Chapter 5: Malingering: Faking it Till it's Real

Roffey MBChB FCPsych(SA), Marc

Chapter 5: Malingering: Faking it Till it's Real

Chapter in Book

2023

Journal Title

Forensic Mental Health: From Assessment to Recovery

Publisher

Edutech

Department

Department of Psychiatry and Mental Health

Faculty

Faculty of Health Sciences

License

http://creativecommons.org/licenses/by-nc-nd/4.0/

Abstract

This chapter examines the complex clinical and legal challenges surrounding malingering—the intentional production or gross exaggeration of physical or psychological symptoms motivated by external incentives—within criminal and civil forensic psychiatric settings. Unlike general psychiatry, forensic mental health assessments require a heightened threshold of suspicion, particularly during medicolegal proceedings or when diagnosing antisocial personality disorder. The author outlines Resnick's classifications of malingering (pure, partial, and false imputation) and explores Rogers and Neumann's explanatory frameworks (pathogenic, criminological, and adaptational models). Key clinical differentiations are established between malingering, factitious disorders, and somatic symptom disorders based on conscious versus unconscious symptom production and motivation. The chapter highlights primary assessment indicators, emphasizing the "ABCs" of forensic interviewing (Avoid accusations, Beware of countertransference, Clarification over confrontation, and Security), alongside the role of collateral information and formal validity testing. Finally, it addresses the nuances of identifying fabricated positive psychotic features, such as atypical hallucinations, and provides practical recommendations for reporting findings neutrally without using pejorative language.

Keywords

Malingering, Forensic Psychiatry, Illness Deception, Factitious Disorder, Somatic Symptom Disorder, Medicolegal Assessment, Feigned Psychosis, Symptom Validity Testing

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