Self-Reported Malingering: Prevalence, Strategies, and Decision Making
Wellman, Bethany Linn Hall
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Objective: Malingering is intentional fabrication or exaggeration of physical or mental symptoms for the purpose of gaining an external incentive, whether it be for a reward or a gain of some sort or avoidance of an unwanted outcome (Gorman, 1982). Understanding malingering behaviors for accurate identification is of vital importance due to both the economic burden on health care corporations, workers compensation and disability services when malingering goes unidentified, as well as the harm caused to individuals with genuine symptoms falsely suspected of malingering. Greater understanding of malingering practices to help improve resources for correct identification is an area within psychological research of continued need. To date, little research has identified strategies individuals utilize to malinger an illness. This study sought to answer how individuals choose what symptoms to malinger. What we know of the prevalence of malingering has been derived from research examining simulated malingering and evaluator identified malingering. This research sought to investigate the prevalence of malingering among adults in ordinary situations based on self-report. Additionally, given the high occurrence of malingering in forensic settings, this study investigated individuals’ response to being placed in a high stakes criminal situation on whether participants would attempt to malinger, the impairments they would feign, and perceptions of symptoms most likely to alleviate criminal responsibility. Results: A total of 246 adult participants were enrolled on this study. All participants were required to complete an online survey that asked about malingering behaviors. Results from this study showed a 50% rate of self-reported malingering. Although no differences in malingering were noted in regard to age, race, and occupation, women self-reported historical malingering more (89%) and at a higher rate than men (average of 12 times); additionally, of those who, endorsed hypothetically malingering in a high stakes criminal scenario 71% were women. Medical and physical impairments were the most commonly feigned symptoms as was the secondary gain of avoiding work or occupational responsibilities. When asked to select reasons for past utilized symptoms, participants chose symptoms they were able to demonstrate with ease most commonly, followed by symptoms that fits the situation/scenario. In a hypothetical criminal scenario, only 8.5% of participants reported they would fake an illness in order to alleviate guilt, most commonly choosing to feign brain and psychological impairments by utilizing their knowledge of symptoms to convince others of their lack of guilt. Lastly, participants believed that brain injury or neurocognitive difficulties would be most effective in alleviating guilt in a criminal case, followed by a major mental health disorder severe enough to require hospitalization. This collective information will aid psychologists in better understanding the motivation for malingering and the strategic decision making that goes into feigning illnesses in order to more reliably differentiate malingering versus legitimate psychopathology.