Faculty mentor/PI email address
wongt@rowan.edu
Is your research Teaching and Learning based?
1
Keywords
Malingering, feigned psychosis, clinical assessment, structured documentation, forensic psychiatry, hallucination
Date of Presentation
5-6-2026 12:00 AM
Poster Abstract
When Malingering is Suspected: A Structured Clinical Framework for Assessment and Documentation
BACKGROUND:
Distinguishing malingering from primary psychosis remains a common challenge across all psychiatric settings from emergency, consult-liaison, and to inpatient units. According to DSM-5-TR, malingering is defined as the intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives. Despite its prevalence, many clinicians receive limited formal training in its systematic assessment. Misidentification carries a bidirectional risk, as falsely labeling a genuinely psychotic patient as malingering may deny treatment whereas failure to detect malingering may result in misallocation of resources. Reliance on clinical impression alone, without structured observation or documentation of reasoning, leaves clinicians without clear documentation to support their decisions.
OBJECTIVE:
To review the clinical features that help distinguish malingering from genuine psychosis and to outline practical strategies for structured assessment and documentation across psychiatric settings.
METHODS:
A narrative literature review of peer-reviewed literature from PubMed and forensic guidelines from American Academy of Psychiatry and the Law (AAPL) was conducted, with a focus on clinical features of malingering psychosis, feigning detection, and defensible psychiatric practice.
RESULTS:
Malingered psychosis is suggested by patterns of inconsistency, atypical symptom phenomenology, and contextual incentives. The primary clinical challenge is not establishing a definitive diagnosis but making sound decision under condition of uncertainty, particularly when patient self-report is unreliable.
Effective assessment relies on four core elements, which include systematic observation of symptom patterns, explicit documentation of inconsistencies, integration of available collateral information, and acknowledgement of diagnostic uncertainty. These elements form the foundation for transparent and defensible clinical decision-making.
CONCLUSIONS:
Malingering and genuine psychosis share overlapping presentations that cannot not be reliably distinguished by clinical impression alone. The goal is not diagnostic certainty but making sound and well-reasoned decisions during times of uncertainty. A practical and transparent approach is characterized by recognition of clinical patterns, inconsistencies of symptoms, use of collateral information, and clear documentation of reasoning. This approach provides a practical standard for evaluating suspected malingering in everyday psychiatric practice.
Disciplines
Medicine and Health Sciences
Included in
When Malingering is Suspected: A Structured Clinical Framework for Assessment and Documentation
When Malingering is Suspected: A Structured Clinical Framework for Assessment and Documentation
BACKGROUND:
Distinguishing malingering from primary psychosis remains a common challenge across all psychiatric settings from emergency, consult-liaison, and to inpatient units. According to DSM-5-TR, malingering is defined as the intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives. Despite its prevalence, many clinicians receive limited formal training in its systematic assessment. Misidentification carries a bidirectional risk, as falsely labeling a genuinely psychotic patient as malingering may deny treatment whereas failure to detect malingering may result in misallocation of resources. Reliance on clinical impression alone, without structured observation or documentation of reasoning, leaves clinicians without clear documentation to support their decisions.
OBJECTIVE:
To review the clinical features that help distinguish malingering from genuine psychosis and to outline practical strategies for structured assessment and documentation across psychiatric settings.
METHODS:
A narrative literature review of peer-reviewed literature from PubMed and forensic guidelines from American Academy of Psychiatry and the Law (AAPL) was conducted, with a focus on clinical features of malingering psychosis, feigning detection, and defensible psychiatric practice.
RESULTS:
Malingered psychosis is suggested by patterns of inconsistency, atypical symptom phenomenology, and contextual incentives. The primary clinical challenge is not establishing a definitive diagnosis but making sound decision under condition of uncertainty, particularly when patient self-report is unreliable.
Effective assessment relies on four core elements, which include systematic observation of symptom patterns, explicit documentation of inconsistencies, integration of available collateral information, and acknowledgement of diagnostic uncertainty. These elements form the foundation for transparent and defensible clinical decision-making.
CONCLUSIONS:
Malingering and genuine psychosis share overlapping presentations that cannot not be reliably distinguished by clinical impression alone. The goal is not diagnostic certainty but making sound and well-reasoned decisions during times of uncertainty. A practical and transparent approach is characterized by recognition of clinical patterns, inconsistencies of symptoms, use of collateral information, and clear documentation of reasoning. This approach provides a practical standard for evaluating suspected malingering in everyday psychiatric practice.