Models of Malingering Behavior

Rogers and colleagues (Rogers 1990; Rogers et al. 1994) have outlined the primary motivations implicit in three explanatory models of malingering: 1) pathogenic, 2) criminological, and 3) adaptational. The pathogenic model proposes that malingering is motivated by an underlying condition that eventually deteriorates and surfaces as the illness progresses. This model has lost support over the past several decades (Rogers 1997, 2008).

The criminological model focuses on multiple aspects of an individual's bad character and bad behavior, "namely, a bad person (antisocial personality disorder), in bad circumstances (legal difficulties), who is performing badly (uncooperative)" (Rogers 1997, p. 7). Rogers (2008, p. 9) indicated that the "DSM classifications (1980, 1987, 1994, 2000) have adopted the criminological model to explain the primary motivation for malingering," but "[w]hen DSM indices are evaluated in a criminal forensic setting, they are wrong four out of five times." According to Rogers (2008, p. 9), "the DSM indicators should not be used even as a screen for potential malingering because they produce an unacceptable error rate." That being said, other studies have examined the relationship between psychopathy and malingering and lend some support to the criminological model. Gacono and colleagues (1995) compared hospitalized insanity acquitees who had successfully malingered mental illness to insanity acquitees who were deemed to be truly insane. This study revealed a significantly higher number of antisocial personality disorder diagnoses among malingerers. A study of 143 college students investigated the relationship between psychopathic personality traits and ma-

Is there a medical or psychiatric disorder that fully explains signs and symptoms of illness in question?

FIGURE 17-1. Differentiation between malingering, factitious disorders, somatoform disorders, and valid medical/psychiatric conditions.

lingering, using the Psychopathic Personality Inventory. The study authors proposed that "psychopathy is somewhat predictive of a willingness to feign mental illness across various forensic/correctional settings" (Edens et al. 2000, p. 290).

The adaptational model, delineated by Rogers (1997), proposes that malingerers engage in a "cost-benefit analysis" (p. 8) during clinician assessment. As Rogers (1997) noted, "Malingering is more likely to occur when 1) the context of the evaluation is perceived as adversarial, 2) the personal stakes are very high, and 3) no other alternatives appear to be viable" (p. 8). In this model, individuals malinger on the basis of their estimate of success in obtaining the desired external incentive. Despite criticism of DSM-IV-TR's overreliance on a criminological model (Rogers 2008), DSM-IV-TR is not completely silent on the issue of the adaptational model, noting, "Under some circumstances, malingering may represent adaptive behavior—for example, feigning illness while a captive of the enemy during wartime" (American Psychiatric Association 2000, p. 739).

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