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Characterizing Auditory Hallucinations: 
An Aid in the Differential Diagnosis of Malingering

Characterizing Auditory Hallucinations: 
An Aid in the Differential Diagnosis of Malingering

  1. Anonymous
    Julie A. Holland, M.D. and Kevin C. Riley, PhD

    Since the famous paper by Rosenhan, "On Being Sane in Insane Places," (1) the concept of malingering psychosis has been an emotionally charged issue. It puts our talents to the test, and we must rely on intuition and collateral sources to arrive at a diagnosis and a safe disposition plan. Although most of the literature on malingering focuses on the forensic population, in the psychiatric emergency room we also see patients who report the presence of auditory hallucinations in order to obtain food and shelter, to receive medication, or perhaps simply to enjoy the benefits of a therapeutic mileu. (2) We are typically taught that the best teacher is experience, and over time we will get a sixth sense to assist us in detecting the patients who attempt to deceive us. Since the phenomenon of auditory hallucinations is fairly well described in the psychiatric literature, one helpful strategy towards identifying malingerers, is to spend time with the patient reviewing the phenomenology of their "voices.." The more we can learn about how auditory hallucinations are experienced by genuinely ill psychiatric patients, the better we can judge the veracity of a patient's subjective report.