ISSN 2043-8087
Journal of Experimental Psychopathology
 Volume 4, Issue 1, 20-37, 2013
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Forced-Choice Tests as Single-Case Experiments in the Differential Diagnosis of Intentional Symptom Distortion

Thomas Merten (a) and Harald Merckelbach (b)
(a) Vivantes Netzwerk fur Gesundheit, Klinikum im Friedrichshain, Berlin, Germany
(b) Forensic Psychology Section (FPN), Maastricht University, The Netherlands

Volume 4, Issue 1, 2013, Pages 20-37

Symptom validity testing has become a prolific research field in neuropsychology. Its original and most powerful version is the forced-choice procedure that continues to play an important role because it allows for an experimental approach to test the hypothesis of intentional symptom distortion. When conducting forced-choice tests, below-chance response patterns are considered to be indicative of this type of distortion. In this article, we discuss the rationale behind the forced-choice technique and its historical development. We also present three case vignettes that illustrate the experimental background of forced-choice testing and how it may help to clarify diagnostic issues. The diagnostic considerations in these cases concerned (1) complete memory loss, (2) Ganser syndrome, and (3) dementia. Employing forced-choice methodology, intentional false symptom production could be demonstrated in all three patients. Thus, the cases demonstrate how, in the context of substantial external benefits, forced-choice testing may help to determine whether healthy individuals try to appear psychologically impaired.

Table of Contents
Historical background of symptom validity testing
The forced-choice SVT and its rationale
Adaptations for assessment of cognitive impairment
Forced-choice SVTs in the forensic realm
Case example: Dissociative amnesia
Case example: Ganser syndrome
Case example: Alzheimer's disease

Correspondence to
Thomas Merten, Vivantes Netzwerk für Gesundheit, Klinikum im Friedrichshain, Department of Neurology, Landsberger Allee 49, D - 10249 Berlin, Germany.

Forced-choice testing, Malingering, Symptom Validity Test, Forensic neuropsychology, Amnesia, Ganser syndrome

Received 6 Sep 2011; Revised 17 Jan 2012; Accepted 19 Jan 2012; In Press 23 Sep 2012

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