May 25

Malingering: When Psychiatric Conditions are Faked

Malingering involves the intentional production or display of false or grossly exaggerated physical or psychological symptoms, with the goal of receiving a specific benefit or reward such as money, an insurance settlement, disability status, evasion of legal consequences or release from incarceration, or avoidance of work, jury duty, the military, or other types of service. Psychologytoday.com

Some cases of malingering are relatively easy to detect, but some can be especially tricky for mental health professionals (and/or physicians) to identify. Such cases of malingering can lead to abuse of the system, with unnecessary tests and interviews being performed and time taken away from other clients and patients.

Malingering is a condition not listed in the DSM-5. However, “It is similar to, but distinct from, factitious disorder, in which an individual fakes symptoms of physical or mental illness but without a concrete motive or expectation of reward. Malingering is also distinct from somatic symptom disorder, in which someone experiences actual psychological distress due to imagined or exaggerated symptoms” (psychologytoday.com).

It may go without saying that individuals who do have ulterior motives for showing up at your therapy door don’t really want or need your help of the therapy kind; what they want is to manipulate you so that they get something else—something they presumably feel they can’t get otherwise.

A couple examples from pop culture: 1) Corporal Max Klinger (actor Jamie Farr) on the old TV show M*A*S*H (1972-83). His plan for getting out of the Army involved trying to prove that he was psychologically unfit. He couldn’t achieve his goal, though, and eventually gave up.

2) Liz Lemon, played by Tina Fey on the more recent TV sitcom 30 Rock. Her goal was to escape jury duty. See below:

A malingerer presenting at a mental health setting could also be driven by such motives as getting out of work, obtaining disability insurance, and seeking drugs.

Reportedly, research has shown, though, that a person who fakes symptoms of mental illness can actually start to believe the illness is real (Scientific American). Put into action, this means Klinger would start to really believe, for example, that he can fly (in his pink bathrobe and slippers), while Liz Lemon would settle into the delusion that she’s a Star Wars character.

On a more positive note, psychologist Elizabeth Loftus is quoted in the above-cited article as envisioning “therapeutic potential in the new study”…

…musing on a hypothetical strategy she calls ‘feigning good,’ which could motivate patients by helping them believe in improved cognitive skills and diminished symptoms of illness. ‘Should clinicians be prescribing a form of feigning? You wouldn’t want patients to feign anxiety, but maybe they could feign the opposite. Maybe they could feign crystal clear concentration.’