TABLE OF CONTENT
Malingering means to lie or exaggerate physical or psychological symptoms. This is done to obtain a desired result. These desired outcomes include relief from duty or work and monetary gain. It is also done for receiving medicines and avoiding or reducing prison sentences. It poses a difficult ethical impasse in societal aspects. These aspects include healthcare, the legal system, and the workplace. Thus, it is important to identify and mitigate malingering. This crucial role of spotting malingering is performed by malingering expert witnesses. They can be psychologists or psychiatrists. These experts use various strategies and tools to identify this act. This blog covers the details on malingering and its recognition by expert witnesses.
Learn about the role of medical expert witnesses in court here.
What is malingering?
The act of lying on purpose to achieve a desired outcome is called malingering. This outcome is the factor that decides if the lying is malingering.
Types of malingering:
There are three types of malingering based on the extent of truthfulness.
1. Pure malingering
This is the one in which you entirely lie about a disease that you don’t have.
For example, a person pretends to see things and hear voices. They have never had these problems. They are doing this for an end goal, such as avoiding jail.
Key points:
- The symptoms are completely fake.
- The person knows they are lying.
- This type is usually easier to spot.
2. Partial malingering
In this type, you do have symptoms of a disease, but you highly exaggerate them to your benefit. For instance, a person faces back ache. They pretend it is so bad that they cannot get out of bed. They are hoping for a desired outcome, such as money from insurance.
Key points:
- Some of the symptoms are real.
- The person exaggerates to get more help or benefits.
- It is hard to know the true extent of the issue.
3. False imputation.
In this type, you attribute your symptoms to a totally unrelated disease. It usually has some material benefits. For instance, you got hurt in a sport. Yet, you claim that you were hurt in your workplace to get compensation.
Key points:
- The symptoms are real.
- The story about how they started is false.
- The person changes the cause to gain something.
“In forensic psychiatric practice, therefore, the two situations in which the question of malingering arises are in relation to compensation for personal injury, both in common law tort actions and statutory workers’ compensation claims, and in relation to the evasion of criminal responsibility.”
George Mendelson & Danuta Mendelson
Which factors should alert you to malingering?
Malingering is usually hard to identify. It has been clinically proven that lying cannot be spotted easily. Some indicators can be used to identify malingering, but they are not certain. The following are the factors that can be classified malingering symptoms:
1. Saying yes to every symptom
The person is saying yes to every symptom. They even say yes to symptoms that are not related at all. They are doing this to appear more sick. Real patients only have a few symptoms. Thus, too many symptoms are a warning sign.
2. Only talking about common symptoms
People who are faking only talk about easy-to-fake symptoms. E.g., they claim to hear voices. They can also claim to be sad. They leave out the hard-to-notice ones. Real patients also show rare symptoms.
3. Symptoms that don’t make sense
Some people show symptoms that don’t make sense. For example, someone keeps saying their memory is very bad. Yet, they talk in detail about how bad their memory is. This is a warning sign.
4. Symptoms that are too severe
A person describes symptoms that seem very severe. This may not match how the illness generally works. It implies that they are trying hard to appear sick.
5. Mixing up of symptoms
People who are faking their illness may mix up symptoms from different diseases. Real illnesses follow a pattern, but they don’t know that. So, they list unrelated signs together.
These signs are not definite proof of someone lying or faking. They should probe the doctors to look closely.
A range of illnesses can be faked. Some examples are psychosis, mood disorders, PTSD, amnesia, etc.
Understanding malingering expert witnesses:
Malingering expert witnesses are professionals who can detect this lying. Malingering expert witnesses are usually mental health professionals. They include the following:
- Clinical experts
- Neuro experts
- Forensic experts
- Disability managers
Learn more on forensic psychiatrist vs psychologist
Role of malingering expert witnesses
Malingering expert witnesses play a very important role in legal matters. Their role is especially crucial where there is already an indication of malingering. Some of the cases where their expertise may be needed are:
- Insurance cases
- Insanity defence
- Personal injury cases
Here is the role malingering expert witnesses play:
1. Identifying malingering:
One of the key roles of malingering expert witnesses is to spot malingering in court cases. It is quite hard to recognise fake mental illnesses generally. It is especially harder when the person has experienced this mental illness previously. They are then aware of the symptoms, and they know how to describe them. These experts have to find out if the mental illnesses are real or fake by checking the incentive.
2. Clinical Evaluation and History Taking
Malingering expert witnesses document what the patient tells them. They look for inconsistencies and clinical patterns. A person who is faking the illness may tell symptoms that do not match any known disorder. Information that contradicts medical history is one of the main signs of malingering. Therefore, these experts have to be vigilant.
Read more on mental health assessments in the UK here.
3. Performing psychological tests
Malingering expert witnesses often carry out these tests. In this way, they can verify the patient’s claims. There can be a series of these tests instead of one. These tests do not confirm malingering certainly. There can be false positives and negatives. This means someone can escape when lying, and someone with a genuine condition can be flagged. These tests should be seen in the context of other data.
4. Giving testimony in court
Malingering expert witnesses give testimony in court. They explain the following to the jury:
- Point out any contradictions they found in the story
- Indicate if the contradictions don’t match real disorders
- In case the court allows, discuss malingering.
Malingering expert witnesses cannot legally say if someone is lying. They just have to present the evidence. It’s for the jury to decide if their findings bear weight.
Learn more on medico-legal expert witness testimony.
5. Neutrality
Malingering expert witnesses have a crucial duty. They have to remain neutral. Legal settings might be adversarial. Lawyers can push the experts to take sides to support the client. To remain impartial, malingering expert witnesses may have to practice. They do the following:
- Explain the diagnosis and do not make moral judgements
- Assist the court in finding facts and not advocate for either side
- Describe test results and behaviour, and do not accuse of anything
How to prove malingering
You can prove malingering by using certain tests. Here is how they do this:
Clinical interview:
Clinical interview is one of the key methods of proving it. First, use open-ended questions. Let the patient take the lead. Get them to describe their disease on their own. Do not give them leading questions that can help them with details of the disease they are claiming. After this, ask detailed questions. You will know if the symptoms match the patterns. Be very aware if there is a clear reason for malingering, such as money or legal trouble. Also, keep noticing if the person gets more inconsistent as the interview proceeds. They can also be more fatigued. The inconsistencies can be of many types. For instance, a person claims delusions and hallucinations. Yet, they do not show other expected signs such as confusion or odd speech. Moreover, look for the symptoms described before in ‘alerting factors’.
Collateral information:
Take a look at the outside records. Check the following:
- Medical files
- Interviews with staff and family
- Work reports
- Insurance investigations
- Police reports
Psychological Tests:
Use psychological tests that are designed to spot faking. Some of these are:
1. Pain test:
The patient has to rank the type of pain and how frequent it is. If the patient answers yes to enough questions, they might be malingering. Pain disability Index is one such test.
2. Effort Test:
Effort tests are often used by malingering expert witnesses. They use them to assess efforts. They check if the person scores very low on an easy test. This might indicate that the patient picked the wrong answers on purpose. Thus, they are malingering. Here is an example of such tests:
TOMM
It stands for test of memory malingering. It is used to assess fake memory loss. It contains a forced-choice test in which you make people pick between two options. People with real memory issues do well in this test. If someone performs very poorly, it may be intentional.
3. Endorsement of symptoms:
In this test, the malingering expert witness asks the patient to endorse the symptoms. If the patient endorses too many, then they are lying. It may also indicate exaggeration. Some of its types are:
MMPI-2
It stands for Minnesota Multiphasic Personality Inventory – 2. It has built-in scales that can validate mental illness. It can detect exaggerated symptoms and flags the following things:
- Effort to make symptoms worse
- Careless or random answers
- Overreporting the usual symptoms
PAI
It stands for Personality Assessment Inventory. It also contains indicators of validity. It helps you in assessing depression, anxiety and psychosis. It is used in legal or disability cases.
4. Waddell’s signs
Waddell’s sign is a test that doctors perform to check if the back pain is caused by psychological reasons. This test does not confirm malingering. Someone feels pain when they should not, biologically, is not necessarily malingering. It should be followed up with other evaluations to confirm findings.
Tests can miss liars or mistakenly flag the wrong person. That is why test results should always be viewed in combination with other factors. Moreover, you can ask the person if something seems off to you. Do this clarification clearly. Don’t accuse them of lying, and beware of your own reactions. Focus more on clarifying than confronting.
Case study of malingering
A 61-year-old man displayed significant issues with cognition. He appeared to be disoriented, displayed memory issues and had a loss of autonomy in daily life. His brain scans (MRI and CT scan) did not support his decline in function. He also performed poorly on malingering tools. The case was particularly hard because the patient had depression. This was mixed up with his malingering and made it difficult for experts to assess.
The key findings in this case suggested suspected malingering. His self-reported symptoms were inconsistent. He performed poorly on relevant tests, and he had an incentive to lie (avoiding prison).
The study suggested the use of different tools to confirm findings. It also advocated for the use of standard tools and AI technologies. This would enhance accuracy in diagnosis.
Challenges in presenting malingering
There are three issues that malingering expert witnesses can come across:
1. Clinical rapports
A clinician builds a good working relationship with a patient. In this process, they may start trusting the person too much. They have a wrong sense of belief that they’ll be able to tell if the patient is lying or being honest. A mistaken sense of confidence may result from this.
2. Bias
Clinicians can make thinking mistakes. They may form a bias of confirmation once they sense the other person is lying. After this, they only notice the evidence that confirms their belief. They can also make attribution errors e.g., their explanation is over the top so they must be lying. These biases can lead them to wrongly accuse someone of lying or miss a real case.
3. Relying on test scores:
These experts can only rely on test results. This would be a mistake because tests can be fooled, and results can be misleading. So, the tests should be interpreted with interviews, history, behaviour, etc.
How can Concise Medico help you in identifying malingering?
Fake illnesses are very hard to figure out. The experts, thus, have to be qualified and objective. At Concise Medico, we provide malingering expert witnesses who add value to your testimony. They present data and help the court interpret it. They make sure to make your case stronger and assist you in every way.
To get the best experts, contact us now.
FAQs
Malingering means to lie or exaggerate physical or psychological symptoms. This is done to obtain a desired result. These desired outcomes include relief from duty or work and monetary gain. It is also done for receiving medicines and avoiding or reducing prison sentences. It poses a difficult ethical impasse in societal aspects. These aspects include healthcare, the legal system, and the workplace. Thus, it is important to identify and mitigate malingering. This crucial role of spotting malingering is performed by malingering expert witnesses. They can be psychologists or psychiatrists. These experts use various strategies and tools to identify this act. This blog covers the details on malingering and its recognition by expert witnesses.
Learn about the role of medical expert witnesses in court here.
What is malingering?
The act of lying on purpose to achieve a desired outcome is called malingering. This outcome is the factor that decides if the lying is malingering.
Types of malingering:
There are three types of malingering based on the extent of truthfulness.
1. Pure malingering
This is the one in which you entirely lie about a disease that you don’t have.
For example, a person pretends to see things and hear voices. They have never had these problems. They are doing this for an end goal, such as avoiding jail.
Key points:
- The symptoms are completely fake.
- The person knows they are lying.
- This type is usually easier to spot.
2. Partial malingering
In this type, you do have symptoms of a disease, but you highly exaggerate them to your benefit. For instance, a person faces back ache. They pretend it is so bad that they cannot get out of bed. They are hoping for a desired outcome, such as money from insurance.
Key points:
- Some of the symptoms are real.
- The person exaggerates to get more help or benefits.
- It is hard to know the true extent of the issue.
3. False imputation.
In this type, you attribute your symptoms to a totally unrelated disease. It usually has some material benefits. For instance, you got hurt in a sport. Yet, you claim that you were hurt in your workplace to get compensation.
Key points:
- The symptoms are real.
- The story about how they started is false.
- The person changes the cause to gain something.
“In forensic psychiatric practice, therefore, the two situations in which the question of malingering arises are in relation to compensation for personal injury, both in common law tort actions and statutory workers’ compensation claims, and in relation to the evasion of criminal responsibility.”
George Mendelson & Danuta Mendelson
Which factors should alert you to malingering?
Malingering is usually hard to identify. It has been clinically proven that lying cannot be spotted easily. Some indicators can be used to identify malingering, but they are not certain. The following are the factors that can be classified malingering symptoms:
1. Saying yes to every symptom
The person is saying yes to every symptom. They even say yes to symptoms that are not related at all. They are doing this to appear more sick. Real patients only have a few symptoms. Thus, too many symptoms are a warning sign.
2. Only talking about common symptoms
People who are faking only talk about easy-to-fake symptoms. E.g., they claim to hear voices. They can also claim to be sad. They leave out the hard-to-notice ones. Real patients also show rare symptoms.
3. Symptoms that don’t make sense
Some people show symptoms that don’t make sense. For example, someone keeps saying their memory is very bad. Yet, they talk in detail about how bad their memory is. This is a warning sign.
4. Symptoms that are too severe
A person describes symptoms that seem very severe. This may not match how the illness generally works. It implies that they are trying hard to appear sick.
5. Mixing up of symptoms
People who are faking their illness may mix up symptoms from different diseases. Real illnesses follow a pattern, but they don’t know that. So, they list unrelated signs together.
These signs are not definite proof of someone lying or faking. They should probe the doctors to look closely.
A range of illnesses can be faked. Some examples are psychosis, mood disorders, PTSD, amnesia, etc.
Understanding malingering expert witnesses:
Malingering expert witnesses are professionals who can detect this lying. Malingering expert witnesses are usually mental health professionals. They include the following:
- Clinical experts
- Neuro experts
- Forensic experts
- Disability managers
Learn more on forensic psychiatrist vs psychologist
Role of malingering expert witnesses
Malingering expert witnesses play a very important role in legal matters. Their role is especially crucial where there is already an indication of malingering. Some of the cases where their expertise may be needed are:
- Insurance cases
- Insanity defence
- Personal injury cases
Here is the role malingering expert witnesses play:
1. Identifying malingering:
One of the key roles of malingering expert witnesses is to spot malingering in court cases. It is quite hard to recognise fake mental illnesses generally. It is especially harder when the person has experienced this mental illness previously. They are then aware of the symptoms, and they know how to describe them. These experts have to find out if the mental illnesses are real or fake by checking the incentive.
2. Clinical Evaluation and History Taking
Malingering expert witnesses document what the patient tells them. They look for inconsistencies and clinical patterns. A person who is faking the illness may tell symptoms that do not match any known disorder. Information that contradicts medical history is one of the main signs of malingering. Therefore, these experts have to be vigilant.
Read more on mental health assessments in the UK here.
3. Performing psychological tests
Malingering expert witnesses often carry out these tests. In this way, they can verify the patient’s claims. There can be a series of these tests instead of one. These tests do not confirm malingering certainly. There can be false positives and negatives. This means someone can escape when lying, and someone with a genuine condition can be flagged. These tests should be seen in the context of other data.
4. Giving testimony in court
Malingering expert witnesses give testimony in court. They explain the following to the jury:
- Point out any contradictions they found in the story
- Indicate if the contradictions don’t match real disorders
- In case the court allows, discuss malingering.
Malingering expert witnesses cannot legally say if someone is lying. They just have to present the evidence. It’s for the jury to decide if their findings bear weight.
Learn more on medico-legal expert witness testimony.
5. Neutrality
Malingering expert witnesses have a crucial duty. They have to remain neutral. Legal settings might be adversarial. Lawyers can push the experts to take sides to support the client. To remain impartial, malingering expert witnesses may have to practice. They do the following:
- Explain the diagnosis and do not make moral judgements
- Assist the court in finding facts and not advocate for either side
- Describe test results and behaviour, and do not accuse of anything
How to prove malingering
You can prove malingering by using certain tests. Here is how they do this:
Clinical interview:
Clinical interview is one of the key methods of proving it. First, use open-ended questions. Let the patient take the lead. Get them to describe their disease on their own. Do not give them leading questions that can help them with details of the disease they are claiming. After this, ask detailed questions. You will know if the symptoms match the patterns. Be very aware if there is a clear reason for malingering, such as money or legal trouble. Also, keep noticing if the person gets more inconsistent as the interview proceeds. They can also be more fatigued. The inconsistencies can be of many types. For instance, a person claims delusions and hallucinations. Yet, they do not show other expected signs such as confusion or odd speech. Moreover, look for the symptoms described before in ‘alerting factors’.
Collateral information:
Take a look at the outside records. Check the following:
- Medical files
- Interviews with staff and family
- Work reports
- Insurance investigations
- Police reports
Psychological Tests:
Use psychological tests that are designed to spot faking. Some of these are:
1. Pain test:
The patient has to rank the type of pain and how frequent it is. If the patient answers yes to enough questions, they might be malingering. Pain disability Index is one such test.
2. Effort Test:
Effort tests are often used by malingering expert witnesses. They use them to assess efforts. They check if the person scores very low on an easy test. This might indicate that the patient picked the wrong answers on purpose. Thus, they are malingering. Here is an example of such tests:
TOMM
It stands for test of memory malingering. It is used to assess fake memory loss. It contains a forced-choice test in which you make people pick between two options. People with real memory issues do well in this test. If someone performs very poorly, it may be intentional.
3. Endorsement of symptoms:
In this test, the malingering expert witness asks the patient to endorse the symptoms. If the patient endorses too many, then they are lying. It may also indicate exaggeration. Some of its types are:
MMPI-2
It stands for Minnesota Multiphasic Personality Inventory – 2. It has built-in scales that can validate mental illness. It can detect exaggerated symptoms and flags the following things:
- Effort to make symptoms worse
- Careless or random answers
- Overreporting the usual symptoms
PAI
It stands for Personality Assessment Inventory. It also contains indicators of validity. It helps you in assessing depression, anxiety and psychosis. It is used in legal or disability cases.
4. Waddell’s signs
Waddell’s sign is a test that doctors perform to check if the back pain is caused by psychological reasons. This test does not confirm malingering. Someone feels pain when they should not, biologically, is not necessarily malingering. It should be followed up with other evaluations to confirm findings.
Tests can miss liars or mistakenly flag the wrong person. That is why test results should always be viewed in combination with other factors. Moreover, you can ask the person if something seems off to you. Do this clarification clearly. Don’t accuse them of lying, and beware of your own reactions. Focus more on clarifying than confronting.
Case study of malingering
A 61-year-old man displayed significant issues with cognition. He appeared to be disoriented, displayed memory issues and had a loss of autonomy in daily life. His brain scans (MRI and CT scan) did not support his decline in function. He also performed poorly on malingering tools. The case was particularly hard because the patient had depression. This was mixed up with his malingering and made it difficult for experts to assess.
The key findings in this case suggested suspected malingering. His self-reported symptoms were inconsistent. He performed poorly on relevant tests, and he had an incentive to lie (avoiding prison).
The study suggested the use of different tools to confirm findings. It also advocated for the use of standard tools and AI technologies. This would enhance accuracy in diagnosis.
Challenges in presenting malingering
There are three issues that malingering expert witnesses can come across:
1. Clinical rapports
A clinician builds a good working relationship with a patient. In this process, they may start trusting the person too much. They have a wrong sense of belief that they’ll be able to tell if the patient is lying or being honest. A mistaken sense of confidence may result from this.
2. Bias
Clinicians can make thinking mistakes. They may form a bias of confirmation once they sense the other person is lying. After this, they only notice the evidence that confirms their belief. They can also make attribution errors e.g., their explanation is over the top so they must be lying. These biases can lead them to wrongly accuse someone of lying or miss a real case.
3. Relying on test scores:
These experts can only rely on test results. This would be a mistake because tests can be fooled, and results can be misleading. So, the tests should be interpreted with interviews, history, behaviour, etc.
How can Concise Medico help you in identifying malingering?
Fake illnesses are very hard to figure out. The experts, thus, have to be qualified and objective. At Concise Medico, we provide malingering expert witnesses who add value to your testimony. They present data and help the court interpret it. They make sure to make your case stronger and assist you in every way.
To get the best experts, contact us now.
