Malingering

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

Malingering is not a psychiatric disorder. It is similar to, but distinct from, factitious disorder, in which an individual fakes symptoms without a concrete motive of reward. Malingering is also separate from somatic symptom disorder, in which a person experiences real psychological distress from imagined or exaggerated symptoms. Malingering 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 merely exaggerated. A patient may simulate symptoms of a specific disorder or deny the existence of a problem that may explain the symptoms they are experiencing.

Malingering is not easy to detect because of the wide range of possible falsified or exaggerated symptoms, as well as the difficulty in gathering overt evidence. A thorough clinical interview is crucial to understanding whether a person is malingering or not.

Causes

In many cases, a malingering patient is seeking a reward, such as time off work or financial gain. In others, the patient may be falsifying 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.

Treatment

If malingering is suspected, the clinician should consider the patient's possible reasons for secondary gain. Cues for the clinician include:

  • The patient has legal problems, potential for financial reward, or antisocial personality disorder
  • The patient's story is incongruent with known facts or other informants' accounts
  • 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
  • Bass, C., & Halligan, P. (2014). Factitious disorders and malingering: challenges for clinical assessment and management. The Lancet, 383(9926), 1422-1432.

Last reviewed 03/20/2019