Healthcare workers continue to face a persistent yet often overlooked challenge that strains clinical resources and complicates patient care — malingering.
A comprehensive clinical review published on April 12, 2026 in the National Library of Medicine’s StatPearls database, authored by Shah Swetang and Naveen Sharma, defines malingering as the “intentional fabrication or exaggeration of physical or psychological symptoms to obtain external incentives, such as financial compensation, avoidance of legal or occupational responsibilities, or access to housing or medications.”
The researchers emphasized that malingering is not a mental illness or clinical disorder. Instead, it is classified as a condition requiring clinical attention under the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, due to its impact on medical decision-making and resource use.
“Malingering is often described in the literature as ‘dimensional and episodic’ rather than ‘categorical,’ suggesting that this condition is better understood as a ‘spectrum’ that varies over time and context, rather than as an all-or-nothing phenomenon,” the researchers said.
“Symptom presentations are often dependent on external circumstances, potential rewards, and the clinical setting. Symptoms may resolve once the reward is attained, but they do not always resolve,” they added.
The review noted that motivations for malingering generally fall into two categories: avoiding difficult situations or obtaining a desired benefit.
Although difficult to measure due to the lack of definitive laboratory tests, the study cited data showing that about 15% to 20% of psychiatric assessments in legal settings involve malingering. In evaluations of competency to stand trial, the rate is estimated at around 17.5%, while up to 64.5% of jail inmates seeking psychiatric services may exhibit signs of symptom exaggeration.
“Individuals who are observed to be malingering may present with inconsistent symptoms, discrepancies between reported limits and actual behavior, and poor compliance with diagnostic evaluation. Patients may endorse improbable symptoms or provide internally inconsistent information,” the researchers said.
The study added that healthcare workers often encounter individuals suspected of malingering who seek controlled substances, temporary shelter, or relief from legal custody.
Data also showed that symptom exaggeration in disability and compensation-related cases ranges from 20% to 50%, with some assessments indicating rates of up to 60%.
“Malingering is suspected in a smaller but clinically significant group of patients who frequently present to emergency departments with exaggerated psychiatric or pain complaints. These visits are frequently linked to substance-seeking, evading the law, or seeking temporary housing or provisions,” the researchers said.
“Additionally, malingering might vary by gender. Some studies have indicated a greater prevalence among men, which may be explained in part because men are overrepresented in forensic and correctional milieus,” they added.
The study also underscored the distinction between malingering and factitious disorder. While individuals with factitious disorder feign illness for “primary gain,” such as psychological satisfaction from assuming the sick role, malingering is driven by “secondary gain,” or external incentives.
These may include avoiding criminal prosecution or military duty, securing financial compensation or disability benefits, and obtaining prescription drugs or shelter.
The American Psychiatric Association’s diagnostic manual advises clinicians to suspect malingering in medicolegal contexts, particularly when there are marked discrepancies between reported symptoms and objective findings, poor cooperation during evaluation, or the presence of antisocial personality disorder.
Researchers warned that undetected malingering can have significant medical and economic consequences. Unnecessary diagnostic tests, invasive procedures, and prolonged hospital stays can waste healthcare resources and expose patients to “iatrogenic harm,” or injury caused by medical interventions.
To address the issue, experts recommend the use of structured assessment tools, such as symptom validity tests, along with stronger interprofessional collaboration.
Crucially, the authors urged healthcare providers to maintain a neutral and objective approach when managing suspected cases.
“Interprofessional collaboration strengthens diagnostic precision and care consistency by integrating observations from physicians, primary care clinicians, advanced practice providers, nurses, psychologists, social workers, case managers, and pharmacists. Interprofessional communication provides the foundation for safe and ethical management. This allows teams to identify discrepancies, explain the rationale for suspected malingering, and discuss clinical concerns in case conferences and discussions,” the study concluded.
