Malingering

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Malingering
Classification and external resources
ICD-10 Z76.5
ICD-9 V65.2
MeSH D008306

In medicine, malingering is fabricating or exaggerating the symptoms of mental or physical disorders for a variety of "secondary gain" motives, which may include financial compensation (often tied to fraud); avoiding school, work or military service; obtaining drugs; getting lighter criminal sentences; or simply to attract attention or sympathy. Malingering is different from somatization disorder and factitious disorder.[1] Failure to detect actual cases of malingering imposes a substantial economic burden on the health care system, and false attribution of malingering imposes a substantial burden of suffering on a significant proportion of the patient population.[2][3]

History[edit]

In the Hebrew Bible, David feigns insanity to escape from a king who views him as an enemy.[4] Odysseus was stated to have also feigned insanity in order to avoid participating in the Trojan War.[5] Malingering has been recorded historically as early as Roman times by the physician Galen, who reported two cases. One patient simulated colic to avoid a public meeting, while the other feigned an injured knee to avoid accompanying his master on a long journey.[6] In his social-climbing manual, Elizabethan George Puttenham recommends that would-be courtiers have "sickness in his sleeve, thereby to shake off other importunities of greater consequence" and suggests feigning a "dry dropsy [...] of some such other secret disease, as the common conversant can hardly discover, and the physician either not speedily heal, or not honestly bewray."[7]

Because malingering was widespread throughout the Soviet Union to escape sanctions or coercion, physicians were limited by the state in the number of medical dispensations they could issue.[8]
With thousands forced into manual labour, doctors were presented with four types of patients:

  1. those who needed medical care;[9][10]
  2. those who thought they needed medical care (hypochondriacs);
  3. malingerers; and
  4. those who 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.[8]

Symptoms[edit]

Some conditions are thought to be easier to feign than others. For example, virtually everyone has experienced pain and knows how a person in pain should appear to others.[11]

In the United States Armed Forces[edit]

Malingering is a court-martial offense in the United States Armed Forces under Article 115 of the Uniform Code of Military Justice, which provides that:

Any person subject to this chapter who for the purpose of avoiding work, duty, or service–
(1) feigns illness, physical disablement, mental lapse or derangement; or
(2) intentionally inflicts self-injury;
shall be punished as a court-martial may direct.[12]

Related conditions[edit]

References[edit]

  1. ^ R. Rogers Clinical Assessment of Malingering and Deception 3rd Edition, Guilford, 2008. ISBN 1-59385-699-7
  2. ^ "Malingering in the Clinical Setting" Garriga, Psychiatric Times. Vol. 24 No. 3, 2007
  3. ^ Shapiro, AP; Teasell, RW (March 1998). "Misdiagnosis of chronic pain as hysteria and malingering". Current Pain and Headache Reports 2 (1): 19–28. doi:10.1007/s11916-998-0059-5. [dead link]
  4. ^ I Sam 21:10-15
  5. ^ Hyginus Fabulae 95. Cf. Apollodorus Epitome 3.7.
  6. ^ "Galen on Malingering, Centaurs, Diabetes, and Other Subjects More or Less Related", Proceedings of the Charaka Club, X (1941), p52-55
  7. ^ "The Art of English Posey: a Critical Edition." George Puttenham. Ed. Frank Whigham & Wayne A. Rebhorn. (2007) 379-380.
  8. ^ a b Structured Strain in the Role of the Soviet Physician, Mark G. Field, 1953 The American Journal of Sociology, v.58;5;493-502
  9. ^ Skumin V A Borderline mental disorders in chronic diseases of the digestive system in children and adolescents. Zhurnal nevropatologii i psikhiatrii imeni SS Korsakova Moscow Russia 1952 (1991), Volume: 91, Issue: 8, Pages: 81-84 PubMed: 1661526
  10. ^ Skumin, VA (1982). "Непсихотические нарушения психики у больных с приобретёнными пороками сердца до и после операции (обзор)." [Nonpsychotic mental disorders in patients with acquired heart defects before and after surgery (review)]. Zhurnal nevropatologii i psikhiatrii imeni S.S. Korsakova (in Russian) 82 (11): 130–5. PMID 6758444. 
  11. ^ McDermott BE, Feldman MD (2007). "Malingering in the medical setting". Psychiatr Clin North Am 30 (4): 645–62. doi:10.1016/j.psc.2007.07.007. PMID 17938038. 
  12. ^ United States Code Title 10, Subtitle A, Part II, Chapter 47. "Article 115 — Malingering". 

Ninivaggi, Frank J., Malingering. In: Sadock BJ, Sadock VA, Ruiz P, eds. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 9th ed. Vol. II. Philadelphia: Wolters Kluver/Lippincott Williams and Wilkins; 2009: 2479-2490. ISBN 978-07817-6899-3.