In contrast, malingering involves the intentional production of false or grossly exaggerated symptoms, motivated by obvious external incentives. Malingering is not the product of unintentional learning or emotions, such as fear of pain. Interpreting the presence of pain behaviours and inconsistencies as malingering has not been demonstrated to help the patient or the clinician. The inevitable consequence of making that interpretation is an adversarial 'them against us' situation. Inconsistent behaviours may exist because the person with back pain perceives that they have little or no control over managing the problem.
Many risk factors are, or are perceived to be, beyond the control of the person with back pain.
The goal of identifying Yellow Flags is to find factors that can be influenced positively to facilitate recovery and prevent or reduce long-term disability and work loss. This includes identifying both the frequent unintentional barriers, and the less common intentional barriers to improvement.