Scams: What Psychiatrists Need to Know

“Mr Anthony,” an older adult, was admitted to the inpatient psychiatry unit following a suicide attempt precipitated by a financial scam. A person posing as a water company representative had called to say Mr Anthony was facing severe consequences without immediate payment for an outstanding balance. The $40,000 he sent to the scammer constituted a significant portion of his savings. Mr Anthony’s son discovered the scam and initiated proceedings for financial guardianship, an action Mr Anthony opposed. The scam exacerbated family tensions, leaving Mr Anthony feeling scared, trapped, and alone.

Financial exploitation is one of the most common and damaging impacts of scams. Individuals with limited resources and mental health vulnerabilities may be victimized in this way. The emotional burden of scams can cut deeper than their financial impact, according to a survey of victims from 30 European nations.¹ Even if a person does not lose money following scam victimization, emotional effects often persist. Symptoms of anxiety and depression are correlated with financial exploitation.^2,3 Scam victimization may be underreported due to embarrassment.⁴ With greater knowledge, mental health professionals can raise awareness and educate patients to help reduce their vulnerability.^2,5

This article discusses the types of scams encountered in psychiatric practice, helps identify those at risk, and explores how mental health professionals across levels of care can prevent, assess, and intervene.

Types of Scams

Scams affect individuals from all walks of life. An exhaustive classification is beyond the scope of this article, in part because scams are constantly evolving. The Table describes scam types.

Mr Anthony, who was threatened with a $40,000 water bill, was victimized by an agency impersonation scam, characterized by impersonating an authority or business and demanding payment for a fraudulent invoice (eg, fake toll payment text messages).

Another patient, “Mr Brody,” was victimized by a romance scam, which often targets psychiatrically vulnerable people.⁶ Mr Brody was a middle-aged man who was hospitalized due to suicidal thoughts, in the context of worsening depressive symptoms and substance abuse. He was cognitively intact yet socially awkward and lonely. During his admission, he asked the nursing staff to help him send money via his smartphone to someone with whom he appeared to be in a relationship. When he gave his phone to a staff member, she noticed a series of flirtatious text exchanges as well as AI-generated sexual images. Mr Brody insisted that these images were photos of a girlfriend, though he acknowledged they had never spoken directly or met in person.

Scammers succeed in part because victims are widely vulnerable. Studies indicate that educational attainment or an advanced degree does not prevent victimization.^7,8 Even physicians succumb to scams, such as threats associated with government agency impersonation. Drug Enforcement Administration impersonators, for example, have threatened legal charges over unpaid, expired registrations. Physicians are also vulnerable to prize scams, such as being told they were nominated for a teaching award, designated as a keynote speaker, or solicited by predatory journals posing as legitimate academic publications. The promised “honor” is only accessible after paying a fee.

Vulnerabilities: Who Is at Increased Risk?

According to 2024 Federal Trade Commission data, while middle-aged adults are more likely to be victimized, older adults suffer greater financial loss.⁵ Mild cognitive decline, as opposed to severe cognitive impairment, has been correlated with greater scam vulnerability.⁸ More severely cognitively impaired older adults are protected from technology based scams as a result of their inability to utilize devices, though phone or in-person scams remain a danger. Individuals with lower literacy and higher internet use are at greater risk of victimization.⁷ Adolescents are at increased risk for romance scams or for “sextortion,” in which scammers obtain or create sexualized images of the victim to use for blackmail.⁹ Because adolescents have lower net worth than middle-aged or older adults, they may be less vulnerable to other types of scams.

Various scams exploit specific psychological liabilities. Individuals who struggle with loneliness may be more vulnerable to romance scams, for instance. Individuals with anxiety about financial security and fears about sanctions may be more vulnerable to phishing scams. Thirst trap scams target victims on social media, using attention-grabbing, sexualized images to advertise alleged services or products as a way to manipulate the viewer to send money or harvest personal data.

Recently, attention has been paid to the addictive algorithms that negatively affect youth.¹⁰ Social media algorithms create increasingly stimulating content to keep viewers engaged. This basic feature creates an efficient medium for scam proliferation. While a viewer may start watching a video of innocuous dance content, the feed may become increasingly sexualized to draw the viewer in and expose them to scams. AI, capable of creating convincing texts and images, puts victims at increasingly greater risk. The following hypothetical vignette illustrates some of these concerns.

“Ms Carmen,” an older woman, was admitted for inpatient psychiatric care for her major depressive disorder after increased isolation and reporting suicidal ideation. She was afraid to use her phone, even to talk with her children, and feared it had been hacked and was no longer usable. The precipitating event was a series of calls from spoofed phone numbers labeled by her smartphone as “potential scam calls.” Initially, it seemed possible that her fears were delusional. However, her phone history indicated many such calls. While she avoided financial exploitation, she suffered an emotional consequence of the assault on her privacy.

Prevention, Assessment, and Intervention

Psychiatrists’ awareness of the widespread nature of scam vulnerability is an essential first step in prevention. With this awareness, both inpatient and outpatient psychiatrists can inquire about patients’ recent experiences with financial losses, requests from others for money, award enticements or threats of humiliation or exposure. Asking about these topics may reveal exploitation. More formally, staff could incorporate a brief screening tool, such as Lichtenberg’s Financial Decision Screening Scale,¹² into intake meetings, similar to screening for food insecurity or other social determinants of health. Nursing personnel should also be educated about scam vulnerability and common scam types, to offer protection and support.

Additional resources include local and national agencies that offer workshops and consumer-friendly publications on scam prevention for elders.¹³ More extensive educational programs designed to increase technological literacy and scam awareness are useful objectives.¹¹ For example, Cuyahoga County Scam Squad (which includes mental health professionals) put out a guide for consumers about spotting and avoiding scams which is freely available online to share with patients.¹⁴

Concluding Thoughts

Ongoing education in these settings can also help increase patients’ vigilance to these ever-evolving threats to financial and psychological well-being. Psychotherapy may play a role in mitigating the emotional consequences of exploitation. Finally, psychiatrists can refer scam victims to credit card fraud assistance, police, or appropriate legal aid to address losses and consequences of identity theft. With the recommended areas of inquiry discussed above as well as the resources described, psychiatrists may help reduce scam vulnerability and its mental health consequences.

Mr Ellison is a mental health specialist at McLean Hospital, Belmont, MA. He is a recent graduate of the Master's in Healthcare Emergency Management at Boston University's Chobanian and Avedisian School of Medicine.

Dr Hatters Friedman is the Phillip J. Resnick Professor of Forensic Psychiatry; professor of psychiatry, reproductive biology, and pediatrics; and adjunct professor of law at Case Western Reserve University in Cleveland, Ohio. She served as editor of the Group for the Advancement of Psychiatry volume Family Murder: Pathologies of Love and Hate, which won the Manfred S. Guttmacher Award.

Dr Sorrentino is a clinical assistant professor at Harvard Medical School in Boston.

Dr Douglas is a psychiatry resident and rising forensic psychiatry fellow at the University of Rochester Medical Center.

References

1. Survey on “Scams and Fraud Experienced by Consumers”: Final Report. European Commission; 2020. Accessed November 5, 2026. https://ec.europa.eu/info/sites/info/files/aid_development_cooperation_fundamental_rights/ensuring_aid_effectiveness/documents/survey_on_scams_and_fraud_experienced_by_consumers_-_final_report.pdf

2. Weissberger GH. Anxiety and depressive symptoms are associated with perceived financial exploitation in Israeli older adults. Clin Gerontol. 2022;45(3):715-721.

3. Nguyen AL, Mosqueda L, Windisch N, et al. Perceived types, causes, and consequences of financial exploitation: narratives from older adults. J Gerontol B Psychol Sci Soc Sci. 2021;76(5):996-1004.

4. Burnes D, Henderson CR, Janes M, et al. Prevalence of financial fraud and scams among older adults in the United States: a systematic review and meta-analysis. Am J Public Health. 2017;107(8):e13-e21.

5. Lichtenberg PA, Hall L, Gross E, Campbell R. Providing assistance for older adult financial exploitation victims: implications for clinical gerontologists. Clin Gerontol. 2019;42(4):435-443.

6. Coluccia A, Pozza A, Ferretti F, et al. Online romance scams: relational dynamics and psychological characteristics of the victims and scammers. A scoping review. Clin Pract Epidemiol Ment Health. 2020;16:24-35.

7. James BD, Boyle PA, Yu L, Bennett DA. Correlates of susceptibility to scams in older adults without dementia. J Elder Abuse Negl. 2014;26(2):107-122.

8. Lichtenberg PA, Campbell R, Hall L, Gross E. Psychological and functional vulnerability predicts fraud cases in older adults: results of a longitudinal study. Clin Gerontol. 2016;39(1):48-63.

9. Doyle C, Douglas E, O’Reilly G. The outcomes of sexting for children and adolescents: a systematic review of the literature. J Adolesc. 2021;92:86-113.

10. Kang C, Mac R, Tan E. Meta and YouTube found negligent in landmark social media addiction case. New York Times. March 25, 2026. Accessed November 5, 2026. https://www.nytimes.com/2026/03/25/technology/social-media-trial-verdict.html

11. Lichtenberg PA, Hall L. A pilot intervention to prevent financial exploitation. Clin Gerontol. 2025;48(4):792-803.

12. Lichtenberg PA, Gross E, Campbell R. A short form of the Lichtenberg Financial Decision Rating Scale. Clin Gerontol. 2020;43(3):256-265.

13. Johnston J. The top 5 financial scams targeting older adults. National Council on Aging. March 17, 2026. Accessed November 5, 2026. https://www.ncoa.org/article/top-5-financial-scams-targeting-older-adults/

14. Cuyahoga County Department of Consumer Affairs. Scam Squad Guide. Accessed November 5, 2026. https://cuyahogacounty.gov/consumeraffairs/scam-squad-guide