Antisocial and Borderline Personality Disorders in the Emergency Department: Conceptualizing and Managing “Malingered” or “Exaggerated” Symptoms

  • Victor HongEmail author
  • Loreen Pirnie
  • Ahmad Shobassy
Personality and Impulse Control Disorders (R Lee, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Personality and Impulse Control Disorders


Purpose of Review

Patients with antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are often suspected of malingering or exaggerating symptoms, though there is no clear evidence that they do so more than other patients. We review the manifestations, etiology, and management of seemingly feigned symptoms in these disorders, particularly related to their presentation in the emergency department (ED).

Recent Findings

It is dangerous to assume that all patients with ASPD and BPD are intentionally feigning symptoms in the ED. However, when ASPD patients are known to be malingering, the focus should be shifted to addressing the motivation behind malingering and the patient’s true goals, ideally done with a curious rather than confrontational approach. BPD patients also may appear to be malingering or exaggerating symptoms, but their presentation often is more accurately attributed to the lack of ability to mentalize and effectively communicate their needs, as well as emotional hypochondriasis.


Education of ED staff, demonstrating genuine concern, and attempting to find a common goal with patients will aid in keeping an objective view of the patient’s distress, minimizing escalation, and optimizing patient outcomes.


Antisocial personality disorder Borderline personality disorder Malingering Emergency department Factitious disorder 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of MichiganAnn ArborUSA

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