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Malingering

Malingering is a condition, wherein an individual falsely exaggerates symptoms, both physical and psychological in order to gain undue advantage. This is not a form of mental illness.


Presentation

Signs of malingering are evident when there is a marked difference between the reported signs and actual observed signs. For example those individuals who report loss of appetite or loss of interest in socializing or a depressed nature can be closely tracked when they are eating, having desserts, interacting with other members, and sleeping peacefully. Their eating habits and sleeping pattern can give a clear idea about malingering. Such a type of behavior can also be observed in presence of external incentive such as for obtaining prescription drugs. Yet another important marker for identifying malingering is reporting that they hear voices while asleep or hear them continuously rather than in intervals.

In addition to the above mentioned signs, individuals also do not participate appropriately during clinical examination, medico-legal context, or show signs of antisocial personality disorder. Patients with malingering often bitterly express their symptoms and also exhibit a feeling of distress while reporting of ailments [6].

Malingering
  • However, in many cases, malingering can often accompany other mental illnesses. Malingering can be classified under 3 different categories namely: pure malingering, partial malingering and false imputation.[symptoma.com]
  • Abstract Malingering is the intentional fabrication of medical symptoms for the purpose of external gain.[ncbi.nlm.nih.gov]
Developmental Disabilities
  • The authors report an unusual presentation of amnestic syndrome mislabeled as malingering in a man with mild developmental disability.[ncbi.nlm.nih.gov]
Mitral Valve Prolapse
  • The contributions of essential hypertension and mitral valve prolapse to the self-induced blood pressure elevations also are considered.[ncbi.nlm.nih.gov]
Muscle Strain
  • strain or other physical types of ailments, and overdosing on drugs. [6] Limitations [ edit ] In most instances, stating categorically that an individual is malingering requires an explicit admission by that individual.[en.wikipedia.org]
Denial
  • Faculty of Psychology and Neuroscience Full course description This course will deal with illness fabrication (faking bad) and illness denial (faking good) in forensic contexts.[maastrichtuniversity.nl]
  • Criminally, an assessment may lead to punishment enhancement, and medically, to denial of future treatment. The DSM-V criteria faces scrutiny for providing poor guidelines.[en.wikipedia.org]
  • . 34 In a broader context, possible consequences of the misclassification of malingering outside of the courts include loss of employment benefits or disability income, exclusion from social services programs or remedial education, unemployment, and denial[jaapl.org]
  • Low critic and judgement; Low response to pharmacotherapy Low compliance Anxiety; Depression Discharge request; Low impulse control; Gambling addiction; Claustrophobia; Low compliance Worries related to illness anxiety; Body concept of illness with denial[jneuropsychiatry.org]
Self Mutilation
  • In future, in all wound cases it must be established whether there is any question of self-mutilation…Moreover, an increasing number of soldiers are suffering from skin diseases.[psywarrior.com]
  • ., self-mutilation) are not included in the category of factitious disorders. These patients are willing to undergo incredible hardship, limb amputation, organ loss, and even death to perpetuate the masquerade.[canadiem.org]
Self-Inflicted Wound
  • Stanley Newcourt-Nowodwoski mentions the booklet and discusses self-inflicted wound in Black Propaganda, Sutton Publishing, UK, 2005: An extreme option for soldiers was the self-inflicted wound…Dr.[psywarrior.com]
Amnesia
  • Strategies for detecting malingering in amnesia are available for anterograde amnesia. Less attention has been given to malingering in retrograde amnesia.[ncbi.nlm.nih.gov]
  • It has been speculated that this friend's experience with amnesia inspired Bruce's malingering . There was a sullenness among them, a blank, passive defiance sometimes and a constant malingering at their work.[diki.pl]
  • They frequently assume that dense amnesia and disorientation are features of psychosis. These descriptions may also apply to some patients with genuine psychiatric disorders.[emedicine.medscape.com]
Cognitive Disorder
  • Assessment of feigned cognitive disorders is an important field of neuropsychology because of its applications to forensic settings. Strategies for detecting malingering in amnesia are available for anterograde amnesia.[ncbi.nlm.nih.gov]
Hyperactivity
  • This included children with conduct disorders (85%), affective disorders (92%), traumatic brain injury (83%), attention-deficit hyperactivity disorder (93%), learning disabilities (100%), and pervasive developmental disorder (88%).[ncbi.nlm.nih.gov]
Behavior Problem
  • In the current study, 194 school-age children with academic and/or behavioral problems were used to compare the accuracy of TOMM1 and TOMMe10 (errors on the first 10 items of TOMM1) in predicting passing/failing of TOMM2.[ncbi.nlm.nih.gov]

Workup

There is no one single method to diagnose malingering. Clinicians use open ended questions during the evaluation process. It is necessary that the questions should be asked without giving any kind of clues and the interview should be carried out for a longer duration. In such situations, it would get difficult for the individual to maintain the fake presentation [7] [8].

Clinicians often recognize malingers by the extent of exaggeration of symptoms. For example, individuals who present with complain of schizophrenia often claim global confusion. This is so because, malingers are often under the impression that global confusion is the trademark of all mental disorders. Over exaggeration of symptoms gives a clear indication to the clinicians that the individual is pretending and is not a prey to any form of medical illness, but is malingering for some personal benefit [9].

In addition to these, various other tests such as complete blood count, neurological examination, observation of patient during period of assessment and mental state examination are also done.

Treatment

No specific treatment regime exists for malingering. However, this is no way implies that the patient should be regarded as liar. Malingering may coexist with other psychosocial problems and therefore, methods should be employed for treating underlying disease conditions if any. In many cases, the cause of malingering could be genuine, such that when a female wants to escape the company of her husband due to his abusive nature [10].

Moreover, it has also be seen that, individuals often seek malingering when they actually have psychiatric disorders and are unable to express the same due to language barrier or other constraints. Therefore, it becomes necessary to arrange for an interpreter whenever possible, to design proper interventions.

Prognosis

The malingering behavior lingers on unless the motive behind such a kind of act is fulfilled. Or the benefit desired outweighs the distress and inconvenience involved for seeking medical confirmation for the fake illness [5].

Etiology

Personal gain is the basic and the major motive behind the act of malingering. Individuals with a selfish motive tend to overstate physical as well as psychological signs and symptoms. Such a kind of act of overstating symptoms is majorly done to abstain from school, gain monetary benefit, obtaining drugs, to get appointed in military service or to get lighter criminal sentence. In some cases, malingering is done to gain sympathy or to attract attention [2].

Epidemiology

Malingering is a common practice and is widely prevalent across the globe. It is more common in settings of military, factories, prison and criminal prosecutions. Individual at any age can practice malingering. Even a child aged 9 years can also seek help from malingering for personal gain. Studies have shown that, about 13% of emergency attendees pretended illness in order to gain food, money, shelter, medical treatment and avoidance of work, family responsibilities and imprisonment.

Another set of studies have also postulated the fact that, malingering is also prevalent amongst the psychiatric population, and about 10 – 12% of them have the habit of exaggerating their symptoms. It has been estimated that in the year 1995, the total cost of health insurance claimed by fraud is about $59 billion in the US.

Sex distribution
Age distribution

Pathophysiology

The exact incidence of malingering is not known. It is certainly not a type of mental illness or a form of psychopathology. Such a kind of condition is purposively created for gaining benefit or for some external purpose. However, in many cases, malingering can often accompany other mental illnesses [3].

Malingering can be classified under 3 different categories namely: pure malingering, partial malingering and false imputation. Pure malingering is a condition, wherein the individual reports of having symptoms which are not at all present. Partial malingering involves exaggeration of symptoms which are present. False imputation is a condition, wherein, individuals falsely attribute the symptoms to an unrelated etiology [4].

Prevention

Malingering is not a disease, neither a mental condition which can be prevented. Conscious efforts for not exaggerating the symptoms can help prevent such a type of condition.

Summary

Individuals often have the habit of fabricating symptoms purposively to have some sort of benefit. For example, students may pretend to suffer from conditions they are not suffering from, to avoid attending school or for gaining sympathy from others. Malingering is not same as factitious disorder or somatization disorder [1].

Patient Information

Definition: Malingering is a condition, wherein the individual intentionally presents with symptoms of psychological or physical illness with a motive of benefit of some kind. In many cases, individuals may also go to the extent of personally harming themselves or play dirty with the laboratory reports just for the purpose of taking undue advantage.

Cause: There is no specific kind of physical or mental cause behind the act of malingering. Individuals resort to such type of behavior in order to gain financial compensation, sick leave, avoid work or school, sympathy or for availing prescription drugs.

Symptoms: There is a significant difference between the reported and observed behavior of the individual. Other signs include failure to follow the prescribed treatment regime and unwillingness to undergo tests.

Diagnosis: Diagnosis is done through open ended questionnaires which is carried out to gather information from the individual and to understand the malingering behavior. In addition, physical and neurological examinations are also carried out to assess the presence of any underlying disease condition. In addition, blood tests are also to done to detect any form of physical ailments. In many cases, MRI may also be indicated to check for any type of anomalies.

Treatment: Treatment is directed towards managing the underlying condition if any. When no physical ailment is found and doctor feels there is an exaggeration of symptoms then confronting the patient is often the best option. In such cases, the patient may also require psychological counseling if any kind of psychiatric illness is detected.

References

Article

  1. Folks DB, Feldman MD, Ford CV. Somatoform disorders, factitious disorders, and malingering. In: Psychiatric Care of the Medical Patient, 2nd ed, Stoudemire A, Fogel B, Greenberg DB. (Eds), Oxford, NY 2000. p.459.
  2. Samuel RZ, Mittenberg W. Determination of Malingering in Disability Evaluations. Primary Psychiatry. 2005;12(12):60-68.
  3. Udell ET. Malingering behavior in private medical practice. Clin Podiatr Med Surg. Jan 1994;11(1):65-72.
  4. Purcell TB. The somatic patient. Emerg Med Clin North Am. Feb 1991;9(1):137-59.
  5. Ziegler SJ. Pain, patients, and prosecution: who is deceiving whom?. Pain Med. Jul-Aug 2007;8(5):445-6; author reply 447-8.
  6. Donaghy M. Symptoms and the perception of disease. Clin Med. Nov-Dec 2004;4(6):541-4.
  7. Resnick PJ. Defrocking the fraud: the detection of malingering. Isr J Psychiatry Relat Sci. 1993;30(2):93-101.
  8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, American Psychiatric Association, Washington, DC, 2000.
  9. McDermott BE, Feldman MD. Malingering in the medical setting. Psychiatr Clin North Am. Dec 2007;30(4):645-62.
  10. Paras ML, Murad MH, Chen LP, et al. Sexual abuse and lifetime diagnosis of somatic disorders: a systematic review and meta-analysis. JAMA 2009; 302:550.

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Last updated: 2019-07-11 22:27