Malingering may occur for many reasons, usually involving self-preservation, but in a forensic context it occurs as an attempt to obtain money, or other reward, by lying. The essential characteristic of malingering is a person’s knowledge that a claim is not true; nevertheless the claim is asserted strongly or with a great deal of attention-getting behavior. Malingering is not the confabulation of the traumatic brain-injuredor demented person, nor is it a case of false memory syndrome, because in these instances the individuals believe what they say is true even though it is not. The malingerer, on the other hand, knows the claim is false.
It may be particularly difficult to diagnose malingering in an individual who has at an earlier time experienced the complaint they are presently making. For example, a person who previously has had a major depressive episode knows what such a condition feels like and what the symptoms are, so at a later time the individual may complain about having a major depressive episode and describe it in convincing terms Other prior disorders are similarly malingered at a subsequent time, usually for monetary rewards, and it is necessary for the forensic evaluator to be able to distinguish the authentic from the inauthentic claim.
When obtaining a clinical history, the impartial examiner strives to elicit symptoms or complaints which are inconsistent with the syndrome the historian is trying to convey. Inauthentic history is one of the hallmarks of malingering. The impartial examiner also administers a battery of psychological tests to determine if contradictory or overstated complaints exist. In order to preserve their usefulness in actual Independent Medical Examination; I will not give any examples about the techniques I use to determine inconsistent history.
When giving expert testimony, forensic psychiatrists are usually limited in their ability to testify as to the authenticity of the individual because restrictions prohibit the expert commenting about the “truthfulness” of the aggrieved party. Instead, the forensic expert must explain inconsistencies contained within the person’s history, which thereby do not fit any known clinical condition. If the forensic evaluator believes Malingering is the diagnosis and if the judge permits such testimony to be introduced insofar as it is a condition that comes to the attention of the clinician, then the medical expert can discuss Malingering at greater and in more specific terms to the trier of facts. As I hope my discussion indicates, a judge must decide if the probative value outweighs the prejudicial effect.
As a forensic psychiatrist, I have had many opportunities to evaluate individuals I believe were malingering. On some of those occasions, I have been permitted to testify to this opinion. Based upon the facts of the case and the judge’s assessment of the probative value of such explicit testimony, I always have been permitted to discuss and explain why an individual’s clinical history and test results were inconsistent with known clinical responses, and then it is left to the trier of facts to decide how much weight to give to the claimant’s allegations.
Here again it is necessary to emphasize that no single psychological test can diagnose malingering nor can any single clinical event. Rather, it is an accumulation of inconsistencies that enable the forensic evaluator to come to this conclusion. Additionally, the mere presence of clinical inconsistencies is not sufficient to diagnose malingering because other medical conditions may also cause the inconsistencies and although the motive may not be intentional.
See Dr. Raffle’s commentary: ”Pain and the Mind,” also “Chronic Pain” and “Psychosomatic Medicine“