Malingering

Malingering is a forensic topic that is also relevant to most nonforensic clinicians. Almost every experienced psychiatrist, psychologist, or therapist has wrestled with, or wondered about, patients who appear to be faking symptoms in order to gain something of obvious value (or avoid something obviously painful). In this column, I will focus on malingered psychiatric or neuropsychiatric symptoms, but the definitions given below apply to malingered general medical symptoms as well. It’s Not Munchausen’s or “Psychosomatic” Take out a copy of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)1 and look at the small, but very important, differences among malingering, factitious syndromes, and somatoform syndromes (Table 1). Although these concepts are often confused, it’s easy to separate them once you understand that malingering refers to feigning or significantly exaggerating symptoms for a conscious gain or purpose, * factitious refers to feigning symptoms for a largely or wholly unconscious