Characteristics of Studies on the Diagnosis of Malingering: A Systematic Review

The authors of this review aimed to examine the characteristics of published research on the clinical diagnosis of malingering and to critically assess the reporting of data on housing, race-ethnicity, and co-occurring psychiatric disorders.

Five databases (Embase, MEDLINE, ProQuest Dissertations and Theses Global, PsycInfo, and Web of Science) were searched from database inception to June 17, 2025. Results were independently screened by two researchers to identify studies of patients given a diagnosis of malingering in a clinical setting. PRISMA guidelines were followed.

Of 3,150 records screened, 21 articles were included. Methods of identifying malingering used by these studies included the nonmutually exclusive categories of chart review (N=17 studies, 81%), ICD codes (N=7, 33%), and DSM criteria (N=3, 14%). Only five (24%) articles reported the housing status of individuals given a diagnosis of malingering. The racial-ethnic characteristics of people determined to be malingering were seldom reported (N=6, 29%). Although nine (43%) articles reported the prevalence of co-occurring psychiatric disorders among people determined to be malingering, the focus of reporting was overwhelmingly on personality, mood, psychotic, and substance use-related disorders, with limited coverage of cognitive disorders and anxiety- and trauma-related disorders. Only three (14%) articles reported data on longitudinal mental health outcomes such as overdose and suicide.

Limited data are available with regard to how diagnostic decisions about malingering take into consideration patients' housing status and mental health history. Potential racial-ethnic disparities in malingering diagnoses are poorly characterized.