Everything about Malingering totally explained
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Malingering is a
medical and
psychological term that refers to an individual fabricating or exaggerating the symptoms of
mental or
physical disorders for a variety of motives, including getting financial compensation (often tied to
fraud), avoiding work, obtaining drugs, getting lighter criminal sentences, trying to get out of going to school, or simply to attract attention or sympathy. Because malingerers are usually seeking some sort of
primary or secondary gain, this disorder remains separate from
Somatization disorders and
factitious disorders in which the gain isn't obvious. Legally, malingering is often referred to as
Fabricated mental illness or
Feigned mental illness. See
United States v. Binion.
History
Malingering has been recorded as early as Roman times by the physician
Galen, who reported two cases. One patient simulated
colic to avoid a public meeting, whilst the other feigned an injured knee to avoid accompanying his master on a long journey.
Because malingering was widespread throughout Soviet Russia to escape sanctions or coercion, physicians were limited by the state in the number of medical dispensations they could issue. With thousands forced into manual labour, doctors were presented with four types of patient; 1. those who needed medical care; 2. those that
thought they needed medical care (
hypochondriacs); 3. malingerers; and 4. those that made direct pleas to the physician for a medical dispensation from work. This dependence upon doctors by poor labourers altered the doctor-patient relationship to one of mutual mistrust and deception.
Symptoms
There is a rich and diverse array of methods for feigning illness. Physical methods reported include trying to deceive measuring devices such as thermometers, inducing swelling, delaying wound healing, over-exercise, drug overdose, self-harm, or directly reporting diagnostic signs of disease, learnt from a medical textbook.
Diagnosis and detection
Diagnosis
DSM-IV-TR
The
DSM-IV-TR states that malingering is suspected if any combination of the following are observed
- Medicolegal context of presentation
- Marked discrepancy between the person’s claimed stress of disability and the objective findings
- Lack of cooperation during the diagnostic evaluation and in complying with prescribed treatment regimen
- The presence of Antisocial Personality Disorder
However, these criteria have been found to be of little use in actually identifying individuals who are malingering. (Clinical assessment of malingering and deception 2nd ed. Rogers, Richard; New York, NY, US: Guilford Press, 1997.)
Detection
Some feature at presentation which are unusual in genuine cases include:
Related conditions
Factitious disorder
Ganser syndrome
Munchausen syndromeFurther Information
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