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Malingering

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.

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.

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.

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