Malingering is not all or nothing, and it is less common than people think, though exaggeration is common. Lean on evidence from the time of the event, a long open conversation and your mental status exam, and unless you are trained in formal malingering assessment, do not call it.
What it is
Malingering is not a binary of fully genuine or fully malingering. That is all-or-nothing thinking; there are many varieties.
“people think of malingering as some binary where you're either fully genuine or fully malingering. And that's the splitting aspect again, right? That's all or nothing type thinking. There are so many varieties”
16:27Lindsay Clancy Case: Biggest Misconceptions After the Mistrial Explained by a Forensic PsychiatristSep 2026 Malingering is not as common as you would think, though exaggeration of symptoms is probably pretty common. People who are malingering tend to get filtered out by the legal system.
“I guess malingering is not as common as you'd think. Exaggeration of symptoms is probably pretty common, but basically people who are malingering, they tend to be Filtered out by that system”
24:04Lindsay Clancy Trial: A Forensic Psychiatrist Explains Psychosis, Malingering, & the Insanity DefenseSep 2026
What it gets confused with
Some symptoms are genuine and believed by the patient but do not come from the disorder they think. They come from the unconscious, from stress or from motivations.
“There's the category of genuine symptoms that the subject believes in, but don't actually come from the disorder that they think. Coming from the unconscious, coming from stress, coming from motivations”
19:56Lindsay Clancy Case: Biggest Misconceptions After the Mistrial Explained by a Forensic PsychiatristSep 2026 Be careful with language: a fully feigned seizure is not a psychogenic seizure, it is a malingered seizure.
“Those aren't psychogenic seizures then. Those are just malingering seizures. Those are just malingering seizures. We have to be very careful in our language”
21:46Lindsay Clancy Case: Biggest Misconceptions After the Mistrial Explained by a Forensic PsychiatristSep 2026 Dissimulation is the reverse: patients with subtle mood and psychotic disorders and low insight who present as healthy because they do not want to be found mentally ill.
“you can see patients who are dissimulating health. So these subtle patients with subtle mood and psychotic disorders, low insight, they often do not want to be found as mentally ill”
26:21Lessons from Forensic Psychiatry: Insanity Defense, Subtle Patients and CulpabilityApr 2025
How we assess it
Start with a pre-evaluation probability of what has been happening, and let the evaluation confirm or overturn it based on the evidence.
“We have a pre-evaluation probability of one particular category of what has been happening. And the evaluation either overturns that assumption based on the available evidence or it confirms it”
17:00Lindsay Clancy Trial: A Forensic Psychiatrist Explains Psychosis, Malingering, & the Insanity DefenseSep 2026 Evidence from the time of the incident is worth more than anyone's recollection after the fact, because memory is fallible.
“evidence that is from that time of the incident is worth more than any recollection by a person after the fact because memory is fallible”
15:39Lindsay Clancy Trial: A Forensic Psychiatrist Explains Psychosis, Malingering, & the Insanity DefenseSep 2026 To detect dissimulation, hold a prolonged conversation that has little to do with evaluating specific symptoms. Talk about things that seem unrelated, and rely on your mental status exam rather than on what the patient says.
“the best way to detect any kind of issues with someone who's dissimulating is to try to hold a prolonged conversation that has nothing or very little to do with evaluating for specific symptoms”
28:22Lessons from Forensic Psychiatry: Insanity Defense, Subtle Patients and CulpabilityApr 2025 Also said in 1 more episode
“You want to talk to them about things that seem unrelated and you want to rely on your mental status exam rather than relying on the output statements of the patient around you”
30:09Lessons from Forensic Psychiatry: Insanity Defense, Subtle Patients and CulpabilityApr 2025
In ordinary clinical work
If you are not experienced in formal malingering assessment, do not call malingering.
“I don't think it's a good idea for people who are not experienced with malingering assessment, formal malingering assessment to call malingering”
29:29Disability Claims 101 for Psychiatrists: Programs, Pitfalls, and Practical StepsDec 2025 In disability evaluations you do not have to act like a forensic evaluator. You are still a medical evaluator doing your regular job.
“Don't believe or feel or act like you have to be a forensic evaluator. You're still a medical evaluator here. You're just doing your regular job”
28:52Disability Claims 101 for Psychiatrists: Programs, Pitfalls, and Practical StepsDec 2025 In clinic the outcome is simply getting the patient better, so you do not have to worry about this as much. In legal work you need to strike a balance.
“In clinic, our outcome is simply getting the patient better. So we don't have to worry about this stuff as much. But when it comes to the law, we need to strike a balance”
18:45Lindsay Clancy Case: Biggest Misconceptions After the Mistrial Explained by a Forensic PsychiatristSep 2026 Do not dismiss a patient as "just malingering." If you think so, put into words a full assessment of why.
“I was always bothered by the intern who's like, oh, they're just malingering. And it's like, well, put into words, verbalize. If you can't give me a full assessment as to why you think that”
52:24Lessons from Forensic Psychiatry: Insanity Defense, Subtle Patients and CulpabilityApr 2025
From these episodes
- Lindsay Clancy Case: Biggest Misconceptions After the Mistrial Explained by a Forensic PsychiatristSep 2026 · 4 points
- Lindsay Clancy Trial: A Forensic Psychiatrist Explains Psychosis, Malingering, & the Insanity DefenseSep 2026 · 3 points
- Disability Claims 101 for Psychiatrists: Programs, Pitfalls, and Practical StepsDec 2025 · 2 points
- Lessons from Forensic Psychiatry: Insanity Defense, Subtle Patients and CulpabilityApr 2025 · 4 points
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.