A patient can have a valid disorder yet still be malingering (falsifying complaints for purposes of tangible gain). Malingering is not a clinical disorder and it is not a fixed point on a scale. Partial malingering is under voluntary control.
Many in the legal and healthcare arenas believe a person either is, or is not, malingering, and if exaggeration of symptoms is present, the entire complaint must be invalid. This belief is inaccurate as is the conviction that someone (me) must determine that one exists to the exclusion of the other.
If you look at malingering as the continuum (and that it is), then you realize that a patient can be entirely and deliberately embellishing or amplifying only one aspect of symptoms while the rest of the complaint is quite real. Think in terms of a common life example: An employee has an uncomfortable “common cold.” S/he calls in and indicates a complete inability to work that day. Partial malingering can be at play.
In reality, the employee knows that working is possible. It would merely be uncomfortable, but the employee would prefer to stay home. S/he purposefully sounds more ill on the telephone and deliberately coughs and sniffs until reassured by the employer that taking the day off is acceptable. A stomachache may be means of avoiding school on the day of a presentation. A headache may be an effective means of avoiding…
It is not that difficult to understand why injured workers would embellish a valid complaint. While s/he has a backache, and has valid diagnostic findings, in reality that employee may be able to work. However for a number of reasons, the employee prefers not to return to work. Similarly, a depressed patient may have long worked with this dysphoric mood, but if given the opportunity now to avoid a return to work, s/he may exaggerate the degree or extent of the depressive symptoms to remain more comfortably at home.
A surgeon once explained that an injury may be quite real, but electing to present that complaint as “disabling” can be conscious and purposeful; partial malingering. It can be a choice. If an injured worker has indeed developed symptoms of a major depressive disorder, there are, by definition, limitations in occupational and social functioning.
And as we know, most limitations can be transcended if the individual is properly motivated. But many symptoms can be presented as disabling if the patient has conscious reason not return to the job. Angry employees, fearful employees, blameful employees, frustrated employees, and even bored and restless employees may find within themselves sufficient motivation to exaggerate a complaint to avoid or delay returning to work.
A better question to ask is, “Why is this person exaggerating his/her symptoms and can this behavior be effectively addressed?”