Malingering

Definition

Malingering is the intentional production of false or grossly exaggerated symptoms motivated by external incentives. Financial compensation, avoiding work/legal responsibilities, obtaining drugs, or attention.

Differentiation

• Malingering: Conscious, for external gain.
• Factitious disorder: Conscious symptom production for internal gain (sick role).
• Somatic symptom disorder: Real distress; symptoms may have no medical explanation but are not feigned.
• Conversion disorder: Unconscious conversion of psychological stress to physical symptoms.

Clinical Red Flags

Inconsistent symptoms on repeat examination, lack of objective findings, symptoms worsen when observed, medical-legal context, history of similar presentations.

Nursing Considerations

Remain nonjudgmental. Avoid labeling the patient. Thorough medical workup to rule out real pathology. Use consistent documentation. Consult psychiatry/behavioral health.

NCLEX Relevance

Conscious + external gain = malingering. Compare with somatic symptom disorder.