The central theme to all definitions of malingering is that the term applies to persons who deliberately pretend to have an illness or disability in order to receive financial or other gain, or to avoid punishment or responsibility.
Personal gain is always the motivation for malingering. Some external reward is sought and is the rationale for feigning an illness. For example, the criminal who does not want to pay for his/her crime, the soldier who does not want to fight, or the person who wishes to be paid for a nonexistent disability all may be tempted to feign an illness.
Malingering can take many forms. However, as specifically related to mental illness, the tendency is to fake more common disorders such as major depressive disorder , post-traumatic stress disorder , and panic disorder with agoraphobia . With very little coaching or research, even a beginner can simulate symptoms of these disorders. Generalized symptoms such as headaches, dizziness, low back pain, stomach pain, etc., are easily manufactured, and x rays, magnetic resonance imaging (MRIs), or CAT scans (computed axial tomography) are unable to determine a physical cause.
Malingerers tend to avoid symptoms such as those associated with more serious psychiatric disorders, because the pretense is very difficult to maintain and objective measures could detect the difference. For example, hearing voices and seeing demons, or living with the idea that others can hear unspoken thoughts, would become a difficult act to maintain over time. On the other hand, to feign a sad mood, loss of interest in formerly enjoyed activities, or a low energy level may not be so difficult to demonstrate. Likewise, responding positively to a series of questions about having heart palpitations, sweating, dizziness, or fear of impending death, could be done readily.
The concept that fakers use less severe symptoms to escape detection was validated in 2001 in a research study. Individuals were asked to fake mental illnesses in such a way as to avoid detection by sophisticated psychological tests. All or portions of the following tests were employed in the research: the Structured Inventory of Malingered Symptomatology, the Psychopathic Personality Inventory, the M-Test, and the Trauma Symptom Inventory. Slightly over 11% of the 540 research participants successfully avoided detection and were diagnosed with real disorders instead of with malingering. Questionnaires completed by those who successfully faked symptoms showed that they avoided detection by endorsing fewer actual symptoms, staying away from unduly strange or bizarre symptoms, and responding based upon personal experience.
Although ordinarily an intended fraud, malingering may serve an adaptive purpose under circumstances of duress, such as while being held captive. Faking an illness at such a time may allow a person to avoid cooperating with their captors or to avoid punishment.
Causes and symptoms
Lying for personal benefit has existed since the beginning of time. As previously stated, personal gain is the goal of the malingerer.
The symptoms may vary a great deal from person to person.
Due to the difficulty of determining and exposing malingering, the incidence is unknown.
When attempting to diagnose malingering, mental health professionals have three possibilities to consider. First, there is the possibility that the illness feigned by the malingerer is real. However, once it is determined that the disorder has no basis in fact, the professional is left with two viable diagnoses: factitious disorder and malingering. Factitious disorder is a legitimate malady, but malingering is not. Both have to do with feigned illnesses.
Unlike malingering, the individual with factitious disorder produces fake symptoms to fulfill the need to maintain the "sick role"—a sort of emotional gain. Being "sick" gives the person with factitious disorder attention from physicians and sympathy from friends and loved ones. Thus, this individual's goal is not the same as the malingerer's.
With malingering, motivation is always external and is designed to accomplish one of three things: (1) evade hard or dangerous situations, punishment, or responsibility; (2) gain rewards such as free income, source for drugs, sanctuary from police, or free hospital care; or (3) avenge a monetary loss, legal ruling, or job termination.
Mental health practitioners become alert to the possibility of malingering when circumstances exist that might help promote such a facade. Malingering is suspected when any combination of events such as the following occur:
- A person is referred by his/her attorney for an evaluation.
- There is a noticeable and distinct difference between the level of distress or disability claimed by the person when compared to information obtained by objective means. (Objective means could take the form of personal observation, task performance ability by the person, or a psychological test like those mentioned above.)
- There is a lack of cooperation from the individual.
- A diagnosis of antisocial personality disorder exists.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association,2000.
Kaplan, Harold I., M.D., and Benjamin J. Sadock, M.D., "Malingering." In Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry. 8th edition. Lippincott, Williams and Wilkins, 1998.
Edens, John F., Laura S. Guy, Randy K. Otto, Jacqueline K. Buffington, Tara L. Tomicic, and Norman G. Poythress. "Factors differentiating successful versus unsuccessful malingerers." Journal of Personality Assessment. 77, no. 2 (2001): 333-338.
American Psychiatric Association. 1400 K Street NW, Washington D.C. 20005. <http://www.psych.org> .
Jack H. Booth, Psy.D.
I believe that for folks with developmental disabilities who malinger, going to the hospital and getting the attention is similar to most people going to the spa. The behavior is always successful for them because their caregivers HAVE to follow through with any complaints from the consumer. I knew one woman who had her staff call 911. She laid on the couch with a big smile on her face while the "cute" paramedics took her vitals. When they suggested they take her to the hospital she normally "attended", she requested another hospital. We all found this strange and the paramedics took her to the requested hospital. Upon arrival at the hospital, the woman asked the paramedics to take her to the third floor because her brother was there receiving care. None of us knew this and she had not requested staff to take her to the hospital to see her brother, which would certainly have happened. One thing to remember with this is that Medicaid paid for the ambulance as well as the tests done to establish that nothing was actually wrong. This person is so good with her malingering that each new person in her life has to experience fake illnesses and emergencies several times before they fully realize what a great actress she is and how extremely manipulative she is being.