“Yet there’s method in his madness …”: Dimensions of deception and dangerousness

Undiagnosed malingering (symptom overreporting or fabrication) can endanger mental health staff. This review paper presents a systematic and empirically based framework to assess symptom overreporting and violence potential. The first half reviews three models of malingering and their implications for violence potential. The first model proposes that people who malinger are attempting to cope with major mental disorders or organic deficits. The violence potential of these often overlooked disorders is explained. The second model describes how some people with character disorders overreport psychological symptoms and use violence to manage interpersonal relationships. The third model proposes that people who malinger are attempting to get their needs met in complex situations. Mishandling these often desperate people can result in a dangerous situation. The second half of this article focuses on conducting evaluations with potential malingerers, including ethical issues, assessment techniques, and treatment recommendations. Public policy implications are also addressed.