Encyclopedia of Psychology and Law

3 =mild, 4 =moderate, 5 =severe,and 6 =extreme.

According to Richard Rogers, gross exaggeration

should be defined as a minimum of three levels of

amplification. To qualify as grossly exaggerated,

(a) slight symptoms would need to be severe or extreme

and (b) mild symptoms would need to be extreme.

Malingering is a DSM-IVclassification and not a

formal diagnosis. This distinction is critical to forensic

evaluations. Malingering is categorized as a “V code,”

which signifies an undiagnosed condition that may be

the focus of clinical attention. Note that the operative

word is “may,” suggesting that malingering is not

always a focal point for clinical attention. More impor-

tant, V codes do not provide inclusion criteria for

clearly establishing a clinical condition. The screening

indicators provided in DSM-IVare merely meant to

raise suspicions of malingering. Misuse of these

screening indicators as inclusion criteria is a very seri-

ous breach of professional practice with ethical impli-

cations. To underscore this crucial issue, forensic

clinicians should draw no conclusions, however tenta-

tive, regarding the presence or absence of malingering

on the basis of DSM-IVscreening indicators.

A careful analysis of DSM-IVscreening indicators

suggests that they should not be used for any purpose,

because of their inaccuracies and lack of discrim-

inability. Based on available research, DSM-IV

screening indicators are likely to lead to false posi-

tives approximately 80% of the time. Consider for the

moment the perils of applying these indicators to

criminal-forensic cases. Two of the four indicators

(e.g., forensic context and antisocial personality)

occur in a high proportion of cases, rendering them

ineffective at distinguishing malingering from gen-

uine disorders. The remaining two indicators (lack

of cooperation and marked discrepancies) also lack

discriminability.

Domains of Malingering

Malingering is almost never a pervasive response

style. Instead, malingerers are typically selective

about what types of symptoms are feigned and what

specific goals can be achieved. Three general domains

of malingering have been identified: mental disorders,

cognitive abilities, and medical complaints. Each

domain places specific demands of malingerers, who

are attempting a successful performance (i.e., the

avoidance of detection). In the next three paragraphs,

each domain is explored.

Feigned Mental Disorders.Malingerers in this domain

must create a plausible set of symptoms with a credi-

ble description of their onset and course. Importantly,

they must decide how much insight to have regarding

these symptoms and their effects on daily functioning.

For truly sophisticated presentations, feigning must

take into account negative symptoms (e.g., the absence

of spontaneous speech) as well as positive symptoms

(e.g., the presence of auditory hallucinations). If pro-

vided treatment, they must decide what changes, if

any, occur with their symptoms and their insights into

these symptoms.

Feigned Cognitive Impairment. Malingerers in this

domain must exhibit “effortful failures.” In other

words, they must portray seemingly genuine effort

while making plausible mistakes on neuropsycholog-

ical and intelligence testing. While the immediate task

of feigning appears comparatively easy (i.e., “try hard

but get it wrong”), malingerers face an additional hur-

dle of feigning believable deficits in light of past doc-

umentation. In most instances, for example, the

feigning of mental retardation poses a daunting chal-

lenge because academic records (e.g., school perfor-

mance and aptitude tests) provide relevant data about

intellectual abilities.

Feigned Medical Complaints. Malingerers in this

domain can be categorized as feigning either nonspe-

cific complaints or a specific diagnosis. Nonspecific

complaints (e.g., headaches, fatigue, and pain) are rel-

atively easy to generate and difficult to disprove, espe-

cially when described as intermittent or sporadic.

However, malingerers must decide whether such com-

plaints will be sufficient to meet their goals (e.g.,

unwarranted compensation in a personal injury case).

Far more complex is the feigning of specific medical

disorders that may involve the deliberate contamina-

tion of laboratory tests. Health care staff may be

alerted to malingering by anomalies in test results. In

addition, malingerers may evidence an unlikely level

of sophistication in their knowledge of test findings

that is uncharacteristic of genuine patients.

Different detection strategies are required for each

domain. For example, assessment methods for identi-

fying bogus hallucinations are likely to be ineffective

with individuals claiming memory loss secondary to a

traumatic injury. In this instance, persons with pur-

ported amnesia have no reasons to fabricate psychotic

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