Malingering

Forensic assessments must evaluate systematically the accuracy and forthrightness of individuals referred for evaluation of psycholegal issues. Among different response styles that should be considered, malingering is a cornerstone issue for forensic consultations. Malingering is defined by the Diagnostic and Statistical Manual of Mental Disorders (fourth edition; DSM-IV) of the American Psychiatric Association as a deliberate fabrication or gross exaggeration of symptoms for an external goal. Feigned symptoms and associated features may be psychological, medical, or a combination of both. Forensic psychologists and psychiatrists should note that minor or even substantive exaggerations do not warrant the classification of malingering; only grossly exaggerated symptoms qualify for malingering. An example of gross exaggeration would be the deliberate misrepresentation of an occasional thought about one's demise (e.g., “I wish I was dead”) as a current suicidal ideation that includes planning and possible preparation. Because court reports require precision, forensic psychologists may wish to operationalize “gross exaggeration.” For such purposes, the Schedule of Affective Disorders and Schizophrenia (SADS) provides a criterion-based standard for rating the severity of reported symptoms. Many symptoms on the SADS are rated on six levels of severity: 1 = absent, 2 = slight or subclinical, [Page 471]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-IV classification 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 important, V codes do not provide inclusion criteria for clearly establishing a clinical condition. The screening indicators provided in DSM-IV are merely meant to raise suspicions of malingering. Misuse of these screening indicators as inclusion criteria is a very serious breach of professional practice with ethical implications. To underscore this crucial issue, forensic clinicians should draw no conclusions, however tentative, regarding the presence or absence of malingering on the basis of DSM-IV screening indicators.

A careful analysis of DSM-IV screening indicators suggests that they should not be used for any purpose, because of their inaccuracies and lack of discriminability. Based on available research, DSM-IV screening indicators are likely to lead to false positives 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 genuine disorders. The remaining two indicators (lack of cooperation and marked discrepancies) also lack discriminability.