Psychiatry
AKT · Psychiatry/Personality & otherlow yield
Malingering
Overview
Intentional feigning or exaggeration of physical/psychological symptoms motivated by an EXTERNAL incentive — money, benefits, avoiding work/military service/criminal responsibility, or obtaining drugs. It is NOT a psychiatric disorder, but a key discriminator.
Recognise
- Symptoms deliberately produced/exaggerated
- Clear EXTERNAL gain (compensation, avoiding duties/prosecution, drugs)
- Inconsistency between claimed disability and observed function; poor cooperation with assessment
Red flags
- Do not miss genuine illness; document objectively; avoid premature labelling
Differentials & how to tell them apart
Factitious disorderalso deliberate, but motivated by the SICK ROLE — no external gain
Conversion (functional neurological) disordersymptoms genuine and UNCONSCIOUS, not feigned
Somatic symptom disordergenuine distress about symptoms, not deliberate
Investigations
Clinical: look for incongruence between symptoms and objective findings and a clear external motive; corroborate with collateral information.
Management
- 1Objective assessment and documentation; do not provide unjustified certification/medication; address sensitively.Gate: External gain (money, avoiding work/prosecution) = malingering; for the sick role with no external gain it is factitious disorder
- 2Manage any genuine comorbid illness on its merits.
No drug — not a treatment issue; address objectively
Key points
The decisive question is the MOTIVE: external gain (malingering) vs sick role (factitious) vs unconscious (conversion). Malingering is not a mental disorder.
Monitor & prognosis
Objective function; consistency over time.
Resolves when the incentive is removed.
Source: DSM-5 (V-code); forensic psychiatry