When Patients Overreport Symptoms: More Than Just Malingering

Abstract

Some mental-health patients exaggerate their symptoms. Clinicians and laypeople often interpret this symptom overreporting as a sign of malingering (Martin, Schroeder, & Odland, 2015; Thompson, Lin, & Parsloe, 2018), a label with negative connotations such as dishonesty and antisocial traits. These connotations are also evident in how the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5; American Psychiatric Association, 2013) portrays malingering. According to the DSM-5, the defining feature of malingering is the intentional overreporting of symptoms, motivated by financial or legal benefits. However, whereas malingerers will engage in symptom overreporting, not everyone who overreports symptoms is a malingerer. When this is overlooked, misunderstandings may arise. Consider, as an example, a widely used test called the Structured Inventory of Malingered Symptomatology (SIMS; Smith & Burger, 1997). The SIMS asks respondents to indicate whether or not they suffer from atypical symptoms; for example, "Sometimes I lose all feeling in my hand so that it is as if I have a glove on." Using the SIMS, a clinician may test whether, relative to normative data, a patient endorses a heightened number of atypical symptoms. If so, the patient is said to overreport symptoms, and questions can be raised 837681C DPXXX10.

Do You Know People Who Feign? Proxy Respondents About Feigned Symptoms

“…The literature on symptom exaggeration is blossoming (Bass & Halligan, 2014;Bass & Wade, 2019;Merckelbach et al, 2019;Suchy, 2019). "Malingering" is a frequently employed descriptive to refer to this phenomenon.…”

Prostate Cancer Radiotherapy: Increased Biochemical Control and Late Toxicity in Men With Medication Allergies

“…It is also notable that MAs are reported more frequently in patients with depression ( 48 , 49 ), anxiety ( 49 ), dissociative symptoms ( 50 ), and increased life stressors ( 51 ). Given that symptom overreporting has been demonstrated to be more frequent among patients with psychiatric diagnoses ( 52 , 53 ), it is possible that patients with MAs are more likely to report symptoms at time of follow-up, accounting for the increase in late toxicity observed. However, these alternative biologic mechanisms and/or symptom overreporting would not explain the improvement in biochemical control seen in patients with MAs and therefore seem unlikely to be the sole cause of the differences in the long-term outcomes reported herein.…”

The effects of symptom overreporting on PTSD treatment outcome

“…In addition, we used the SIMS as a standalone screening measure for overreporting, and did not include objective measures for external motives of patients. Future research should use additive performance validity tests which measure cognitive underperformance (Merkelbach et al, 2019 ), and gather information about patients’ external incentives. Further, our results are limited to PTSD patients in this specific clinical context, and cannot be generalized to other treatment settings, such as a forensic or military setting.…”

“…Young, 2015 ). However, some researchers have emphasized that symptom overreporting may have other underlying reasons than malingering per se (Merckelbach, Dandachi-FitzGerald, van Helvoort, Jelicic, & Otgaar, 2019 ), such as inattentive responding that may be caused by specific genuine PTSD-symptoms. For instance, difficulties with concentration, one of the key symptoms of PTSD, may lead to low attention, and thereby to inadequate answering of items on a questionnaire.…”