Malingering

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

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] According to the Texas Department of Insurance, fraud that includes malingering costs the U.S. insurance industry approximately $150 billion each year.[4]

Symptoms[edit]

The symptoms most commonly feigned include those associated with mild head injury, fibromyalgia, chronic fatigue syndrome, and chronic pain. Generally, malingerers complain of psychological disorders such as anxiety. Malingering may take the form of complaints of chronic whiplash pain from automobile accidents. The psychological symptoms experienced by survivors of disaster (post-traumatic stress disorder) are also faked by malingerers.[4]

Many dishonest methods are used by individuals feigning symptoms of malingering.[clarification needed] Some of these include harming oneself, trying to convince medical professionals one has a disease after learning about its details (such as symptoms) in medical textbooks, taking drugs that provoke certain symptoms common in some diseases, performing excess exercise to induce muscle strain or other physical types of ailments, and overdosing on drugs.[4]

Diagnosis[edit]

Malingering may be suspected:[4]

  • When a patient is referred for examination by an attorney
  • When the onset of illness coincides with a large financial incentive, such as a new disability policy
  • When objective medical tests do not confirm the patient's complaints
  • When the patient does not cooperate with the diagnostic work-up or prescribed treatment
  • When the patient has antisocial attitudes and behaviors (antisocial personality)
  • When a patient who claims to be schizophrenic informs the phycisian about being confused and is eager to discuss the delusions[5]

The judgment of the morality of malingering is largely a matter of the observer and circumstances. Most people would regard the defraudment of an insurance company, through a false injury, as an antisocial act. In contrast, the malingering of a prisoner of war, who is attempting to manipulate his or her captors, would be seen by most compatriots as a skillful coping mechanism.[6]

History[edit]

In the Hebrew Bible, King David feigns insanity to Achish, king of the Philistines (I Sam. 21:10-15). This is by many supposed not to have been feigned, but a real epilepsy or falling sickness, and the Septuagint uses words which strongly indicate this sense.[7] Odysseus was stated to have also feigned insanity in order to avoid participating in the Trojan War.[8] Malingering has been recorded historically as early as Roman times by the physician Galen (Quomodo morbum simulantes sint deprehendendi), 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.[9] During the Renaissance, a treatise on feigned diseases (De iis qui morborum simulant deprehensis) by Giambattista Silvatico, was published at Milan in 1595. Various phases of malingering (les gueux contrefaits) are well represented in the etchings and engravings of Jacques Callot (1592–1635).[10] 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."[11]

Soviet Union[edit]

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.[12]

With thousands forced into manual labour, doctors were presented with four types of patients:

  1. those who needed medical care;[13][14]
  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.[12]

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.[15]

See also[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. Archived from the original on July 14, 2011. 
  4. ^ a b c d Robert Scott Dinsmoor (2011), "Malingering", in Laurie J. Fundukian, The Gale Encyclopedia of Medicine 4 (4th ed.), Gale, pp. 2737–2739, ISBN 978-1-4144-8646-8 
  5. ^ Phillip J. Resnick, MD, James Knoll, MD Faking it: How to detect malingered psychosis, Current Psychiatry, November 2005
  6. ^ Charles V. Ford (2008), "Factitious Disorders and Malingering", in Michael H. Ebert; Peter T. Loosen; Barry Nurcombe; et al., Current Diagnosis & Treatment: Psychiatry (2nd ed.), McGraw-Hill, ISBN 978-0-07-142292-5 
  7. ^ John McClintock; James Strong, eds. (1894), "Madness", Cyclopaedia of Biblical, Theological and Ecclesiastical Literature 5, Harper & Brothers, pp. 628b–629a 
  8. ^ Hyginus Fabulae 95. Cf. Apollodorus Epitome 3.7.
  9. ^ "Galen on Malingering, Centaurs, Diabetes, and Other Subjects More or Less Related", Proceedings of the Charaka Club, X (1941), p52-55
  10. ^ Fielding H. Garrison (1921), History of Medicine (3rd ed.), W. B. Saunders, pp. 201, 312 
  11. ^ "The Art of English Posey: a Critical Edition." George Puttenham. Ed. Frank Whigham & Wayne A. Rebhorn. (2007) 379-380.
  12. ^ 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
  13. ^ "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 91, (8): 81–84. 1991. PMID 1661526. 
  14. ^ 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. 
  15. ^ United States Code Title 10, Subtitle A, Part II, Chapter 47. "Article 115 — Malingering". 

External links[edit]