Recently, the man charged with murdering Chris Kyle, a U.S. Navy sniper whose autobiography inspired the film American Sniper, was said to have faked schizophrenia. Yet, the defense expert witness testified that the accused had paranoid schizophrenia and exhibited signs that could not be faked (Herskovitz, 2015).
So the question arises, how does one distinguish feigned psychosis from the authentic experience of psychotic disturbance?
First, it is important to understand that malingering is an intentional and voluntary deception for secondary gain by fabricating or grossly exaggerating psychiatric symptoms (American Psychiatric Association [APA], 2013). Also, becoming familiar with the diagnostic criteria for Schizophrenia Spectrum and Other Psychotic Disorders is needed to recognize thought-disorder-based psychosis. Additionally, understanding the cluster of symptoms and how they contribute to psychosocial impairment is necessary when assessing psychosis (Richter, 2014).
Malingered psychosis is skewed to the presentation of positive rather than negative symptoms of schizophrenia (Resnick & Knoll, 2008). Specifically, those who malinger are found to show higher proclivity of bogus symptoms, suicidal ideation, visual hallucination, and memory problems (Cornell & Hawk, 1989, as cited in Richter, 2014). A sudden onset of positive symptoms, with no history of negative or chronic symptoms may indicate possible malingering (Richter, 2014).
With schizophrenia, the experiences of tactile and olfactory hallucinations are rare, tend to be intermittent and correlate with existing delusions (Richter, 2014). Possible malingering is suspected when hallucinations are “continuous or not associated with delusions” (Richter, 2014, p. 216). Also, no indications of developed coping strategies for hallucinations are common with malingered psychosis (Richter, 2014). Individuals who malinger report visual hallucinations more often (Richter, 2014). Of note, genuine visual hallucinations tend to be in color, are of normal sized people, may appear suddenly, and do not change if eyes are open or closed (Caldwell, 2009; Resnick, 1997; as cited in Richter, 2014). Auditory hallucinations are most common in schizophrenia, and usually are clear, with both familiar and unfamiliar voices of male and female type (Richter, 2014). Malingered command hallucinations are presented as terrifying and overpowering, with the inability to resist compliance (Richter, 2014). They are also characterized as being dramatic, with stilted language, as well as continuous and presented without association to delusional thought (Richter, 2014).
Delusions as presented by the malingering person often have a sudden onset or termination and the individual eagerly discusses the content (Richter, 2014). Malingering is suspected when disclosure of persecutory nature occurs in the absence of paranoid behavior (Richter, 2014) and when bizarre, atypical delusions are presented without disorganized thought (Resnick & Knoll, 2005; as cited in Richter, 2014). In general, the absence of disorganized thinking is often associated with malingering (Richter, 2014).
Furthermore, individuals who malinger initially show treatment compliance, yet become difficult, often accusing the clinician of believing their symptoms are being faked (Resnick & Knoll, 2008). Moreover, highly social behavior is largely inconsistent with the negative symptoms of schizophrenia and would suggest malingering if observed. Overall, the negative symptoms (anhedonia, alogia, avolition) are often not consistent with malingered psychosis, but are replaced by bizarre positive symptoms (Richter, 2014). The above material offers a brief synopsis of characteristics consistent with malingered psychosis, for a more comprehensive review and discussion of assessment strategies please see Richter’s (2014) article listed below.
American Psyciatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Herskovitz, J. (2015, February 20). Accused in U.S. sniper’s murder faked schizophrenia: psychologist. Reuters, retrieved from http://news.yahoo.com/accused-u-snipers-murder-faked-schizophrenia-psychologist-172922927.html
Richter, J. G. (2014). Assessment of malingered psychosis in mental health counseling. Journal of Mental Health Counseling, 36(3), 208-227.
Dannie Harris, M.A., M.A., M.A.Ed., Ed.S.,
WKPIC Practicum Trainee