Overview
BackgroundMalingering is not considered a mental illness. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), malingering receives a Z code as one of the other conditions that may be a focus of clinical attention. The DSM-5-TR describes malingering as the intentional production of false or grossly exaggerated physical or psychological problems. Motivation for malingering is usually external (eg, avoiding military duty or work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs). [1]
PathophysiologyMalingering is deliberate behavior for a known external purpose. It is not considered a form of mental illness or psychopathology, although it can occur in the context of other mental illnesses.
EpidemiologyMalingering rates vary by population and setting, making overall prevalence hard to determine. The presence of malingering in emergency departments is estimated to exceed 20%, especially among frequent visitors and in psychiatric care. Actual rates are likely higher. [2] Malingering costs US insurers an estimated $150 billion annually. [3]
PrognosisMalingering behavior typically persists as long as the desired benefit outweighs the inconvenience or distress of seeking medical confirmation of the feigned illness.
Patient EducationThe following link is provided to assist you in educating your patients about their condition. This resource can be used as a starting point to help your patients learn about their health and make informed care decisions.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Washington DC: American Psychiatric Association; 2022. 835.
Rumschik SM, Appel JM. Malingering in the Psychiatric Emergency Department: Prevalence, Predictors, and Outcomes. Psychiatr Serv. 2019 Feb 1. 70 (2):115-122. [QxMD MEDLINE Link].
Mason AM, Cardell R, Armstrong M. Malingering psychosis: guidelines for assessment and management. Perspect Psychiatr Care. 2014 Jan. 50 (1):51-7. [QxMD MEDLINE Link].
Faust D. The detection of deception. Neurol Clin. 1995 May. 13(2):255-65. [QxMD MEDLINE Link].
Resnick PJ. Defrocking the fraud: the detection of malingering. Isr J Psychiatry Relat Sci. 1993. 30(2):93-101. [QxMD MEDLINE Link].
Purcell TB. The somatic patient. Emerg Med Clin North Am. 1991 Feb. 9(1):137-59. [QxMD MEDLINE Link].
Samuel RZ, Mittenberg W. Determination of Malingering in Disability Evaluations. Primary Psychiatry. 2005. 12(12):60-68. [Full Text].
Donaghy M. Symptoms and the perception of disease. Clin Med. 2004 Nov-Dec. 4(6):541-4. [QxMD MEDLINE Link].
Malone RD, Lange CL. A clinical approach to the malingering patient. J Am Acad Psychoanal Dyn Psychiatry. 2007 Spring. 35(1):13-21. [QxMD MEDLINE Link].
Brink, K. Applying the use of activity in the assessment of malingering: A case illustration. Work. 2007. 29:47-53.
Anderson JM. Malingering: A constant challenge in disability arenas. J Controversial Med Claims. May 2008. 15(2):1-9.
Koshelva E, Spadoni AD, Strigo IA, et al. Faking Bad: The Neural Correlates of Feigning Memory Impairment. Neuropsychology. 2016. 30(3):377-384.
Slick DJ, Sherman EM, Iverson GL. Diagnostic criteria for malingered neurocognitive dysfunction: proposed standards for clinical practice and research. Clin Neuropsychol. 1999 Nov. 13 (4):545-61. [QxMD MEDLINE Link].
Hegedish O, Kivilis N, Hoofien D. Preliminary Validation of a New Measure of Negative Response Bias: The Temporal Memory Sequence Test. Appl Neuropsychol Adult. 2015 Feb 4. 1-7. [QxMD MEDLINE Link].
Chafetz MD. The A-Test: a symptom validity indicator embedded within a mental status examination for Social Security Disability. Appl Neuropsychol Adult. 2012. 19(2):121-6. [QxMD MEDLINE Link].
Udell ET. Malingering behavior in private medical practice. Clin Podiatr Med Surg. 1994 Jan. 11(1):65-72. [QxMD MEDLINE Link].
Voiss DV. Occupational injury. Fact, fantasy, or fraud?. Neurol Clin. 1995 May. 13(2):431-46. [QxMD MEDLINE Link].
McDermott BE, Feldman MD. Malingering in the medical setting. Psychiatr Clin North Am. 2007 Dec. 30(4):645-62. [QxMD MEDLINE Link].
LoPiccolo CJ, Goodkin K, Baldewicz TT. Current issues in the diagnosis and management of malingering. Ann Med. 1999 Jun. 31(3):166-74. [QxMD MEDLINE Link].
Diagnostic algorithm for suspicious symptoms.
Author
David Bienenfeld, MD Professor, Departments of Psychiatry and Geriatric Medicine, Wright State University, Boonshoft School of Medicine
David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, Association for Academic Psychiatry
Disclosure: Nothing to disclose.
Specialty Editor Board
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Chief Editor
Ana Hategan, MD, FRCPC Associate Clinical Professor, Department of Psychiatry and Behavioral Neurosciences, Division of Geriatric Psychiatry, McMaster University School of Medicine; Geriatric Psychiatrist, St Joseph's Health Care Hamilton, Canada
Ana Hategan, MD, FRCPC is a member of the following medical societies: Canadian Academy of Geriatric Psychiatry, Canadian Coalition for Seniors' Mental Health, Canadian Psychiatric Association, International Psychogeriatric Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada
Disclosure: Book royalties and/or honoraria for articles from American Psychiatric Publishing, Springer, and Current Psychiatry.
Additional Contributors
Barry I Liskow, MD Professor of Psychiatry, Vice Chairman, Psychiatry Department, Director, Psychiatric Outpatient Clinic, The University of Kansas Medical Center
Disclosure: Nothing to disclose.
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