Background
Malingering is not considered a mental illness. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), malingering receives a V code as one of the other conditions that may be a focus of clinical attention. The DSM-5 describes malingering as the intentional production of false or grossly exaggerated physical or psychological problems. Motivation for malingering is usually external (e.g., avoiding military duty or work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs). [1]
Pathophysiology
Malingering is deliberate behavior for a known external purpose. It is not considered a form of mental illness or psychopathology, although it can occur in the context of other mental illnesses.
Epidemiology
Mortality/Morbidity
Feigning illness in order to receive disability compensation is common in Social Security Disability examinations, occurring in 45.8%–59.7% of adult cases. In 2011, the estimated cost of malingering in medicolegal cases totaled $20.02 billion. [2]
Prognosis
Malingering behavior typically persists as long as the desired benefit outweighs the inconvenience or distress of seeking medical confirmation of the feigned illness.
Patient Education
While the physician may wish to educate the patient about better ways of achieving goals than by malingering, the reasons are usually more deeply rooted than just a cognitive deficit and require behavioral interventions, psychotherapy, and counseling.
Family education
The physician should determine whether revealing the malingering to the family will do more harm than good. If the family is adversely affected by the malingering behavior, it may be helpful for family members to know that the evidence is strong that no physical ailment is causing the patient's distress. They may be encouraged to resist the patient's efforts to manipulate them to accommodate the feigned illness at their own. While malingerers are both resistant to accepting psychotherapy and refractory to its benefits, family members may benefit from family counseling to develop adaptive approaches to the malingering behavior. [3, 4]
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Diagnostic algorithm for suspicious symptoms.
