Signs of malingering are evident when there is a marked difference between the reported signs and actual observed signs. For example those individuals who report loss of appetite or loss of interest in socializing or a depressed nature can be closely tracked when they are eating, having desserts, interacting with other members, and sleeping peacefully. Their eating habits and sleeping pattern can give a clear idea about malingering. Such a type of behavior can also be observed in presence of external incentive such as for obtaining prescription drugs. Yet another important marker for identifying malingering is reporting that they hear voices while asleep or hear them continuously rather than in intervals.

In addition to the above mentioned signs, individuals also do not participate appropriately during clinical examination, medico-legal context, or show signs of antisocial personality disorder. Patients with malingering often bitterly express their symptoms and also exhibit a feeling of distress while reporting of ailments [6].

• Malingering

  Malingering & Deception Evaluations Malingering and Deception Psychological Evaluations Dr. [psycholegalassessments.com]

  Because it is often impossible to determine who is malingering and who is not, it is impossible to know how frequently malingering occurs. [medical-dictionary.thefreedictionary.com]

  TMT error and ratio scores have been suggested as possible markers of malingering. The present study examined the utility of various TMT scores as malingering measures in 94 TBI litigants. [ncbi.nlm.nih.gov]

  What Constitutes Malingering in the Military Being found guilty of malingering depends on a few factors. [usmilitary.about.com]

• Disability

  See also MUNCHAUSEN'S SYNDROME. malingering Feigning illness or disability (often for the purpose of gaining compensation or avoiding duty). [medical-dictionary.thefreedictionary.com]

  Hence, the nature or permanence of a self-inflicted injury is not material on the question of guilt, nor is the seriousness of a physical or mental disability which is a shame. [usmilitary.about.com]

  Also important is the distinction between disability and physical impairment as a consequence of physical pathology. The contribution of psychological, social, and behavioral factors to disability ranges from minimal to major. [bcmj.org]

  Caution may be necessary when drawing conclusions about test-taking effort based on the recommended TOMM cutoff scores when evaluating children with disabilities. [ncbi.nlm.nih.gov]

• Military Personnel

  Many in the Department of Veterans Affairs (VA) would have us believe PTSD is unique to military personnel, but that is not true. Law enforcement officers, firefighters and even missionaries and relief workers in Haiti can suffer. [washingtontimes.com]

  M&S provides rehearsal environments for civilian first responder and military personnel. Repeated rehearsal of procedures improves performance, saving countless lives as well as aircraft, ships, and other vehicles. [simulationaustralasia.com]

  Simulation is often used in the training of civilian and military personnel. This usually occurs when it is prohibitively expensive or simply too dangerous to allow trainees to use the real equipment in the real world. [en.wikipedia.org]

• Fever

  […] obesity); behaviors to hide or avoid public exposure of "defect" Usually several years SSRI may be beneficial, otherwise similar to somatization Factitious disorder with physical symptoms Yes—motivation primary gain: sick role, attention Unexplained fever [accessmedicine.mhmedical.com]

  Common examples of simulated symptoms include a fever of unknown origin or seizure disorders. [canadiem.org]

• Severe Pain

  Distracted straight-leg raise (report of pain in low back or posterior thigh; lessening of pain with continued leg raising; severe pain at 10? flexion in patient with no apparent disability). 6. [docguide.com]

• Osteoporosis

  Therapists have special training in women’s health issues including back pain during pregnancy, osteoporosis and pelvic floor dysfunction. [backclinicinc.com]

  While claiming that he was disabled and impaired, it was discovered that he was doing teleradiology as well as osteoporosis treatment. Further investigation revealed a decline in his income in the years preceding his claim. [primarypsychiatry.com]

• Antisocial Personality Disorder

  Some factors they look at are: Lack of cooperation by the patient Previous diagnosis of antisocial personality disorder - people with antisocial personality disorder generally don't care about the rights or feelings of others and are aggressive Referrals [study.com]

  The timeline highlights the development of antisocial personality disorder over the ensuing years. Antisocial personality disorder is a common comorbid disorder among individuals who malinger. FIGURE 1. [ajp.psychiatryonline.org]

  However, people who adopt malingering behaviors often have a diagnosable mental illness called antisocial personality disorder. [promisesbehavioralhealth.com]

  Malingering may coexist with the antisocial personality disorder, with various factitious disorders, such as the Ganser Syndrome and the Munchausen Syndrome, with the hysterias and with traumatic neuroses and other mental disorders. [ncbi.nlm.nih.gov]

• Visual Hallucination

  In contrast to suspect visions, patients with genuine visual hallucinations may report being upset or distraught, resulting in distress or fear. They may also report never having seen the visual before. [healio.com]

  […] and nature of genuine symptoms Reports seeing visual hallucinations in black and white, whereas genuine visual hallucinations are seen in color Between reported symptoms and psychological test results Alleges genuine psychotic symptoms, yet testing suggests [currentpsychiatry.com]

  Some were representing clear symptoms have dealings with mental disorder, such as suicidal image and visual hallucinations [ 4 ]. [omicsonline.org]

• Denial

  Faculty of Psychology and Neuroscience Full course description This course will deal with illness fabrication (faking bad) and illness denial (faking good) in forensic contexts. [maastrichtuniversity.nl]

  Denial and minization among sex offenders: A review of competing models of deception.Annals of Sex Research, 4, 49–63. Google Scholar Rogers, R., Dion, K. L., & Lynett, E. (1992). [link.springer.com]

  34 In a broader context, possible consequences of the misclassification of malingering outside of the courts include loss of employment benefits or disability income, exclusion from social services programs or remedial education, unemployment, and denial [jaapl.org]

  Low critic and judgement; Low response to pharmacotherapy Low compliance Anxiety; Depression Discharge request; Low impulse control; Gambling addiction; Claustrophobia; Low compliance Worries related to illness anxiety; Body concept of illness with denial [jneuropsychiatry.org]

• Self-Mutilation

  Individuals who readily admit that they have produced their own injuries (e.g., self-mutilation) are not included in the category of factitious disorders. [canadiem.org]

  In future, in all wound cases it must be established whether there is any question of self-mutilation…Moreover, an increasing number of soldiers are suffering from skin diseases. [psywarrior.com]

  Kapfhammer H Rothenhausler H Dietrich E Dobmeier P Mayer C Artifactual disorders–between deception and self-mutilation: experiences in consultation psychiatry at a university clinic. Nervenartz. 1998; 69: 401-409 56. [thelancet.com]

• Self-Inflicted Wound

  Stanley Newcourt-Nowodwoski mentions the booklet and discusses self-inflicted wound in Black Propaganda, Sutton Publishing, UK, 2005: An extreme option for soldiers was the self-inflicted wound…Dr. [psywarrior.com]

• Amnesia

  Strategies for detecting malingering in amnesia are available for anterograde amnesia. Less attention has been given to malingering in retrograde amnesia. [ncbi.nlm.nih.gov]

  It has been speculated that this friend's experience with amnesia inspired Bruce's malingering. There was a sullenness among them, a blank, passive defiance sometimes and a constant malingering at their work. [diki.pl]

  They frequently assume that dense amnesia and disorientation are features of psychosis. These descriptions may also apply to some patients with genuine psychiatric disorders. [emedicine.medscape.com]

There is no one single method to diagnose malingering. Clinicians use open ended questions during the evaluation process. It is necessary that the questions should be asked without giving any kind of clues and the interview should be carried out for a longer duration. In such situations, it would get difficult for the individual to maintain the fake presentation [7] [8].

Clinicians often recognize malingers by the extent of exaggeration of symptoms. For example, individuals who present with complain of schizophrenia often claim global confusion. This is so because, malingers are often under the impression that global confusion is the trademark of all mental disorders. Over exaggeration of symptoms gives a clear indication to the clinicians that the individual is pretending and is not a prey to any form of medical illness, but is malingering for some personal benefit [9].

In addition to these, various other tests such as complete blood count, neurological examination, observation of patient during period of assessment and mental state examination are also done.

No specific treatment regime exists for malingering. However, this is no way implies that the patient should be regarded as liar. Malingering may coexist with other psychosocial problems and therefore, methods should be employed for treating underlying disease conditions if any. In many cases, the cause of malingering could be genuine, such that when a female wants to escape the company of her husband due to his abusive nature [10].

Moreover, it has also be seen that, individuals often seek malingering when they actually have psychiatric disorders and are unable to express the same due to language barrier or other constraints. Therefore, it becomes necessary to arrange for an interpreter whenever possible, to design proper interventions.

The malingering behavior lingers on unless the motive behind such a kind of act is fulfilled. Or the benefit desired outweighs the distress and inconvenience involved for seeking medical confirmation for the fake illness [5].

Personal gain is the basic and the major motive behind the act of malingering. Individuals with a selfish motive tend to overstate physical as well as psychological signs and symptoms. Such a kind of act of overstating symptoms is majorly done to abstain from school, gain monetary benefit, obtaining drugs, to get appointed in military service or to get lighter criminal sentence. In some cases, malingering is done to gain sympathy or to attract attention [2].

Malingering is a common practice and is widely prevalent across the globe. It is more common in settings of military, factories, prison and criminal prosecutions. Individual at any age can practice malingering. Even a child aged 9 years can also seek help from malingering for personal gain. Studies have shown that, about 13% of emergency attendees pretended illness in order to gain food, money, shelter, medical treatment and avoidance of work, family responsibilities and imprisonment.

Another set of studies have also postulated the fact that, malingering is also prevalent amongst the psychiatric population, and about 10 – 12% of them have the habit of exaggerating their symptoms. It has been estimated that in the year 1995, the total cost of health insurance claimed by fraud is about $59 billion in the US.

The exact incidence of malingering is not known. It is certainly not a type of mental illness or a form of psychopathology. Such a kind of condition is purposively created for gaining benefit or for some external purpose. However, in many cases, malingering can often accompany other mental illnesses [3].

Malingering can be classified under 3 different categories namely: pure malingering, partial malingering and false imputation. Pure malingering is a condition, wherein the individual reports of having symptoms which are not at all present. Partial malingering involves exaggeration of symptoms which are present. False imputation is a condition, wherein, individuals falsely attribute the symptoms to an unrelated etiology [4].

Malingering is not a disease, neither a mental condition which can be prevented. Conscious efforts for not exaggerating the symptoms can help prevent such a type of condition.

Individuals often have the habit of fabricating symptoms purposively to have some sort of benefit. For example, students may pretend to suffer from conditions they are not suffering from, to avoid attending school or for gaining sympathy from others. Malingering is not same as factitious disorder or somatization disorder [1].

Definition: Malingering is a condition, wherein the individual intentionally presents with symptoms of psychological or physical illness with a motive of benefit of some kind. In many cases, individuals may also go to the extent of personally harming themselves or play dirty with the laboratory reports just for the purpose of taking undue advantage.

Cause: There is no specific kind of physical or mental cause behind the act of malingering. Individuals resort to such type of behavior in order to gain financial compensation, sick leave, avoid work or school, sympathy or for availing prescription drugs.

Symptoms: There is a significant difference between the reported and observed behavior of the individual. Other signs include failure to follow the prescribed treatment regime and unwillingness to undergo tests.

Diagnosis: Diagnosis is done through open ended questionnaires which is carried out to gather information from the individual and to understand the malingering behavior. In addition, physical and neurological examinations are also carried out to assess the presence of any underlying disease condition. In addition, blood tests are also to done to detect any form of physical ailments. In many cases, MRI may also be indicated to check for any type of anomalies.

Treatment: Treatment is directed towards managing the underlying condition if any. When no physical ailment is found and doctor feels there is an exaggeration of symptoms then confronting the patient is often the best option. In such cases, the patient may also require psychological counseling if any kind of psychiatric illness is detected.

1. Folks DB, Feldman MD, Ford CV. Somatoform disorders, factitious disorders, and malingering. In: Psychiatric Care of the Medical Patient, 2nd ed, Stoudemire A, Fogel B, Greenberg DB. (Eds), Oxford, NY 2000. p.459.
2. Samuel RZ, Mittenberg W. Determination of Malingering in Disability Evaluations. Primary Psychiatry. 2005;12(12):60-68.
3. Udell ET. Malingering behavior in private medical practice. Clin Podiatr Med Surg. Jan 1994;11(1):65-72.
4. Purcell TB. The somatic patient. Emerg Med Clin North Am. Feb 1991;9(1):137-59.
5. Ziegler SJ. Pain, patients, and prosecution: who is deceiving whom?. Pain Med. Jul-Aug 2007;8(5):445-6; author reply 447-8.
6. Donaghy M. Symptoms and the perception of disease. Clin Med. Nov-Dec 2004;4(6):541-4.
7. Resnick PJ. Defrocking the fraud: the detection of malingering. Isr J Psychiatry Relat Sci. 1993;30(2):93-101.
8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, American Psychiatric Association, Washington, DC, 2000.
9. McDermott BE, Feldman MD. Malingering in the medical setting. Psychiatr Clin North Am. Dec 2007;30(4):645-62.
10. Paras ML, Murad MH, Chen LP, et al. Sexual abuse and lifetime diagnosis of somatic disorders: a systematic review and meta-analysis. JAMA 2009; 302:550.