From the Guidelines
Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding work, obtaining financial compensation, or receiving prescription medications. This behavior is distinct from factitious disorder, where symptoms are produced for psychological needs, and from somatic symptom disorders, where symptoms are not intentionally produced and are not associated with material gain 1. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, symptoms that are intentionally created for external gain are categorized as malingering, whereas those that result in significant impairment in psychosocial functioning without external incentives are classified as somatic symptom disorders 1. Key characteristics of malingering include:
- Inconsistency between reported symptoms and objective findings
- Lack of cooperation during examinations
- Discrepancies in the patient's history
- Symptoms that appear only in certain contexts Healthcare providers must approach suspected cases of malingering with caution, as incorrect labeling could deny care to individuals with legitimate conditions 1. It is essential to conduct a thorough assessment to differentiate malingering from other conditions, such as somatic symptom disorders or factitious disorder, to ensure appropriate treatment and management 1.
From the Research
Definition of Malingering
- Malingering is the intentional production of false or grossly exaggerated symptoms motivated by internal and external incentives 2, 3
- It is considered a diagnosis of exclusion, and a differential diagnosis framework is used to guide physicians in identifying malingering 2
Types of Malingering
- Malingering of mental illness, including psychotic symptoms, has been studied extensively 4, 3, 5
- Malingering of medical illness, including pain and cognitive deficits, has also been examined 4
- Subtypes of feigning behaviors, such as partial or pure malingering, dissimulation, and false imputation, can be suspected when patients have marked discrepancies between reported stressors and objective findings 3
Detection and Assessment of Malingering
- Structured assessments have been developed to help detect malingering, but in daily practice, physicians should suspect malingering when there are tangible incentives and when reported symptoms do not match the physical examination or no organic basis for the physical complaints is found 4
- A thorough understanding of potential signs of malingering vs. genuine psychosis is needed, as well as knowledge of legal ramifications 5
- The NEAL (neutral, empathetic, and avoid labeling) strategy can be used when caring for patients suspected of malingering 2
Prevalence and Outcomes of Malingering
- Malingering is commonly encountered in the psychiatric emergency department, with a suspected prevalence of around one-third of patients 6
- High suspicion of malingering is associated with malingering of multiple symptoms and is likely to result in immediate discharge, while lower suspicion is associated with being held for further observation 6