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Moving Beyond "Malingering": Reconceptualizing Feigned Symptoms as Motive-Based Phenomena
1Icahn School of Medicine at Mount Sinai, Attending Physician, Mount Sinai Health System, New York, New York, USA.
Behavioral Sciences & the Law
|July 17, 2026
Summary
Malingering, or feigning illness, is not a single behavior but driven by diverse motives. This study proposes a new taxonomy to better understand and ethically address these varied presentations.
Area of Science:
- Psychiatry
- Forensic Psychology
- Behavioral Science
Background:
- Malingering is traditionally viewed as a singular concept.
- Patients feign illness for various reasons, including material needs and legal avoidance.
- The current clinical category of malingering has limitations.
Purpose of the Study:
- To critique the limitations of the unitary construct of malingering.
- To propose a novel, motivation-based taxonomy for feigned symptoms.
- To enhance clinical approaches to feigned presentations.
Main Methods:
- Conceptual analysis of the construct of malingering.
- Development of a motivation-based taxonomy.
- Categorization of feigned symptoms based on underlying drivers.
Main Results:
- Identified limitations in treating malingering as a unitary construct.
- Proposed a taxonomy including Resource-Driven Symptom Expression (RDSE), Accountability-Avoidant Symptom Expression (AASE), Care Access Symptom Expression (CASE), and Socially Motivated Symptom Expression (SMSE).
- Demonstrated the utility of a motive-based framework.
Conclusions:
- Reframing feigned presentations by motive, not just symptoms, is crucial.
- A motivation-based approach allows for individualized, ethical, and just clinical practice.
- This taxonomy offers a more nuanced understanding of feigned illness.
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