A Couple More Tips for Spotting Malingering

“So long as there is imagination there is hope.”

Christopher Fowler
British Writer, circa 1998

A Couple More Tips for Spotting Malingering

TISA Description of the Problem: Spotting clients who are malingering is frequently not easy. These difficult assessment situations are fairly common in clinical tasks such as emergency room assessments (when patients are malingering to obtain admission), prison settings (when patients are malingering to get access to medical units to escape problems back in their own cell blocks), and in disability assessments. Kevin Rice, LCSW has several excellent tips that can assist the clinician as he or she attempts to spot malingering.

Tip: I find that one of the best ways to spot malingering is to ask the client about symptoms that rarely, if ever occur in the real world of psychopathology. Often malingering clients assume that if a symptom is asked about, then obviously the clinician has seen it before. In an effort to “look sick” such clients will sometimes endorse outlandish symptoms thus tipping that malingering is afoot. In this light I find the following two questions to be of use:

“When you hear voices, do you ever actually feel lips touching up against one of your ears?”

“Do you ever have the experience of hearing a voice and simultaneously, at the exact same time, smell odors like burning rubber or spoiled food?”

TISA Follow-up: Questions such as the above can be surprisingly effective at uncovering a malingered history. It emphasizes yet one other reason why a thorough understanding of the phenomenology of psychopathological symptoms can prove to be invaluable in clinical practice. Here it is the clinician’s understanding of what is not common during the process of auditory hallucinations that does the trick.

Tip provided by:

Kevin Rice, LCSW
Tri-city Mental Health Center
Pomona, California