Abstract
<p>Validity tests are widely used to detect distorted symptom presentation but offer little guidance on why such distortions occur. In an explorative qualitative study, we examined how forensic inpatients (n = 36) described antecedents of their response patterns during a collaborative feedback interview. Patients were classified as inattentive responders (n = 8), overreporters (n = 7), underreporters (n = 14), or comparison patients (n = 7) based on stand-alone validity measures administered during routine assessment. Transcripts were primarily coded on 11 literature-derived antecedent themes. Inattentive responders emphasized comprehension/scale-use problems, attention lapses, and disengagement. Overreporters described emotion-processing difficulties, needs for social attention, external incentives, and comprehension issues. Underreporters referred to self-presentational concerns, stigma, reactance-related disengagement, forensic stakes, autonomy/control motives, and mistrust/fear of disclosure. Accounts often highlighted modifiable treatment targets (e.g., interoception, stigma, mistrust, reactance). Overall, collaborative discussion of poor validity may inform case formulation and treatment planning in high-stakes forensic settings.</p>