DSM-IV-TR (American Psychiatric Association 2000, p. 739) notes that malingering should be "strongly suspected if any combination of the following" is noted:
1. Medicolegal context of presentation
2. Marked discrepancy between the person's claimed stress or disability and the objective findings
3. Lack of cooperation during the diagnostic evaluation and in complying with the prescribed treatment regimen
Clark (1997) has questioned the utility of singling out evaluees with antisocial personality disorder. He suggests that these individuals are simply more likely to be involved in adversarial situations in which it would benefit them to malinger, for example, if facing criminal charges. Edens and colleagues (2000) endorsed a contrary opinion, stating that results of their study "lend support to the position that the relationship between psychopathic personality features and malingering is not exclusively a function of an increased likelihood that dissimulation will occur in forensic contexts" (p. 293). They concluded that psychopathic traits are associated with attitudes that may be conducive to engaging in malingering in forensic settings.
The psychological research in this area suggests that a wide range of individuals with and without Axis I and Axis II psychiatric disorders engage in a variety of symptom exaggeration behaviors. Limiting the consideration of malingering only to individuals with diagnosable antisocial personality disorder will result in significant underdetection of individuals who are overendorsing or fabricating emotional and/or cognitive symptoms.
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