Malingering

Malingering is pretending to be sick when you aren’t or pretending to be sicker than you are, particularly when you have something to gain.

Definition

Malingering is the purposeful production of falsely or grossly exaggerated physical or psychological complaints with the goal of receiving a reward. These may include money, insurance settlement, drugs or the avoidance of punishment, work, jury duty, release from incarceration, the military, or some other kind of service. A malingerer may attempt to raise the temperature of a thermometer through heat from a lamplight or alter a urine sample by adding sand to it; however, if the malingerer is more discrete, the clinician may have great difficulty gathering evidence for an accurate diagnosis.

Malingering is not a psychiatric disorder and can lead to abuse of the medical system, with unnecessary tests being performed and time taken away from other patients.

Symptoms

Malingering can exist in a variety of intensities, from pure (in which all symptoms are falsified) to partial, in which symptoms are exaggerated. A patient may simulate symptoms of a specific disorder or deny the existence of the problem that may explain the symptoms. Malingering is not easy to detect because of the difficulty in gathering overt evidence. A thorough clinical interview is crucial to understanding whether a person is malingering or not.

Malingering should not be confused with factitious disorder (in which the motive is the desire to occupy a sick role, rather than some form of material gain) and somatoform disorders (in which symptoms are not produced willfully).

Causes

In some cases, the patient may be seeking a reward (time off work or financial gain); in others, the patient may falsify their symptoms because they think that the symptoms will inevitably arise sometime in the future. For example, an individual may falsely claim that they have symptoms of infection while they can receive compensation, because they believe that they will likely develop the infection at some future point.

Treatments

If malingering is suspected, the clinician should consider the patient's possible reasons for secondary gain. Cues for the clinician include: If the patient has legal problems, potential for financial reward, or antisocial personality disorder; if the patient's story is incongruent with known facts or other informant accounts; if the patient will not cooperate while being evaluated.

Psychological evaluation is also recommended as a way to detect malingering. Psychologists have multiple assessment tools in addition to the clinical interview that are designed to provide objective, scientifically based information about whether an individual has responded honestly to the test, or whether he or she has exaggerated or minimized psychological problems (possibly to obtain an external incentive, such as money damages in a personal injury lawsuit).

References

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
  • DSM-IV(TM) Made Easy: The Clinician's Guide to Diagnosis
  • Bass, C., & Halligan, P. (2014). Factitious disorders and malingering: challenges for clinical assessment and management. The Lancet, 383(9926), 1422-1432.  

Last reviewed 12/29/2016