V65.2 Malingering
The essential feature of Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs. Under such circumstances, Malingering may represent adaptive behavior – for example, feigning illness while a captive of the enemy during wartime.
Malingering should be strongly suspected if any combination of the following is noted:
- Medicolegal context of presentation (e.g., the person is referred by an attorney to the clinician for examination.
- Marked discrepancy between the person’s claimed stress or disability and the objective findings.
- Lack of cooperation during the diagnostic evaluation and in complying with the prescribed treatment regimen.
- The presence of Antisocial Personality Disorder.
Malingering differs from Factitious Disorder in that the motivation for the symptom production in Malingering is an external incentive, whereas in Factitious Disorder external incentives are absent. Evidence of an intrapsychic need to maintain the sick role suggest Factitious Disorder. Malingering is differentiated from Conversion Disorder and other Somatoform Disorders by the intentional production of symptoms and by the obvious, external incentives associated with it. In Malingering (in contrast to Conversion Disorder), symptom relief is not often obtained by suggestion or hypnosis.