ABSTRACT
Some cases are more challenging than others, even for the experienced forensic neuropsychologist. This chapter deals with those that present with a varied mix of cognitive and emotional symptoms of a (seemingly) severe nature. The reader of this volume will recognize that the diagnosis of malingering or the presence of exaggerated complaints and/or cognitive “impairment” along with genuine neurocognitive deficits and/or psychopathology are not mutually exclusive; they may co-exist. While some cases reported are fairly straightforward, in that they easily fulfill the criteria outlined in Slick, Sherman, and Iverson (1999) for unequivocal definite malingered neurocognitive dysfunction, others are somewhat less clear and require greater analysis and clinical judgment. This appears to be especially true in cases more appropriate for the probable and possible malingering categories and/or when the clinician believes that genuine cognitive deficits and/or actual psychopathology are present in a context of secondary gain (SG) behavior. Cases in which evidence of malingering exists, along with the presence of clinically determined actual psychopathology or cognitive dysfunction, sometimes become especially challenging; clinicians often wonder whether the diagnosis of “malingering” can and should be made when such circumstances exist. That is, can someone be both genuinely impaired/psychologically disturbed and a malingerer?
