything that is assessed as representing a continuum, such

that any characteristic will be shared by some portion of the populationthat any characteristic will be shared by some portion of the population Terminology such as unique and different can be substituted for Terminology such as unique and different can be substituted for

“abnormal”, “deviant”, or “pathological”“abnormal”, “deviant”, or “pathological” Client need not agree with your feedback. Objections can be used to Client need not agree with your feedback. Objections can be used to

clarify findings and as a starting point for the interventionclarify findings and as a starting point for the intervention Have client summarize info. Back to youHave client summarize info. Back to you

Providing feedback to clients - p.2Providing feedback to clients - p.2

Feedback should also include information on the tests themselves Feedback should also include information on the tests themselves (validity and reliability) in language that can be understood by the client (validity and reliability) in language that can be understood by the client – General psychometrics can be used to enhance the credibility of the test General psychometrics can be used to enhance the credibility of the test

e.g., “The MMPI has been used for over 50 years by clinicians and it is one e.g., “The MMPI has been used for over 50 years by clinicians and it is one of the most widely used tests. Many research studies have been done to of the most widely used tests. Many research studies have been done to show that it is pretty consistent in the scores it produces and that it works show that it is pretty consistent in the scores it produces and that it works pretty well at predicting behaviors.”pretty well at predicting behaviors.”

This issue may be further complicated when giving feedback to those This issue may be further complicated when giving feedback to those with limited cognitive abilities, but a more detailed account can be with limited cognitive abilities, but a more detailed account can be provided to those who have legal guardianshipprovided to those who have legal guardianship

Providing MMPI-2 feedback to clientsProviding MMPI-2 feedback to clients

Empirical evaluation of getting MMPI-2 feedbackEmpirical evaluation of getting MMPI-2 feedback Compared MMPI-2 feedback of college students relative to attention Compared MMPI-2 feedback of college students relative to attention

with no feedbackwith no feedback The former showed increased self-esteem, immediately & after 2 The former showed increased self-esteem, immediately & after 2

weeksweeks Decreased symptomatic distress, immediately and after 2 weeksDecreased symptomatic distress, immediately and after 2 weeks Why would this occur?Why would this occur?

– Nature of the client population? (higher functioning, therefore feedback is Nature of the client population? (higher functioning, therefore feedback is likely to be generally positive?)likely to be generally positive?)

– Selective sampling? (Those seeking out personality evaluations are Selective sampling? (Those seeking out personality evaluations are wanting feedback and are more likely to construe it positively?)wanting feedback and are more likely to construe it positively?)

When initially meeting with clients and discussing the testing and the When initially meeting with clients and discussing the testing and the eventual feedback you will be able to differentiate those who will be eventual feedback you will be able to differentiate those who will be most/least receptive to the feedbackmost/least receptive to the feedback– Highlights the importance of having the client arrive at the decision to testHighlights the importance of having the client arrive at the decision to test

Legal precedentsLegal precedents

Griggs v Duke Power Company (1971) – job testingGriggs v Duke Power Company (1971) – job testing Hobson v Hansen (1967) – racial disparity (problems with standardization & norms; Hobson v Hansen (1967) – racial disparity (problems with standardization & norms;

assessed present skills rather than innate ability) assessed present skills rather than innate ability) Larry P. V Riles (1972) – culturally biased IQ tests for EMR determinationLarry P. V Riles (1972) – culturally biased IQ tests for EMR determination PASE v. Hannon (1980) – reversed the Larry P. decision based on the fact that EMR PASE v. Hannon (1980) – reversed the Larry P. decision based on the fact that EMR

determinations were based on more than just IQ testing (any thoughts on the item by item determinations were based on more than just IQ testing (any thoughts on the item by item review by the judge?)review by the judge?)

Lora v Board of Education City of New York – use of TAT, Rorschach, & Bender-Gestalt Lora v Board of Education City of New York – use of TAT, Rorschach, & Bender-Gestalt to label minority children as to label minority children as emotionally disturbedemotionally disturbed (vague def. for latter) (vague def. for latter)

Note: Most personality tests are administered voluntarily. Test validation issues:Note: Most personality tests are administered voluntarily. Test validation issues:– Tests must be validated for the purpose for which they are being usedTests must be validated for the purpose for which they are being used– Tests must be reliable for the pop being used, and appropriate norms must exist for Tests must be reliable for the pop being used, and appropriate norms must exist for

that pop.that pop.– The tests must be capable of generating appropriate decisions for that pop (i.e., The tests must be capable of generating appropriate decisions for that pop (i.e.,

validity)validity) Note: many personality tests were developed for adults and co-opted for children. Which Note: many personality tests were developed for adults and co-opted for children. Which

of the above issues is most affected?of the above issues is most affected?

Example DSM-IV codes: ReviewExample DSM-IV codes: Review

The parenthetical term “(provisional)” may follow a diagnosis to indicate a significant The parenthetical term “(provisional)” may follow a diagnosis to indicate a significant degree of diagnostic uncertaintydegree of diagnostic uncertainty

The phrase “rule out” is used to denote other diagnoses that should be considered The phrase “rule out” is used to denote other diagnoses that should be considered and that are still to be ruled out. and that are still to be ruled out.

The numeric code should follow the AXIS number and then the formal name of the The numeric code should follow the AXIS number and then the formal name of the disorder should be listed. disorder should be listed. – e.g., AXIS I: 295.40 Schizophreniform disorder (Provisional, rule out e.g., AXIS I: 295.40 Schizophreniform disorder (Provisional, rule out

Organic Delusional Disorder), with(out) good Organic Delusional Disorder), with(out) good prognostic features. prognostic features.

Numeric codes from the DSM are matched to the ICD (International Classification of Numeric codes from the DSM are matched to the ICD (International Classification of Diseases) codes to allow for international compatibility.Diseases) codes to allow for international compatibility.

Recording procedures: e.g., Major Depressive DisorderRecording procedures: e.g., Major Depressive Disorder– AXIS I: 296.34 - 4AXIS I: 296.34 - 4 thth digit is either 2 (single episode) or 3 (multiple) digit is either 2 (single episode) or 3 (multiple)

-5-5thth digit is severity: 1 = mild, 2= moderate, 3 = severe without digit is severity: 1 = mild, 2= moderate, 3 = severe without psychotic features, 4= severe with psychotic psychotic features, 4= severe with psychotic features, features, 5= partial 5= partial remission, 6= full remissionremission, 6= full remission

– 44thth and 5 and 5thth digits typically apply to most recent or current episode digits typically apply to most recent or current episode

DSM-IV codes - continuedDSM-IV codes - continued

Recording procedures: e.g., Bipolar I disorderRecording procedures: e.g., Bipolar I disorder– AXIS I: 296.34AXIS I: 296.34 - 4- 4thth digit is 0 (single episode). For recurrent episodes, digit is 0 (single episode). For recurrent episodes,

it’s 4 if current or most recent episode is it’s 4 if current or most recent episode is hypomanic or hypomanic or manic, 5 if depressive, 6 if mixed, 7 if manic, 5 if depressive, 6 if mixed, 7 if unspecified. unspecified.

-5-5thth digit is severity: 1 = mild, 2= moderate, 3 = digit is severity: 1 = mild, 2= moderate, 3 = severe severe without psychotic features, 4= severe with without psychotic features, 4= severe with psychotic psychotic features, 5= partial remission, 6= full features, 5= partial remission, 6= full remission, 0 = remission, 0 = unspecified (except for unspecified (except for hypomanic where 5hypomanic where 5thth digit is digit is always a 0, always a 0, and unspecified, where there is no 5and unspecified, where there is no 5thth digit). digit).

For Bipolar II, the 4For Bipolar II, the 4thth digit coding is the same, but do not use the 5 digit coding is the same, but do not use the 5 thth digit digit code as is already specified as 9. code as is already specified as 9.