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Effort, exaggeration and malingering after concussion
  1. Jonathan M Silver
  1. Correspondence to Dr Jonathan M Silver, Clinical Professor of Psychiatry, New York University School of Medicine, 40 East 83rd Street, Suite 1E, New York, NY 10028, USA; jonsilver{at}


Although most individuals who suffer a mild traumatic brain injury have complete recovery, a number experience persistent symptoms that appear inconsistent with the severity of the injury. Symptoms may be ascribed to malingering, exaggeration or poor effort on cognitive testing. The purpose of this paper is to propose that previously unconsidered factors, informed by social psychology and behavioural economics, can appear as ‘symptom magnification’ or ‘poor effort’, which are incorrectly interpreted as the result of a conscious process. These are complex and multi-determined behaviours with a unique differential diagnosis which have important implications for research, evaluation and treatment.

  • Malingering
  • effort
  • exaggeration
  • concussion
  • traumatic brain injury
  • head injury
  • neuropsychiatry

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  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.