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Malingering mental disorders: Clinical assessment

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

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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Copyright
Corresponding author
Correspondence Dr Derek K. Tracy, The Memorial Hospital, Shooter's Hill, London SE18 3RG. Email: derek.tracy@nhs.net
Footnotes
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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

None

Footnotes
References
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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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