DSM-IV-TR classifies malingering under "Additional Conditions That May Be a Focus of Clinical Attention." Malingering in this nomenclature is not considered to be a diagnosis, as by definition it is "the intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives" (American Psychiatric Association 2000). External incentives that may motivate a person to malinger symptoms include avoiding work, evading criminal prosecution, obtaining drugs, receiving financial compensation, avoiding military duty, or escaping other intolerable situations. Table 14–5 provides the DSM-IV-TR guidelines for when to suspect malingering. However, many experts consider these criteria overly broad and inclusive, which may in turn lead to the overidentification of patients as malingerers. For example, Rogers (1990a) noted that using these guidelines as criteria for detecting malingering—that is, requiring that an individual meet two of the four criteria—leads to the correct classification of approximately two-thirds of true malingerers. However, he determined that this strategy led to the overclassification of true psychiatric patients. Rogers concluded that persons meeting two of the four DSM-IV-TR criteria have a one in five chance of being a true malingerer. An 80% false-positive rate is inordinately high and generally considered unacceptable.

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TABLE 14–5. DSM-IV-TR warning signs for malingering
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TABLE 14–6. Clinical decision model for the assessment of malingering of psychosis
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TABLE 14–7. Threshold model for the assessment of hallucinations and delusions
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TABLE 14–8. Standardized assessments for detecting the malingering of psychiatric disturbances


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