Detecting when someone is feigning illness can be a challenge, especially in Social Work settings where clients present with a wide range of medical and psychological concerns. Whether it’s in clinical practice, forensic evaluations, or community interventions, Social Workers must be equipped to recognize when symptoms are exaggerated or fabricated.
Understanding feigning illness indicators isn’t just a valuable skill—it’s essential for making ethical and informed decisions. And if you’re preparing for the ASWB exam, you can expect to encounter questions that test your ability to assess these situations accurately.
The ASWB exam doesn’t just measure memorization; it evaluates critical thinking, ethical reasoning, and practical application. You’ll need to analyze case scenarios, recognize inconsistencies in reported symptoms, and determine appropriate next steps. Without a solid grasp of feigning illness indicators, you could struggle with exam questions that require you to differentiate between genuine conditions and malingering. That’s why targeted preparation is crucial—so you can confidently navigate these challenges, both on the exam and in real-world practice.
Fortunately, you don’t have to prepare alone! Agents of Change offers top-tier study resources, including practice exams, live study groups, and flashcards designed to strengthen your understanding of ASWB exam topics like feigning illness.
Learn more about the ASWB exam and create a personalized ASWB study plan with Agents of Change. We’ve helped tens of thousands of Social Workers pass their ASWB exams and want to help you be next!
1) What Are Feigning Illness Indicators?
Feigning illness indicators are signs that a person may be fabricating, exaggerating, or intentionally inducing symptoms of a medical or psychological condition.
Social Workers often encounter clients who present with symptoms that don’t align with objective medical findings or whose motivations for seeking a diagnosis appear questionable. Identifying these indicators is critical to ensuring appropriate interventions while maintaining ethical standards.
Why Do People Feign Illness?
People feign illness for various reasons, often tied to external rewards or personal motives. Some of the most common reasons include:
- Financial Gain – Seeking disability benefits, workers’ compensation, or insurance payouts.
- Avoiding Responsibilities – Escaping work, legal consequences, or military service.
- Seeking Medications – Attempting to obtain prescription drugs, often opioids or benzodiazepines.
- Gaining Attention or Sympathy – Seeking validation from family, friends, or healthcare providers.
- Accessing Services – Trying to qualify for housing, financial assistance, or mental health services.
Understanding a person’s possible motives can help Social Workers assess the validity of their claims while maintaining an empathetic approach.
Key Signs of Feigning Illness
Not every case of reported illness is fabricated, but there are several telltale signs that Social Workers should be aware of when evaluating a client’s symptoms.
1. Inconsistencies in Symptoms
One of the strongest indicators of feigned illness is when a client’s symptoms don’t match their observed behavior. Some red flags include:
- Complaints of severe pain but no physiological evidence to support it.
- Symptoms that shift dramatically depending on the audience.
- Discrepancies between reported and observed physical limitations (e.g., a person claiming severe back pain but seen lifting heavy objects effortlessly).
2. Overly Dramatic or Vague Descriptions
Clients who feign illness often describe their symptoms in extreme or theatrical ways while struggling to provide clear details. Be wary of:
- Excessive use of emotionally charged language (e.g., “I’m in the worst pain imaginable!”).
- Descriptions that seem rehearsed or exaggerated.
- A lack of specificity when asked to elaborate on symptoms.
3. Resistance to Examination or Treatment
While most people seeking medical help are eager for solutions, those who feign illness often avoid deeper scrutiny. They may:
- Refuse diagnostic tests or medical evaluations.
- React defensively when inconsistencies are pointed out.
- Dismiss suggested treatments that don’t align with their personal goals (e.g., rejecting non-narcotic pain relief).
4. Secondary Gains and External Incentives
A major red flag in feigning illness cases is the presence of clear external benefits. Social Workers should consider:
- The client’s financial, legal, or personal motivations.
- Patterns of using illness claims to avoid responsibilities.
- Previous documented instances of malingering or symptom exaggeration.
How Feigning Illness Differs from Factitious Disorder
Feigning illness (malingering) is often confused with factitious disorder, but they are distinct conditions.
| Feigning Illness (Malingering) | Factitious Disorder |
|---|---|
| Motivated by external rewards (e.g., money, avoiding work). | Motivated by a psychological need to assume the sick role. |
| Symptoms are consciously fabricated or exaggerated. | Symptoms may be intentionally induced, but without clear external benefits. |
| Clients often avoid medical scrutiny or reject treatments that don’t serve their goals. | Clients may eagerly undergo procedures, even at personal risk. |
Social Workers must be able to distinguish between these conditions to provide appropriate interventions and referrals.
What to Do If You Suspect Feigned Illness
If you encounter a client who may be feigning illness, take the following steps:
- Remain Objective – Avoid making immediate assumptions and continue gathering evidence.
- Document Thoroughly – Keep detailed notes on reported versus observed symptoms.
- Consult with Medical Professionals – Work alongside healthcare providers to confirm or rule out legitimate conditions.
- Assess for Underlying Issues – Sometimes, feigned illness is tied to deeper concerns, such as trauma or unmet needs.
Recognizing feigning illness indicators is an essential skill for Social Workers, both in real-world practice and on the ASWB exam. The better you understand these patterns, the more effectively you can navigate client interactions and ensure ethical, informed decision-making.
Agents of Change packages include 30+ ASWB topics, 2 free study groups per month, and hundreds of practice questions so you’ll be ready for test day!
2) Feigning Illness and the ASWB Exam
If you’re preparing for the ASWB exam, understanding feigning illness indicators is crucial. The exam is designed to test your ability to assess, diagnose, and ethically manage cases where malingering may be present. You’ll likely encounter questions that require you to analyze client behavior, identify inconsistencies, and determine the best course of action—all while maintaining professional integrity.
Below, we’ll explore how feigning illness appears on the ASWB exam, the types of questions you may face, and how to best prepare.
How Feigning Illness Appears on the ASWB Exam
Feigning illness isn’t just a theoretical concept—it’s a real-world issue that Social Workers must navigate carefully. The ASWB exam integrates questions on this topic into various domains, including:
- Assessment and Diagnosis – Recognizing malingering versus genuine mental health conditions.
- Ethics and Professionalism – Responding appropriately when a client is suspected of feigning symptoms.
- Intervention Planning – Determining the most appropriate next steps when dealing with potential malingering.
Since the ASWB exam emphasizes real-world scenarios, expect to analyze case studies that require critical thinking.
Types of ASWB Exam Questions on Feigning Illness
Understanding the structure of ASWB exam questions can help you feel more prepared. Below are common question formats:
1. Case Scenario Questions
You may be presented with a clinical case and asked to determine whether feigning illness is a possibility.
Example Question:
A Social Worker in a hospital setting meets with a 35-year-old male who reports severe back pain due to a workplace injury. However, medical evaluations show no evidence of injury, and the client refuses physical therapy but insists on receiving opioid medication. The Social Worker notices that the client walks normally when he thinks no one is watching but winces dramatically when observed. What is the Social Worker’s best course of action?
A. Immediately confront the client and inform him that malingering is unethical.
B. Report the client for insurance fraud based on observed behaviors.
C. Continue assessing the client, documenting observations, and refer him for further medical evaluation.
D. Discharge the client, as he does not meet the criteria for continued services.
(Correct Answer: C – The Social Worker should maintain an objective approach, document observations, and refer for further evaluation rather than making premature assumptions.)
2. Ethical Dilemma Questions
These questions evaluate how you balance ethical responsibility with professional boundaries.
Example Question:
A Social Worker in a community mental health clinic is working with a client who has been diagnosed with major depressive disorder. Over multiple sessions, the client inconsistently reports worsening symptoms but appears highly functional in non-clinical settings. The client has also applied for disability benefits. The Social Worker is unsure whether the symptoms are genuine. What is the most ethical response?
A. Inform the disability office that the client may be exaggerating symptoms.
B. Conduct a thorough assessment, document inconsistencies, and discuss concerns with a supervisor.
C. Ignore the inconsistencies and continue supporting the client’s claim.
D. Tell the client directly that they are suspected of malingering and must prove otherwise.
(Correct Answer: B – Ethical practice involves assessing, documenting, and consulting, rather than making accusations or disregarding potential concerns.)
3. Best Intervention Questions
These questions assess your knowledge of proper assessment and intervention strategies.
Example Question:
A school Social Worker is evaluating a 16-year-old student who frequently reports severe anxiety attacks to avoid taking exams. However, teachers note that the student appears calm and engaged in non-academic settings. What is the best course of action?
A. Conduct a structured clinical interview and collaborate with school staff for a comprehensive evaluation.
B. Assume the student is malingering and refuse to provide accommodations.
C. Encourage the student to take the exam without additional support.
D. Immediately recommend an Individualized Education Plan (IEP) based on the student’s self-report.
(Correct Answer: A – A thorough evaluation is necessary before making decisions about accommodations or assumptions about malingering.)
How to Prepare for Feigning Illness Questions on the ASWB Exam
Since feigning illness is an advanced clinical concept, preparation is key. Here’s how you can strengthen your knowledge:
- Use Comprehensive Study Guides – Resources from Agents of Change provide structured learning materials tailored to the ASWB exam.
- Take Practice Exams – Exposure to exam-style questions helps reinforce your ability to recognize malingering in clinical scenarios. Agents of Change offers 3 full-length practice exams here.
- Join Live Study Groups – Engaging in discussions with peers allows you to refine your critical thinking and ethical decision-making skills. All Agents of Change programs include 2 live study groups per month.
- Review Ethical Standards – The NASW Code of Ethics offers guidance on maintaining professionalism in cases involving potential malingering.
- Utilize Flashcards – Memorizing feigning illness indicators and related ethical considerations is easier with structured study tools.
By combining these study strategies with real-world case analysis, you’ll be well-prepared to tackle feigning illness-related questions on the ASWB exam. Remember, the goal isn’t just to pass the test—it’s to develop the skills you’ll need in professional practice.
3) Ethical and Clinical Considerations
When a Social Worker suspects a client may be feigning illness, handling the situation requires a balance of professional skepticism, ethical responsibility, and clinical judgment.
Misidentifying a client’s symptoms—whether as malingering or a legitimate condition—can lead to serious consequences, including misdiagnosis, denial of needed services, or breaches of professional ethics. To navigate this challenge, Social Workers must apply a structured, ethical, and clinically sound approach.
Maintaining an Ethical Approach
Ethical practice is central to Social Work, and cases involving feigned illness must be handled with care to avoid causing harm or violating professional guidelines. The National Association of Social Workers (NASW) Code of Ethics provides guidance on maintaining integrity and client-centered care, even when malingering is suspected.
Key Ethical Principles to Follow:
- Avoid Assumptions – Always assess clients objectively, recognizing that even individuals with secondary gains may have legitimate health concerns.
- Respect Client Dignity – Regardless of suspicion, clients should be treated with empathy and respect.
- Ensure Proper Documentation – Maintaining detailed, factual records is essential for accountability and professional integrity.
- Consult with Supervisors or Medical Professionals – When in doubt, seek guidance rather than making unilateral decisions.
- Adhere to Informed Consent Principles – If an evaluation or further assessment is needed, clients should be informed of the process and its implications.
Failing to uphold ethical standards can impact the client’s well-being and place the Social Worker at risk of professional misconduct claims.
Clinical Assessment of Feigning Illness
A thorough clinical assessment is essential in determining whether an individual is feigning illness. Since Social Workers are not medical doctors, their role is to identify inconsistencies, refer for further evaluation, and document findings rather than making definitive medical determinations.
Steps for Clinically Assessing Potential Feigned Illness:
-
Gather Comprehensive Client History
- Review previous medical, psychological, and behavioral records.
- Identify patterns of symptom exaggeration or inconsistencies in past reports.
-
Observe Behavioral Patterns
- Compare reported symptoms with observed behaviors.
- Note whether symptoms worsen in the presence of an audience.
-
Use Standardized Screening Tools (if applicable)
- Instruments such as the Structured Interview of Reported Symptoms (SIRS) or Minnesota Multiphasic Personality Inventory (MMPI-2) can help in identifying malingering.
- Collaborate with medical or psychological professionals for formal assessments.
-
Look for Secondary Gains
- Evaluate whether the client may be seeking financial benefits, medication, or exemption from responsibilities.
- Consider contextual factors, such as legal implications or external pressures.
-
Discuss Findings in a Non-Confrontational Manner
- Rather than directly accusing a client of malingering, use open-ended questions to explore inconsistencies:
- “Can you help me understand why your symptoms change depending on the setting?”
- “What do you think would happen if these symptoms persist long-term?”
- Encourage collaboration to ensure the client receives appropriate support, whether for a genuine condition or another underlying issue.
- Rather than directly accusing a client of malingering, use open-ended questions to explore inconsistencies:
When and How to Intervene
If malingering is suspected, intervention must be handled delicately. Jumping to conclusions without thorough evaluation can lead to mistrust or ethical violations.
Appropriate Steps for Intervention:
- Refer for Medical or Psychological Evaluation – If inconsistencies arise, collaborate with healthcare professionals to confirm or rule out a legitimate condition.
- Offer Alternative Support – If a client is seeking disability benefits but appears to be feigning symptoms, explore other supportive services that might meet their needs.
- Document Without Bias – Keep factual records without labeling a client as a “malingerer.” Instead, document observations objectively, noting discrepancies without making direct accusations.
- Consult with Supervisors or Ethical Review Boards – If unsure how to proceed, seek guidance from senior professionals or ethical committees within your organization.
The Role of Social Workers in Feigning Illness Cases
Social Workers must always advocate for client well-being while upholding professional integrity. In cases where feigned illness is suspected:
- The priority should always be ensuring the client receives appropriate care—whether for a real condition or other underlying issues (such as trauma or substance use).
- Ethical concerns must be balanced with clinical judgment to avoid wrongful accusations or enabling deceptive behavior.
- Documentation and collaboration with multidisciplinary teams are crucial to ensuring a fair and objective assessment.
By integrating ethical responsibility with clinical expertise, Social Workers can effectively navigate the complexities of feigned illness cases while maintaining trust and professionalism.
4) Feigning Illness (Malingering) vs. Factitious Disorder
Feigning illness can take different forms, and distinguishing between malingering and factitious disorder is essential for Social Workers. While both involve the fabrication or exaggeration of symptoms, their motivations and underlying psychological factors differ.
Understanding these distinctions is critical when assessing clients, making ethical decisions, and answering related questions on the ASWB exam.
Key Differences Between Malingering and Factitious Disorder
At first glance, malingering and factitious disorder may seem similar—both involve individuals presenting false symptoms. However, their motivations, behaviors, and clinical implications set them apart.
| Feature | Malingering | Factitious Disorder |
|---|---|---|
| Primary Motivation | External rewards (e.g., financial gain, avoiding work, obtaining drugs) | Psychological need to assume the sick role |
| Awareness of Deception | Conscious and intentional | May involve some unconscious psychological processes |
| Response to Detection | Likely to become defensive or discontinue the deception | May persist in fabricating symptoms even when confronted |
| Willingness for Treatment | Avoids treatment that doesn’t align with personal goals | Actively seeks unnecessary medical interventions or procedures |
| Typical Setting | Legal, workplace, disability claims, healthcare settings | Primarily medical settings, often with repeated hospital visits |
Understanding these distinctions helps Social Workers approach clients with the appropriate level of care and intervention.
Malingering: Feigning Illness for External Gain
Malingering is not considered a mental illness but rather a behavior where an individual deliberately fabricates or exaggerates symptoms for personal benefit. This can include:
- Avoiding work, military duty, or legal consequences
- Gaining financial compensation, such as disability benefits
- Securing housing, social services, or legal protections
- Obtaining prescription medications, often narcotics
Common Signs of Malingering
Clients suspected of malingering often exhibit:
- Inconsistencies in Symptoms – Symptoms change depending on the setting or observer.
- Resistance to Non-Medicated Treatments – They reject solutions that don’t align with their goal (e.g., refusing physical therapy but demanding pain medication).
- Dramatic or Over-the-Top Symptom Descriptions – The individual may present an exaggerated narrative about their suffering.
- Lack of Cooperation with Medical Professionals – They may refuse diagnostic tests or become defensive when asked for medical history.
Social Workers should approach suspected malingering cases without judgment while maintaining professional boundaries and ethical standards.
Factitious Disorder: The Need to Be Seen as Ill
Unlike malingering, factitious disorder is a recognized mental health condition in which a person deliberately produces, fakes, or worsens symptoms with no clear external rewards. Instead, the motivation stems from a deep-seated psychological need to assume the sick role and receive attention or sympathy.
Types of Factitious Disorder:
- Factitious Disorder Imposed on Self (FDIS) – The individual feigns or induces illness in themselves.
- Factitious Disorder Imposed on Another (FDIA) – The individual fabricates or induces illness in someone else (e.g., a caregiver harming a child, previously known as Münchausen Syndrome by Proxy).
Common Signs of Factitious Disorder
People with factitious disorder often:
- Eagerly Seek Medical Attention – Unlike malingerers, they may voluntarily undergo invasive tests or procedures.
- Exhibit Extensive Medical Knowledge – They may use complex medical jargon to describe their symptoms.
- Have a History of Frequent Hospitalizations – Many have long and inconsistent medical records from multiple providers.
- Fabricate or Induce Symptoms – Some go as far as self-harming or tampering with medical tests (e.g., injecting bacteria to cause infection).
How Social Workers Can Respond to Malingering and Factitious Disorder
Identifying whether a client is malingering or suffering from factitious disorder requires careful assessment and ethical considerations.
Best Practices for Addressing Malingering:
- Avoid Direct Accusations – Instead of labeling a client as a malingerer, focus on objective findings and inconsistencies.
- Refer for Further Evaluation – Medical and psychological assessments can help confirm or rule out conditions.
- Document Thoroughly – Keep factual records of reported versus observed symptoms.
- Explore Alternative Support – If secondary gain is a motivation (e.g., financial distress), offer solutions such as employment services or mental health referrals.
Best Practices for Addressing Factitious Disorder:
- Build Trust and Rapport – Individuals with factitious disorder may feel deep psychological distress and require compassionate engagement.
- Refer to Mental Health Professionals – This condition often requires psychiatric intervention.
- Assess for Risk of Self-Harm or Harm to Others – Especially in cases of Factitious Disorder Imposed on Another (FDIA), intervention may be critical for safety.
- Work with Multidisciplinary Teams – Coordination with medical, psychological, and legal professionals ensures appropriate care.
Final Thoughts: Why This Matters for the ASWB Exam
The ASWB exam may include questions that test your ability to distinguish malingering from factitious disorder, apply ethical considerations, and select appropriate interventions.
Understanding these conditions and their implications will prepare you for real-world Social Work scenarios and exam success.
Key Takeaways:
- Malingering is intentional and motivated by external rewards, whereas factitious disorder is psychologically driven.
- Malingerers often avoid medical scrutiny, while those with factitious disorder seek excessive medical attention.
- Social Workers should assess these cases objectively, document findings carefully, and refer clients for appropriate care.
Recognizing these differences is crucial—not only for passing the ASWB exam but also for making sound clinical and ethical decisions in practice.