Signal Detection Theory principles help audiologists extract true thresholds from feigning patients

Evidence

For patients with bilateral pseudohypacusis, the audiologist must make modifications to the audiometric procedures in order to determine true absolute thresholds. The procedures in place were specifically designed in order to encourage patients to provide a neutral or liberal criterion. However, in the cases of pseudohypacusis, these practices have not achieved that goal. To obtain a more accurate audiologic threshold, the audiologist essentially applies the principles of Signal Detection Theory to encourage the patient to adopt a more neutral or liberal criterion. Consequently, the first step in audiometric testing for patients with suspected pseudohypacusis is to re-instruct the patient. This allows patients to be aware that you are suspicious of their thresholds and gives them the opportunity to readjust their criterion (whether it is consciously or unconsciously overly conservative). In many cases, re-instruction is sufficient to obtain a true audiogram. — Jennifer Lentz, Psychoacoustics- Perception of Normal…, 1766

Categorization

• XREF: Applies Signal Detection Theory (already introduced in earlier chapters of this book) to a clinical diagnostic problem — criterion manipulation as an audiological lever.
• QUESTION: How are pseudohypacusis patients distinguished from those with genuine conservative response styles? Is feigning consciously intentional in most cases?