Prevalence Estimates of Symptom Feigning and Malingering in Spain

Abstract

Symptom feigning and malingering should be evaluated in forensic contexts due to their important socio-economic consequences. Despite this, to date, there is little research in Spain that evaluates its prevalence. The aim of this study was to investigate this issue using the perception of the general population, students, and professionals of medicine and forensic psychology. Three adapted questionnaires were applied to a total of 1003 participants (61.5% women) from 5 different groups. Approximately two-thirds of participants reported knowing someone who feigned symptoms, and one-third disclosed feigning symptoms themselves in the past. Headache/migraine, neck pain, and anxious–depressive symptoms were the most commonly chosen. Experts in psychology and forensic medicine estimated a prevalence of 20 to 40% of non-credible symptom presentations in their work settings and reported not having sufficient means to assess the distorted presentation of symptoms with certainty. Professionals and laypersons alike acknowledge that non-credible symptom presentations (like feigning or malingering) are relevant in Spain and occur at a non-trivial rate, which compares with estimates in other parts of the world.

Laypeople's prevalence estimates of malingering: Survey data from the Netherlands.

“…This result contradicts myths continuously held among some clinicians and even forensic experts that malingering was a rare or even negligeable event (e.g., Ramesh, 2013). However, the number of participants who admitted having feigned symptoms themselves at some point in the past (14.3%) turned out to be relatively low, in contrast to results obtained in other studies (Dandachi-FitzGerald et al, 2020: 34.2%; Merten & Giger, 2018: 41.0%; Puente-López et al, 2022: 33.9%). The most plausible explanation for this discrepancy is the definition of the Dutch simulatie to be limited to pure malingering only.…”

“…Ever since the seminal survey by Mittenberg et al (2002), the international literature has brought about a notable number of expert surveys investigating the prevalence of malingered, feigned, or otherwise invalid symptom presentations both among forensic and clinical patient groups (e.g., Dandachi-FitzGerald et al, 2013; Martin et al, 2015; Santamaría et al, 2013). More recently, a number of surveys from different countries (e.g., from the U.S.: Aita et al, 2020; from the Netherlands: Dandachi-FitzGerald et al, 2020; from Italy: Giromini et al, 2022; from Spain: Puente-López et al, 2022) confirm our main result that noncredible symptom presentations are perceived by experts to occur in a sizable, nontrivial number of cases. Also, in more recent years, noncredible symptom reports in clinical and rehabilitation contexts have increasingly drawn the attention of researchers and practitioners alike (e.g., Carone & Bush, 2018; Martin & Schroeder, 2020; Merten et al, 2020; Schroeder & Martin, 2022).…”

“…This number is well in line with results from various expert surveys, in particular those estimates published by Mittenberg et al (2002) for personal injury cases (adjusted base rate: 34.4%) and disability or worker’s compensation referrals (32.7%). Other expert surveys yielded similar estimates of noncredible symptom presentations or malingering (e.g., Aita et al, 2020: up to 29.3% of chronic pain patients; Dandachi-FitzGerald et al, 2013: 20% of forensic neuropsychological patients; Puente-López et al, 2022: 20 to 40% of forensic psychological cases). They also compare with the results of another study from the Netherlands.…”

The prevalence of feigning and concealment of Covid-19 infections in an international sample

“…Further, more than a third of the sample (34%, n = 341) admitted having feigned symptoms themselves. Headaches/migraines, neck pain and depression-anxiety related complaints were the most popular complaints used to secure a sick leave from work/school and monetary benefits ( Puente-López et al, 2023 ). In both surveys, the preference for certain symptoms to be feigned was related to how easy it is to feign them and whether one has prior experience with these symptoms (i.e.…”

“…In both surveys, the preference for certain symptoms to be feigned was related to how easy it is to feign them and whether one has prior experience with these symptoms (i.e. familiarity; Dandachi-FitzGerald et al, 2020 ; Puente-López et al, 2023 ).…”