2nd February 2024

Criteria -DSM-5

• The medico-legal context of the presentation
• Marked discrepancy between the individual’s “claimed stress or disability” and “objective finding and observation”
• Lack of compliance with diagnostic evaluation, treatment regimen and follow-up care
• Presence of antisocial personality disorder 

Protracted and unrelenting thorough observation can divulge evidence of malingering because it is difficult for the person who is malingering to sustain uniformity and consistency with the incorrect or embroidered claims for lengthy periods.

The malingerer typically lacks understanding of the nuances of the feigned disorder. For example, someone complaining of nerve compression syndrome in the upper limb may be referred to occupational therapy, where the person who is malingering would be unable to predict the effect of true syndrome on tasks in an art shop or painting task. They might use simple techniques like adding contaminants to urine or heating a thermometer under a lamp to feign temperature to stay in the hospital.

Individuals malingering psychotic illness repeatedly overstress hallucinations and delusions but cannot impersonate formal thought disorders. They usually cannot fake blunted affect, concrete thinking, or impaired interpersonal relatedness. They frequently assume that dense amnesia and confusion are features of psychosis. 

It is observed that malingerers in ED work towards the external gain of obtaining shelter and or drugs whilst in offices or clinics, and their goal could be financial gains.