Moral Reminders Do Not Reduce Symptom Over-Reporting Tendencies

Brechje Dandachi-Fitzgerald,Marko Jelicic,Wenke Müller,Harald Merckelbach,Isabella J M Niesten

doi:10.1007/s12207-017-9303-9

Abstract

Is presenting patients with moral reminders prior to psychological testing a fruitful deterrence strategy for symptom over-reporting? We addressed this question in three ways. In study 1, we presented individuals seeking treatment for ADHD complaints (n = 24) with moral primes using the Mother Teresa Questionnaire and compared their scores on an index of symptom over-reporting (i.e., the Structured Inventory of Malingered Symptomatology, SIMS) with those of unprimed patient controls (n = 27). Moral primes slightly decreased SIMS scores, but the effect was not significant. In study 2, we took a different approach to activate moral categories: we recruited individuals seeking treatment for ADHD complaints and asked some of them to sign a moral contract (i.e., prime; n = 19) declaring that they would complete the tests in an honest way and compared their scores on the SIMS and standard clinical scales measuring self-reported psychopathology with those of unprimed patient controls (n = 17). Again, we found no convincing evidence that moral cues suppress symptom over-reporting. In study 3, we gave individuals from the general population (N = 132) positive, negative, or neutral moral primes and implicitly induced them to feign symptoms, after which they completed a brief validated version of the SIMS and an adapted version of the b Test (i.e., an underperformance measure). Again, primes did not affect over-reporting tendencies. Taken together, our findings illustrate that moral reminders are not going to be useful in clinical practice. Rather, they point towards the importance of studying contextual and individual difference factors that guide moral decision-making in patients and may be modified to discourage symptom over-reporting.

Highlights

Is presenting patients with moral reminders prior to psychological testing a fruitful deterrence strategy for symptom over-reporting? We addressed this question in three ways
Why do current reduction strategies only have a modest effect at best? One explanation can be found in cognitive dissonance theory: Because people prefer to see themselves as moral beings, acting inconsistently with this self-definition causes an aversive state of arousal or dissonance
We examined whether differences between the two conditions emerged regarding Brief Symptom Inventory (BSI) and attention deficit hyperactivity disorder (ADHD)-RS total scores

Summary

Introduction

Is presenting patients with moral reminders prior to psychological testing a fruitful deterrence strategy for symptom over-reporting? We addressed this question in three ways. Studies support the idea that the act of feigning is dissonanceinducing to some individuals (e.g., Niesten et al, 2015; Niesten et al, 2017) Both clinical cases and empirical data suggest that people may resolve this dissonance through a self-deceptive reevaluation of initially feigned symptoms as signs of genuine illness (i.e., BI really do suffer from symptom X^; Kunst, Aarts, Frolijk, & Poelwijk, 2015; Merckelbach, Jelicic, & Pieters, 2011; for an extensive theoretical analysis of dissonance in the context of symptom over-reporting see Bayer, 1985). This suggests that cognitive dissonance might account for the observation that overall, warnings and feedback have little corrective potential

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