Malingering

Malingering is the intentional production or exaggeration of physical or psychological symptoms for external incentives. It is not a mental disorder in itself but a behavior that clinicians may encounter in medical, psychiatric, and forensic settings. Common external incentives include avoiding work or military duty, obtaining financial compensation or medications, or evading legal responsibility.

Assessment relies on evidence of intentional symptom production and motivation by external gain. Clinicians look for inconsistencies between reports and observed functioning, improbable symptom patterns, selective cooperation, and collateral information from records or others. There are no single laboratory tests that prove malingering; instead, validity testing, structured interviews, and cross-checking history are used. The diagnosis is made cautiously, given the potential for misclassification and stigmatization.

Different conditions can resemble malingering. Factitious disorder involves intentional symptom production to assume the sick role, without obvious external incentives. Somatic symptom disorders and conversion (functional neurological) syndromes involve real distress and medical symptoms that are not deliberately produced. Distinguishing among these requires careful clinical judgment and, when appropriate, multidisciplinary evaluation.

Context and implications: Malingering is commonly discussed in disability, workers’ compensation, and forensic assessments because it affects judgments about prognosis, treatment, and liability. Management focuses on objective evaluation, communicating findings to relevant parties, and addressing external incentives when appropriate. Ethical practice requires avoiding premature accusations and documenting the basis for conclusions and uncertainties.