chapter  85
6 Pages

Malingering

WithHannah Crisford, Hayley Dare

Disorders (DSM), the DSM provides a useful starting point. The Diagnostic and Statistical Manual of Mental Disorders 4th Edition, Text Revision3 specified malingering as the “intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives” and noted that it should be suspected if “any combination of the following is seen: medicolegal context…; marked discrepancy between the person’s claimed stress or disability and objective findings; lack of cooperation during the diagnostic evaluation and in complying with the prescribed treatment regimen; the presence of Antisocial Personality Disorder.” Berry and Nelson4 highlighted conceptual concerns with this definition including the following: It is categorical (i.e., “yes or no”) and not dimensional; it is criminological or moralistic. In addition to this, Rogers5 commented that the definition focuses on negative characteristics or circumstances, and it assumes that malingerers will “fake bad” on nearly all diagnostic measures. Speculation about the intentions of the malingerer is likely to be just that, speculation; it can be extremely difficult to objectively discriminate on motivation.4 More recently, DSM-5 has placed malingering as a differential diagnosis under the criteria for factitious disorder, with malingering differing in having the motivation for personal gain.