Malingering, Exaggeration, and Symptom Validity in New York Psychiatric IMEs

Stephan M. Carlson, MD, MBA, FAPA · Civil Psychiatric IME

“Malingering” is one of the most damaging words a psychiatric examiner can write. It is also one of the easiest to write carelessly. In a civil psychiatric IME, the core question is usually not whether the plaintiff is lying. It is whether the presentation is sufficiently reliable to support the claimed diagnosis, impairment, and causation opinion. What malingering is and is not DSM-5-TR classifies malingering as a condition that may be a focus of clinical attention, not as a psychiatric disorder. It involves intentional production or gross exaggeration of symptoms motivated by external incentives, such as money, avoiding work, medication access, or legal advantage. Two elements matter: inte

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