Psychiatrists should use caution when trying to discern whether an inmate
is malingering, according to James Knoll, M.D.
"The DSM notes that under certain circumstances, malingering
is adaptive," he said, such as a prisoner of war's feigning illness."
I believe that being an inmate is not too much unlike being held
captive in a hostile environment."
Sometimes inmates must engage in maladaptive behaviors to get the attention
of the correctional facility's mental health staff. For instance, inmates may
cut themselves to get the attention of mental health staff when staff
resources are strained. Such behaviors do not constitute malingering in a true
sense, he said.
Knoll noted that it may be difficult to distinguish a patient's motives for
feigning symptoms in correctional settings. A patient who is malingering has
external motives for feigning symptoms, such as avoiding work or criminal
prosecution. However, some patients feign symptoms to play the "sick
role." In such cases, patients have factitious disorder and are not
Psychological tests used to detect malingering usually cannot determine
whether patients are malingering or have a factitious disorder. In addition,"
no psychological tests rule out all genuine illness," he
One of the reasons psychiatrists should use caution when applying a
diagnosis of malingering is that inmates will be cut off from psychiatric
treatment for an indefinite period of time, Knoll said.
A sure sign that an inmate is not malingering is improvement after
treatment, he noted. Another sign is a long history of special observations
for suicide attempts within the correctional system.