Malingering
is a deliberate behavior for a known external purpose. It is not
considered a form of mental illness or psychopathology, although
it can occur in the context of other mental illnesses. Malingering
can be expressed in several forms from pure malingering in which
the individual falsifies all symptoms to partial malingering in
which the individual has symptoms but exaggerates the impact which
they have upon daily functioning. Another form of malingering
is simulation in which the person emulates symptoms of a specific
disability or dissimulation when the patient denies the existence
of problems which would account for the symptoms as in the case
of drug abuse. Another form of malingering is false imputation
in which the individual has valid symptoms but is dishonest as
to the source of the problems, attributing them, for example,
to an automobile accident when the cause was, in fact, an injury
occurring in the home
It can be
manifested in several ways:
A medical condition is fabricated. When this occurs, the patient
claims to have a series of non-existent problems.
A medical condition or injury that resulted from the incident
is exaggerated for financial gain. Examples include months of
chiropractic treatment for low back pain, or physical therapy
without improvement. This is not to be confused with those patients
who have legitimate serious injuries that fail to respond to conservative
treatment.
The accident is staged so that the injury is deliberately caused.
Malingerers are usually not willing to produce disease in themselves
or undergo extensive painful diagnostic testing, treatment or
surgery.
There is a marked discrepancy between the person's claimed symptoms
and the medical or psychiatric findings.
Displays a lack of cooperation during the physician's evaluation
and noncompliance with treatment.
Anti-social
or Borderline
Personality.
Claims to have preposterous symptoms. The individual may consciously
and intentionally fake poor responses on neuropsychological tests.
Associated
Features:
External
Motives - possible financial reward.
Differential
Diagnosis:
Some disorders have similar symptoms. The clinician, therefore,
in his diagnostic attempt, has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis.
Factitious
Disorder / Munchausen
syndrome by proxy
Hypochondriasis
Conversion Disorder
Somatization Disorder
Pain associated with psychological factors
True medical or psychiatric illness related to presenting complaints
Cause:
While the
malingering individual is seeking tangible gains such as time-off
from work and/or financial gain, the underlying motivations may
differ among such persons. There may be individuals who falsify
their symptoms because they believe that it is inevitable that
such symptoms will arise later. For example, an individual may
state that they have symptoms of infection when not present, while
they can receive compensation, because they believe that they
will likely develop the infection at some future point
Common
motivating factors are:
Avoidance
of going to jail or release from jail, avoidance of work or
family responsibility.
Desire to obtain narcotics.
Desire to be awarded money in litigation.
Need for attention.
Treatment:
People who malinger almost
never accept psychiatric referral, and the success of such consultations
is minimal. Avoid consultations to other medical specialists because
such referrals only perpetuate malingering. However, in cases
of serious uncertainty about the presence of genuine psychiatric
illness, suggest psychiatric consultation.
Counseling
and Psychotherapy [ See
Therapy Section ]:
