Malingering is a medical
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

 term that refers to fabricating or exaggerating the symptoms of mental or physical
Physical disorder
A physical disorder is often used as a term in contrast to a mental disorder, in an attempt to differentiate medical disorders that have an available mechanical test , from those disorders which have no laboratory or imaging test, and are diagnosed only by behavioral syndrome A physical disorder...

 disorders for a variety of "secondary gain" motives, which may include financial compensation (often tied to fraud
In criminal law, a fraud is an intentional deception made for personal gain or to damage another individual; the related adjective is fraudulent. The specific legal definition varies by legal jurisdiction. Fraud is a crime, and also a civil law violation...

); avoiding school, work or military service; obtaining drugs; getting lighter criminal sentences; or simply to attract attention or sympathy. A common form of malingering in legal procedure prosecution is sometimes referred to as fabricated mental illness or feigned madness
Feigned madness
Feigned madness a term used in popular culture to describe the assumption of a mental disorder for purposes of evasion or deceit, or to divert suspicion, perhaps in advance of an act of revenge.-To avoid responsibility:...

; a 2005 case, United States v. Binion
United States v. Binion
United States v. Binion, 132 F. App'x 89 , is a case in which the United States Court of Appeals for the Eighth Circuit applied two recent U.S. Supreme Court decisions United States v. Binion, 132 F. App'x 89 (8th Cir. 2005), is a case in which the United States Court of Appeals for the Eighth...

addressed malingering hindering prosecution. Malingering remains separate from somatization disorder
Somatization disorder
Somatization disorder is a psychiatric diagnosis applied to patients who persistently complain of varied physical symptoms that have no identifiable physical origin...

s and factitious disorder
Factitious disorder
Factitious disorders are conditions in which a person acts as if he or she has an illness by deliberately producing, feigning, or exaggerating symptoms. Factitious disorder by proxy is a condition in which a person deliberately produces, feigns, or exaggerates symptoms in a person who is in their...

s in which primary and secondary gain
Primary and secondary gain
Primary gain or secondary gain are used in medicine to describe the significant psychological motivators patients may have in reporting symptoms....

, such as the relief of anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...

 or the assumption of the "patient role", is the goal. The symptoms most commonly feigned include those associated with mild head injury
Head injury
Head injury refers to trauma of the head. This may or may not include injury to the brain. However, the terms traumatic brain injury and head injury are often used interchangeably in medical literature....

, fibromyalgia
Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure. It is an example of a diagnosis of exclusion...

, chronic fatigue syndrome
Chronic fatigue syndrome
Chronic fatigue syndrome is the most common name used to designate a significantly debilitating medical disorder or group of disorders generally defined by persistent fatigue accompanied by other specific symptoms for a minimum of six months, not due to ongoing exertion, not substantially...

, and chronic pain
Chronic pain
Chronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and...

. Failure to detect actual cases of malingering imposes a substantial economic burden on the health care system, and false attribution of malingering imposes a substantial burden of suffering on a significant proportion of the patient population.


In the Hebrew Bible
Hebrew Bible
The Hebrew Bible is a term used by biblical scholars outside of Judaism to refer to the Tanakh , a canonical collection of Jewish texts, and the common textual antecedent of the several canonical editions of the Christian Old Testament...

, David feigns insanity
Feigned madness
Feigned madness a term used in popular culture to describe the assumption of a mental disorder for purposes of evasion or deceit, or to divert suspicion, perhaps in advance of an act of revenge.-To avoid responsibility:...

 to escape from a king who views him as an enemy. Odysseus was stated to have also feigned insanity in order to avoid participating in the Trojan War
Trojan War
In Greek mythology, the Trojan War was waged against the city of Troy by the Achaeans after Paris of Troy took Helen from her husband Menelaus, the king of Sparta. The war is among the most important events in Greek mythology and was narrated in many works of Greek literature, including the Iliad...

. Malingering has been recorded historically as early as Roman times by the physician Galen
Aelius Galenus or Claudius Galenus , better known as Galen of Pergamon , was a prominent Roman physician, surgeon and philosopher...

, who reported two cases. One patient simulated colic
Colic is a form of pain which starts and stops abruptly. Types include:*Baby colic, a condition, usually in infants, characterized by incessant crying*Renal colic, a pain in the flank, characteristic of kidney stones...

 to avoid a public meeting, while the other feigned an injured knee to avoid accompanying his master on a long journey. In his social-climbing manual, Elizabethan George Puttenham
George Puttenham
George Puttenham was a sixteenth-century English writer, literary critic, and notorious rake. He is generally considered to be the author of the enormously influential handbook on poetry and rhetoric, The Arte of English Poesie ....

 recommends that would-be courtiers have "sickness in his sleeve, thereby to shake off other importunities of greater consequence" and suggests feigning a "dry dropsy [...] of some such other secret disease, as the common conversant can hardly discover, and the physician either not speedily heal, or not honestly bewray."

Because malingering was widespread throughout the Soviet Union to escape sanctions or coercion, physicians were limited by the state in the number of medical dispensations they could issue.

With thousands forced into manual labour, doctors were presented with four types of patient;
  1. those who needed medical care;
  2. those who thought they needed medical care (hypochondriacs);
  3. malingerers; and
  4. those who made direct pleas to the physician for a medical dispensation from work.

This dependence upon doctors by poor labourers altered the doctor-patient relationship
Doctor-patient relationship
The doctor-patient relationship is central to the practice of healthcare and is essential for the delivery of high-quality health care in the diagnosis and treatment of disease. The doctor-patient relationship forms one of the foundations of contemporary medical ethics...

 to one of mutual mistrust and deception.


There is a rich and diverse array of methods for feigning illness. Physical methods reported include trying to deceive measuring devices such as thermometers, inducing swelling, delaying wound healing, over-exercise, drug overdose, self-harm, or directly reporting diagnostic signs of disease, learnt from a medical textbook. Patients may report a fictitious history, such as describing epileptic seizures or a heart attack, sometimes supplementing this with the use of agents which mimic disease, such as taking neuroleptic drugs to mimic tremor. Detection is made more difficult in those who do have a diagnosed, organic disease already, sometimes called "partial malingering". In these cases, malingering is sometimes described as a "functional overlay" on an existing disease. Persons who have an intermittent disorder may feign a return of symptoms in order to gain some benefit. The indigent homeless
Homelessness describes the condition of people without a regular dwelling. People who are homeless are unable or unwilling to acquire and maintain regular, safe, and adequate housing, or lack "fixed, regular, and adequate night-time residence." The legal definition of "homeless" varies from country...

 may do this in cold weather, in order to obtain indoor lodgings.

Some conditions are thought to be easier to feign than others. For example, everyone has experienced pain and knows how a person in pain should appear to others. The medical literature, especially in psychiatry, has become keenly aware of the complex issues related to malingering.

Ganser syndrome
Ganser syndrome
Ganser syndrome is a rare dissociative disorder previously classified as a factitious disorder. It is characterized by nonsensical or wrong answers to questions or doing things incorrectly, other dissociative symptoms such as fugue, amnesia or conversion disorder, often with visual...

 was once thought to be a form of factitious disorder, or malingering psychiatric symptoms for psychological gain. This was seen when prisoners were released from extreme solitary confinement, often involving the inability to communicate with anybody, and perpetual darkness. However, the symptoms were different from other mental illness, but consistent from one prison to another, where the affected individuals did not know one another. It has since been determined to be a genuine syndrome, resulting from the stress of isolation.


Although it is not considered an actual disorder, the DSM-IV-TR states that malingering is suspected if any combination of the following are observed
  1. Medicolegal context of presentation
  2. Marked discrepancy between the person’s claimed stress of disability and the objective findings
  3. Lack of cooperation during the diagnostic evaluation and in complying with prescribed treatment regimen
  4. The presence of Antisocial Personality Disorder
    Antisocial personality disorder
    Antisocial personality disorder is described by the American Psychiatric Association's Diagnostic and Statistical Manual, fourth edition , as an Axis II personality disorder characterized by "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood...

However, these criteria have been found to be of little use in actually identifying individuals who are malingering.


Some features at presentation which are unusual in genuine cases include:
  1. Dramatic or atypical presentation
  2. Vague and inconsistent details, although possibly plausible on the surface
  3. Long medical record with multiple admissions at various hospitals in different cities
  4. Knowledge of textbook descriptions of illness
  5. Admission circumstances that do not conform to an identifiable medical or mental disorder
  6. An unusual grasp of medical terminology
  7. Employment in a medically related field
  8. Pseudologia fantastica (i.e., patients' uncontrollable lying characterized by the fantastic description of false events in their lives)
  9. Presentation in the emergency department during times when obtaining old medical records is hampered or when experienced staff are less likely to be present (e.g., holidays, late Friday afternoons)
  10. A patient who has few visitors despite giving a history of holding an important or prestigious job or a history that casts the patient in a heroic role
  11. Acceptance, with equanimity, of the discomfort and risk of diagnostic procedures
  12. Acceptance, with equanimity, of the discomfort and risk of surgery
  13. Substance abuse, especially of prescribed analgesics and sedatives
  14. Symptoms or behaviors only present when the patient knows he is being observed
  15. Controlling, hostile, angry, disruptive, or attention-seeking behavior during hospitalization
  16. Reporting of wild psychological symptoms, and silly wrong answers on questionaires, not likely in patients with similar but real conditions.
  17. Fluctuating clinical course, including rapid development of complications or a new pathology if the initial workup findings prove negative
  18. Coinciding indigence or homelessness of the patient, with impending cold weather and a need for indoor lodgings.
  19. Giving approximate answers to questions, usually occurring in factitious disorder
    Factitious disorder
    Factitious disorders are conditions in which a person acts as if he or she has an illness by deliberately producing, feigning, or exaggerating symptoms. Factitious disorder by proxy is a condition in which a person deliberately produces, feigns, or exaggerates symptoms in a person who is in their...

     with predominantly psychological signs and symptoms (see Ganser Syndrome
    Ganser syndrome
    Ganser syndrome is a rare dissociative disorder previously classified as a factitious disorder. It is characterized by nonsensical or wrong answers to questions or doing things incorrectly, other dissociative symptoms such as fugue, amnesia or conversion disorder, often with visual...

  20. Eagerly endorsing symptoms suggested by a clinician, but not mentioned by the patient, though they would have been prominent and obvious had they been real.
  21. A test for factitious mental disorders presents symptoms which are extremely improbable. Endorsing these symptoms which almost never occur can raise doubt of the person's sincerity.

When malingering takes on a legal context it is more common either for private investigators to find evidence of malingering (say, videotaping a "paralysed" person walking around their home), or reports from friends, colleagues, or family members.

If a psychiatrist or neuropsychologist suspects malingering in a case of possible brain damage (i.e. caused by head trauma or stroke), they may look for a discrepancy between the patient's reported functions of daily living and their performance on neuropsychological tests. In theory, any neuropsychological test
Neuropsychological test
Neuropsychological tests are specifically designed tasks used to measure a psychological function known to be linked to a particular brain structure or pathway. Tests are used for research into brain function and in a clinical setting for the diagnosis of deficits. They usually involve the...

 could be used in this way, depending on the context. No one test, administered by itself, can proffer a diagnosis of malingering, so a neuropsychological examination typically consists of a battery of tests. Three tests commonly used to determine malingering are:
  • Computerized Assessment of Response Bias (CARB)
  • Minnesota Multiphasic Personality Inventory (MMPI)
    Minnesota Multiphasic Personality Inventory
    The Minnesota Multiphasic Personality Inventory is one of the most frequently used personality tests in mental health. The test is used by trained professionals to assist in identifying personality structure and psychopathology....

     (see Validity scales)
  • The Test of Memory Malingering (TOMM)

The psychiatrist or neuropsychologist may use these tests, and use the DSM-IV TR criteria while adding a "dimensional analysis" to assist in diagnosis and treatment. Dimensional analysis consists of learning the patient’s history, information about similar cases, and the context of the illness, which could help differentiate cases of malingering from factitious disorders.


Treatment is psychological, and varies according to the underlying cause of the individual's unique symptoms. Treatment options may include psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...

, family therapy
Family therapy
Family therapy, also referred to as couple and family therapy, family systems therapy, and family counseling, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of...

, cognitive behavioural therapy, or pharmacotherapy
Pharmacotherapy is the treatment of disease through the administration of drugs. As such, it is considered part of the larger category of therapy....

. It is important that other members of the medical team such as nurses, ward assistants, and physical therapists be informed about the patients' history. On being confronted with a diagnosis of malingering, many patients discharge themselves immediately, only to present at another medical facility to try again. Medical personnel may tell the patient he has Munchausen's syndrome, expecting he will not know what that means, and will repeat it to the next medical facility he visits.

Although malingering patients do waste a lot of resources, they are still entitled to the same safeguards as other patients. For instance, it is not considered ethical (or legal) to "blacklist
A blacklist is a list or register of entities who, for one reason or another, are being denied a particular privilege, service, mobility, access or recognition. As a verb, to blacklist can mean to deny someone work in a particular field, or to ostracize a person from a certain social circle...

" patients by warning other healthcare facilities about them without the patient's permission, searching through their personal effects to find evidence of malingering, or covertly videotaping them without their consent.

Malingering for external gain does not generally involve a psychological problem. A malingering person is oftentimes motivated by the hope that they will avoid work, prison, or military service by pretending to have an illness. Or, the person may be motivated by monetary gain, such as receiving a pension or an insurance settlement if it is believed they are ill or injured.

Impact on society

Malingering is damaging in three ways. Firstly, by reducing the productivity of industry or the military through absenteeism
Absenteeism is a habitual pattern of absence from a duty or obligation. Traditionally, absenteeism has been viewed as an indicator of poor individual performance, as well as a breach of an implicit contract between employee and employer; it was seen as a management problem, and framed in economic...

, secondly by depleting private and governmental social security, disability, worker's compensation, and insurance benefits, and thirdly by draining the medical system of resources. Malingerers take up the time and energy of medical personnel, as well as requiring detailed and expensive testing to rule out obscure conditions. Therefore malingering can deprive more seriously ill individuals of the care they deserve.

The financial costs of malingering are thought to be high. In the United States "fraud that broadly includes malingering costs the insurance industry $150 billion annually, increasing the cost of insurance by $1800 per family."

Malingering is regarded unfavorably by the criminal justice system. For example, in some cases feigning mental illness has led to a harsher sentence, because malingering during a competency evaluation
Competency evaluation (law)
In the United States criminal justice system, a competency evaluation is an assessment of the ability of a defendant to understand and rationally participate in a court process....

 resulted in a charge and enhanced sentencing for obstruction of justice
Obstruction of justice
The crime of obstruction of justice, in United States jurisdictions, refers to the crime of interfering with the work of police, investigators, regulatory agencies, prosecutors, or other officials...


In many militaries, malingering is an offense. Examples include the United States military and the Singapore Armed Forces
Singapore Armed Forces
The Singapore Armed Forces is the military arm of the Total Defence of the Republic of Singapore; as well as the military component of the Ministry of Defence. The SAF comprises three branches: the Singapore Army, the Republic of Singapore Air Force and the Republic of Singapore Navy...

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