Current issues in the diagnosis and management of malingering

Malingering is a diagnosis that is frequently avoided by physicians. When t here is a claim of symptoms or diseases that either are exaggerated or do n ot exist, the diagnosis of malingering should be entertained. Malingering i s associated with a conscious intent to deceive in order to obtain a known gain. Psychoanalytical, criteria-based (DSM-IV) and 'adaptational' models h ave been advanced to explain malingering, The differential diagnosis of mal ingering includes factitious disorder, the somatoform disorders, the dissoc iative disorders, and specific medical conditions without somatoform disord er. Upon consideration of the differential diagnosis, confirmation of the s uspicion of malingering is still required in order to make the diagnosis. C onfirmation can be achieved by observation or by inferential methods. Obser vation can be employed with controlled environment observation or with cove rt, 'real- world' surveillance; inference may involve primary and/or second ary source information. It may be concluded that a greater attempt should b e made to identify this diagnosis, as the cost of malingering to society is considerable.