MALINGERING [ back to Glossary Index ]
Malingering is not a diagnosis of a disease but a conclusion that a patient, or a plaintiff in litigation for damages, is consciously and deliberately "faking bad" to convince others that he is injured (when he is really not) or that he is more sick, more injured or more disabled than he is in fact. Because being wrong about an accusation of malingering has such terrible consequences (improper denial of treatment or compensation)  most health care professionals tread very cautiously and carefully before making such a charge. It is believed that malingering is rare, because of the many opportunities for detection and the drastic financial, legal and social  consequences of being  caught. To the extent that anyone would really malinger in a personal injury suit, it is believed that malingering is more common with bad backs than with brain damage, because no one would willingly want others to believe his brain has stopped working right. For ethical reasons, most authors of textbooks on how to detect malingering  take the position that no conclusion can be reached unless the plaintiff is caught "red handed" in an act of undeniable fakery (e.g. walking hours after giving a sworn deposition that he could not get out of his wheelchair). Further, exaggeration of symptoms can be unconscious or influenced by emotional factors (e.g. by the need for attention, concern or nurturing) rather than a cynical deception. Because the subjective motivation of the patient or plaintiff can only be guessed at, but never known with certainty, the waters get quite muddy, and some professionals prefer to stand clear and not speculate. Occasionally, one encounters a highly confident defense expert who evinces certainty that the plaintiff is malingering even when no other expert on either side of the case is willing to take so bold a position.

Experts who do this cannot rely on their gut, but must cite tests backed up by peer reviewed studies. What such experts fail to mention are the flaws in the studies. The vast majority of studies are based on simulated malingering not real malingering. The few cases in the literature discussing apprehension of real malingerers deals with the incompetent ones who got caught. This is a difficult and ambiguous area with many traps for the unwary. Whether the defense charge of malingering is given serious consideration or rejected outright as absurd by a jury depends on many factors including the severity of the trauma, the credibility of the plaintiff, the plaintiff's life story as presented by lay witnesses who knew her before and after the trauma and the convincing quality of the analysis of the issue given by the expert witnesses. Malingerers should never be confused with persons who produce symptoms for reasons and motivations which remain unconscious and inaccessible to their conscious minds, a class of sufferers with "somatiform" disorders. For more information on Somatiform Disorders, click here.