Symptom Validity Testing in Somatoform and Dissociative Disorders: A Critical Review

Abstract

When patients present with unusual, atypical, and difficult-to-understand complaints known as dissociative and somatoform disorders or medically unexplained symptoms, clinicians may administer symptom validity tests (SVTs) to determine whether or not the patient exhibits negative response bias. Such tests are especially informative in a context where incentives play a substantial role (e.g., the legal arena). If patients fail SVTs and exhibit negative response bias, how should that bias be interpreted? Some authors have argued that psychological problems (e.g., unconscious conflicts and depression) and circumstances (e.g., a cry for help) may explain such bias. In the current article, we critically review this “psychopathology = superordinate” position. We argue that (1) there is no empirical evidence to suggest that psychological problems may foster SVT failure per se and (2) that the “psychopathology = superordinate” position invites circular argumentation: to clarify the nature of the atypical symptoms, SVTs are administered and a negative response bias is found, which is explained away by the atypical symptoms. Negative response bias allows for only one conclusion: the patient’s self-report of symptoms and life history can no longer be taken at face value.