Deception, Feigning, and Malingering

Dealing with inaccurate clinical information is a fact of medical life. In-accuracies can creep into the medical record because of transcription errors, misunderstandings by either the physician or the informant, or other human error, and once recorded, can persist indefinitely. Another source of inaccuracy is the patient’s choice to provide incorrect information. Patients may conceal the truth out of fear, shame, or mistrust; some go further and deliberately misrepresent symptoms by misattributing their causes, exaggerating their impacts, and even by making them up entirely. Attempted deception is believed to be commonplace among those seeking disability benefits or financial settlement and hardly unusual among those facing criminal charges. The prevalence and consequences of deception in routine clinical settings has generated little scholarly interest. In this article, barriers to the recognition, acknowledgement, and study of deceptive behaviors including malingering will be discussed.