The Identification and Management of Malingering in Clinical Settings

Malingering is the “intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives.” Malingering is difficult to identify and a challenge for physicians to manage. There are innumerable incentives for malingering, including financial gain, housing, and controlled substances. Although there is no definitive way to identify malingering, clues that suggest malingering include inconsistencies in history and exam, discrepancies among collateral informants, and the results of neuropsychological testing. By recognizing how malingering may be a rational, adaptive choice for patients to address their needs, psychiatrists can preserve the doctor-patient relationship and build an alliance to achieve the patient’s goals in a more productive manner. Pitfalls for clinicians treating malingering patients include burnout, aversive countertransference reactions, and inadequate treatment of comorbid medical or psychiatric conditions. Psychiatrists must also be attentive to appropriate documentation and personal safety. The long-term prognosis of malingering patients is not well understood. This review contains 5 figures, 7 tables, and 95 r