Individuals sometimes falsely report symptoms of mental illness during forensic evaluations. They might falsely report relatively minor symptoms, such as anxiety or insomnia, or they might pretend to suffer from a severe illness, such as schizophrenia. The reasons for this behavior are wide-ranging and deserve an entire series, but in this post we’re going to explore some useful strategies to help determine if symptoms are feigned or genuine.
Like medical illnesses, psychiatric illnesses are based in biology. At their core, psychiatric illnesses are due to malfunctioning neurons in the brain. Illnesses are defined by their symptoms, onset, and progression. The combinations and characteristics of expected symptoms are well-defined. Of course, illnesses don’t read the textbooks, but it is useful to remember that typical features are common and unusual features are uncommon.
You can fool some of the people all of the time, and all of the people some of the time, but you can not fool all of the people all of the time.
Time is the most powerful tool for detecting a fabricated mental illness. Pretending to have a severe mental illness is not easy. One must first know how an affected individual behaves, convincingly behave in that way, and then maintain the behavior whenever they might be observed. In certain settings that could mean pretending for 24 hours a day.
Time also presents a different sort of challenge. In general, mental illnesses don’t occur at random. Psychotic illnesses, for example, tend to occur within a usual age range and follow a typical progression. It is extremely suspicious if a person suddenly develops unusual symptoms in the context of legal trouble.
Many individuals will falsely report symptoms without any attempt to manifest the symptoms, or they will pretend to manifest the symptoms only when a specific question reminds them to do so. Pretending to experience hallucinations is difficult to maintain for a long conversation.
Individuals sometimes use dramatic language in an attempt to emphasize the severity of the symptoms. They might report seeing “demons” or being haunted by a small child. Claiming to see “dead people,” ghosts, or shadows is remarkably common. Dramatic language should raise suspicions about the nature of the reported symptoms.
It is important to remember that uncommon or atypical illnesses do occur. Additionally, severely ill individuals sometimes report false symptoms. Confidently identifying which symptoms are fabricated and which symptoms are real takes years of experience.