Base rates of malingering and symptom exaggeration

J Clin Exp Neuropsychol. 2002 Dec;24(8):1094-102. doi: 10.1076/jcen.24.8.1094.8379.


Base rates of probable malingering and symptom exaggeration are reported from a survey of the American Board of Clinical Neuropsychology membership. Estimates were based on 33,531 annual cases involved in personal injury, (n = 6,371). disability (n = 3,688), criminal (n = 1,341), or medical (n = 22,131) matters. Base rates did not differ among geographic regions or practice settings, but were related to the proportion of plaintiff versus defense referrals. Reported rates would be 2-4% higher if variance due to referral source was controlled. Twenty-nine percent of personal injury, 30% of disability, 19% of criminal, and 8% of medical cases involved probable malingering and symptom exaggeration. Thirty-nine percent of mild head injury, 35% of fibromyalgia/chronic fatigue, 31% of chronic pain, 27% of neurotoxic, and 22% of electrical injury claims resulted in diagnostic impressions of probable malingering. Diagnosis was supported by multiple sources of evidence, including severity (65% of cases) or pattern (64% of cases) of cognitive impairment that was inconsistent with the condition, scores below empirical cutoffs on forced choice tests (57% of cases), discrepancies among records, self-report, and observed behavior (56%), implausible self-reported symptoms in interview (46%), implausible changes in test scores across repeated examinations (45%), and validity scales on objective personality tests (38% of cases).

Publication types

  • Comparative Study

MeSH terms

  • Demography
  • Diagnosis, Differential
  • Disability Evaluation*
  • Expert Testimony
  • Humans
  • Malingering / diagnosis
  • Malingering / epidemiology*
  • Malingering / psychology
  • Neuropsychological Tests / standards*
  • Reproducibility of Results
  • Sick Role
  • Workers' Compensation / statistics & numerical data