Objective: Individuals who present for neuropsychological assessment often are significantly distressed emotionally and seek proper recognition of and treatment for their deficits. Because inaccurately diagnosing malingering can have profound negative consequences, we tested the hypothesis that failing a performance validity test (PVT) may not solely be due to external incentive (secondary gain) but could, for some, represent pronounced help-seeking behavior (primary gain). Method: We presented a simulation condition to 40 volunteers (41% male, 59% female; mean age = 29.8; mean education = 16 years) asking them to imagine that they were seeking services at a health clinic and were experiencing significant emotional distress. Participants were administered the Immediate Recall (IR), Delayed Recall (DR), and Consistency (CONS) portions of the Word Memory Test (WMT) and informed that the test's purpose was to assess distress for the purpose of determining who would receive services at the clinic. They were asked to convince clinic staff of their distress and need for help, but without faking. Results: Of the 40 simulators, 28 (70%) failed at least one of the three WMT portions, and 23 (57%) failed all three portions. Average simulator scores on the IR, DR, and CONS indexes were each significantly below (p < .05) the published WMT passing score of 82.5%. Conclusion(s): Emotional distress and associated help-seeking behavior results in PVT failure among simulated assessment clients. Further research is needed to expand these findings beyond simulated conditions, but clinicians should keep in mind that emotional distress can result in suboptimal cognitive PVT performances.