Malingering of Psychotic Symptoms in Psychiatric Settings: Theoretical Aspects and Clinical Considerations

Abstract

Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives. Although the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) does not list malingering in its diagnostic section and therefore does not identify it as a formal mental disorder, malingering and verified mental illness commonly coexist. Some subtypes of feigning behaviors, such as partial or pure malingering, dissimulation, and false imputation, can be suspected when patients have marked discrepancies between reported stressors and objective findings. The article discusses these three theoretical concepts with their possible clinical aspects, illustrating each phenomenon by clinical case with self-reported and/or observed psychotic symptoms. We summarized relevant findings and provided a review of clinical considerations that physicians can use to aid in the evaluation of psychotic symptoms in the context of those three concepts.

An Update Review to Cast Light on the Possible Role of Altered Oropharyngeal Microbiota in Differentiating True Psychosis from Malingered Psychosis in a Forensic Psychiatric Setting

“…Malingered psychosis comprises the intentional falsification of psychiatric symptoms in order for the presenting patient to externally benefit in a tangible manner [1]. Since a wide range of clinical presentations constitutes the term "psychosis" [2], malingering patients mostly have a tendency for psychosis falsification instead of another form of disorder for gaining external benefits and induce clinicians to have a diagnostic dilemma, who often classify malingering with similar clinical phenomena and factitious disorders by delivering the benefit of the doubt [2,3].…”

Screening a Suspected Malingerer Using the Symptom Checklist-90-Revised and Visual Analogue Pain Scale Questionnaires

“…The definition of a malingering patient feigns physical or psychological symptoms to gain external benefits, monetary benefits, access to particular medications, or to avoid personal responsibilities (time off work, time off school, etc.) [ 1 ]. The ability to identify malingering patients is crucial to ensure high-value, high-quality care is provided to patients, as the estimated financial burden of malingering is roughly $20 billion per year [ 2 ].…”

Oropharyngeal microbiome composition as a possible diagnostic marker for true psychosis in a forensic psychiatric setting: A narrative literature review and an opinion

“…Malingered psychosis encompasses intentionally falsifying psychiatric symptoms aiming to externally benefit the presenting patient in a tangible manner [1]. As the term "psychosis" includes a broad variety of clinical presentations [2], it is very likely for malingering patients to decide to falsify psychosis for another kind of disorder to derive external benefits and provoke clinicians to cast doubt on their diagnoses, who usually categorize malingering with factitious disorders and analogous clinical phenomena by giving benefit of the doubt [2,3].…”