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Malingering mental disorders: Clinical assessment

  • Derek K. Tracy and Keith J. B. Rix

Malingering is the dishonest and intentional production of symptoms. It can cause considerable difficulty as assessment runs counter to normal practice, and it may expose clinicians to testing medicolegal situations. In this first part of a two-article review, we explore types of psychiatric malingering and their occurrence across a range of common and challenging scenarios, discussing presentations that may help delineate true from feigned illness. A framework is provided for undertaking an assessment where malingering is suspected, including recommendations on clinician approach, the use of collateral information, and self-evaluation of biases. The uses, and limitations, of psychometric tests are discussed, including ‘general’, malingering-specific and ‘symptom validity’ scales.

Learning Objectives

• Understand the challenges of determining ‘real’ from ‘malingered’ symptomatology across a range of psychiatric conditions

• Have a rational strategy for approaching a clinical assessment where malingering is suspected

• Appreciate the role and limitations of various psychometric tests that can be used in such assessments

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Corresponding author
Correspondence Dr Derek K. Tracy, The Memorial Hospital, Shooter's Hill, London SE18 3RG. Email:
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This is the first of two articles on psychiatric malingering. The second, which will appear in the March issue, will consider the challenges for the expert when presenting findings in the medicolegal context: Rix KJB, Tracy DK (2017) Malingering mental disorders: medicolegal reporting. BJPsych Advances, in press.

Declaration of Interest


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Allcott, D, Anderson, S, Friedland, D, et al (2014) How do experts reporting for the legal process validate symptoms? The results of a survey. Medicine, Science, and the Law, 54: 6873.
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5). APA.
Bagot, KS, Kaminer, Y (2014) Efficacy of stimulants for cognitive enhancement in non-attention deficit hyperactivity disorder youth: a systematic review. Addiction, 109: 547–57.
Burges, C, McMillan, TM (2001) The ability of naive participants to report symptoms of post-traumatic stress disorder. British Journal of Clinical Psychology, 40: 209–14.
Choi, O (2015) Using fMRI for lie detection: ready for court? In Psychiatric Expert Testimony: Psychiatric Expert Testimony (eds Weiss, KJ, Watson, C): 84101. Oxford University Press.
Demakis, GJ, Elhai, JD (2011) Neuropsychological and psychological aspects of malingered posttraumatic stress disorder. Psychological Injury and Law, 4: 2431.
Erichsen, JE (1882) On Concussion of the Spine: Nervous Shock and Other Obscure Injuries of the Nervous System in their Clinical and Medico-Legal Aspects. Bermingham & Co.
Faust, D (1995) The detection of deception. Neurologic Clinics, 13: 255–65.
Freeman, T, Powell, M, Kimbrell, T (2008) Measuring symptom exaggeration in veterans with chronic posttraumatic stress disorder. Psychiatric Research, 158: 374–80.
Hall, RCW, Hall, RCW (2006) Malingering of PTSD: forensic and diagnostic considerations, characteristics of malingerers and clinical presentations. General Hospital Psychiatry, 28: 525–35.
Harrison, AG, Edwards, MJ, Parker, KC (2007) Identifying students faking ADHD: Preliminary findings and strategies for detection. Archives of Clinical Neuropsychology, 22: 577–88.
Hunt, EJ, Wessely, S, Jones, N, et al (2014) The mental health of the UK Armed Forces: where facts meet fiction. European Journal of Psychotraumatology, 5: 23617 (
Jones, E, Milroy, H (2016) Stolen trauma: why some veterans elaborate their psychological experience of military service. Defense & Security Analysis, 32: 5163.
Kanaan, RA, Wessely, SC (2010) The origins of factitious disorder. History of the Human Sciences, 23: 6885.
Kleinman, SB, Stewart, L (2004) Psychiatric-legal considerations in providing mental health assistance to disaster survivors. Psychiatric Clinics of North America, 27: 559–70.
Kleinman, SB, Martell, D (2015) Failings of trauma-specific and related psychological tests in detecting post-traumatic stress disorder in forensic settings. Journal of Forensic Sciences, 60: 7683.
Knoll, J, Resnick, PJ (2006) The detection of malingered post-traumatic stress disorder. Psychiatric Clinics of North America, 29: 629–47.
Lees-Haley, PR (1997) MMPI-2 base rates for 492 personal injury plaintiffs: implications and challenges for forensic assessment. Journal of Clinical Psychology, 53: 745–55.
Lipman, FD (1962) Malingering in personal injury cases. Temple Law Quarterly, 35: 141–62.
Lund, FB (1941) Galen on Malingering, Centaurs, Diabetes and Other Subjects More or Less Related. Columbia University Press.
Mason, AM, Cardell, R, Armstrong, M (2014) Malingering psychosis: guidelines for assessment and management. Perspectives in Psychiatric Care, 50: 51–7.
McCarthy-Jones, S, Resnick, PJ (2014) Listening to voices: the use of phenomenology to differentiate malingered from genuine auditory verbal hallucinations. International Journal of Law and Psychiatry, 37: 183–9.
Merten, T, Merckelbach, H (2013) Symptom validity testing in somatoform and dissociative disorders: a critical review. Psychological Injury and Law, 6: 122–37.
Mittenberg, W, Patton, C, Canyock, EM, et al (2002) Base rates of malingering and symptom exaggeration. International Journal of Law and Psychiatry, 24: 1094–102.
Musso, MW, Gouvier, WD (2014) “Why is this so hard?” A review of detection of malingered ADHD in college students. Journal of Attention Disorders, 18: 186201.
Pella, RD, Hill, BD, Shelton, JT, et al (2012) Evaluation of embedded malingering indices in a non-litigating clinical sample using control, clinical, and derived groups. Archives of Clinical Neuropsychology, 27: 4557.
Quinn, CA (2003) Detection of malingering in assessment of adult ADHD. Archives of Clinical Neuropsychology, 18: 379–95.
Resnick, P (1995) Guidelines for the evaluation of malingering in posttraumatic stress disorder. In Posttraumatic Stress Disorder in Litigation: Guidelines for Forensic Assessment (ed Simon, R): 117–34. American Psychiatric Press.
Richards, L (2010) The Black Art: British Clandestine Psychological Warfare against the Third Reich. Psywar.
Rix, KJB, Tracy, DK (2017) Malingering mental disorders: medicolegal reporting. BJPsych Advances, in press.
Rosenhan, DL (1973) On being sane in insane places. Science, 179: 250–8.
Rowe, AR, Merce, L, Casetti, V, et al (2015) Dementia praecox redux: a systematic review of the nicotinic receptor as a target for cognitive symptoms of schizophrenia. Journal of Psychopharmacology, 29: 197211.
Rubenzer, S (2009) Posttraumatic stress disorder: assessing response style and malingering. Psychological Injury and Law, 2: 114–42.
Schroeder, RW, Marshall, PS (2011) Evaluation of the appropriateness of multiple symptom validity indices in psychotic and non-psychotic psychiatric populations. Clinical Neuropsychologist, 25: 437–53.
Slobodin, O, de Jong, JT (2015) Mental health interventions for traumatized asylum seekers and refugees: What do we know about their efficacy? International Journal of Social Psychiatry, 61:1726.
Steffan, JS, Morgan, RD, Lee, J, et al (2010) A comparative analysis of MMPI-2 malingering detection models among inmates. Assessment, 17: 185–96.
Townsend, M (2016) Many military veterans' PTSD claims ‘fabricated or exaggerated’. The Guardian, 23 January ( Accessed 14 October 2016.
Tracy, DK (2014) Evaluating malingering in cognitive and memory examinations: a guide for clinicians. Advances in Psychiatric Treatment, 20: 405–12.
Wiley, SD (1998) Deception and detection in psychiatric diagnosis. Psychiatric Clinics of North America, 21: 869–93.
Williamson, KD, Combs, HL, Berry, DT, et al (2014) Discriminating among ADHD alone, ADHD with a comorbid psychological disorder, and feigned ADHD in a college sample. Clinical Neuropsychologist, 28: 1182–96.
World Health Organization (1992) The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO.
Yehuda, R, Vermetten, E, McFarlane, AC, et al (2014) PTSD in the military: special considerations for understanding prevalence, pathophysiology and treatment following deployment. European Journal of Psychotraumatology, 5: doi 10.3402/ejpt.v5.25322.
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BJPsych Advances
  • ISSN: 2056-4678
  • EISSN: 2056-4686
  • URL: /core/journals/bjpsych-advances
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Malingering mental disorders: Clinical assessment

  • Derek K. Tracy and Keith J. B. Rix
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