malingering


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Related to malingering: Factitious disorder

Malingering

 

Definition

In the context of medicine, malingering is the act of intentionally feigning or exaggerating physical or psychological symptoms for personal gain.

Description

People may feign physical or psychological illness for any number of reasons. Faked illness can get them out of work, military duty, or criminal prosecution. It can also help them obtain financial compensation through insurance claims, lawsuits, or workers' compensation. Feigned symptoms may also be a way of getting the doctor to prescribe certain drugs.
According to the American Psychiatric Association, patients who malinger are different from people who invent symptoms for sympathy (factitious diseases). Patients who malinger clearly have something tangible to gain. People with factitious diseases appear to have a need to play the "sick" role. They may feign illness for attention or sympathy.
Malingering may take the form of complaints of chronic whiplash pain from automobile accidents. Whiplash claims are controversial. Although some people clearly do suffer from whiplash injury, others may be exaggerating the pain for insurance claims or lawsuits. Some intriguing scientific studies have shown that chronic whiplash pain after automobile accidents is almost nonexistent in Lithuania and Greece. In these countries, the legal systems do not encourage personal injury lawsuits or financial settlements. The psychological symptoms experienced by survivors of disaster (post-traumatic stress disorder) are also faked by malingerers.

Causes and symptoms

People malinger for personal gain. The symptoms may vary. Generally malingerers complain of psychological disorders such as anxiety. They may also complain of chronic pain for which objective tests such as x rays can find no physical cause. Because it is often impossible to determine who is malingering and who is not, it is impossible to know how frequently malingering occurs.

Diagnosis

Malingering may be suspected:
  • 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).
The diagnosis of malingering is a challenge for doctors. On the one hand, the doctor does not want to overlook a treatable disease. On the other hand, he or she does not want to continue ordering tests and treatments if the symptoms are faked. Malingering is difficult to distinguish from certain legitimate personality disorders, such as factitious diseases or post-traumatic distress syndrome. In legal cases, malingering patients may be referred to a psychiatrist. Psychiatrists use certain written tests to try to determine whether the patient is faking the symptoms.

Treatment

In a sense, malingering cannot be treated because the American Psychiatric Association does not recognize it as a personality disorder. Patients who are purposefully faking symptoms for gain do not want to be cured. Often, the malingering patient fails to report any improvement with treatment, and the doctor may try many treatments without success.

Resources

Organizations

American Psychiatric Association. 1400 K Street NW, Washington DC 20005. (888) 357-7924. http://www.psych.org.

Key terms

Antisocial personality — A personality characterized by attitudes and behaviors at odds with society's customs and moral standards, including illegal acts.
Factitious diseases — Conditions in which symptoms are deliberately manufactured by patients in order to gain attention and sympathy. Patients with factitious diseases do not fake symptoms for obvious financial gain or to evade the legal system.
Post traumatic stress disorder (PTSD) — A disorder that occurs among survivors of severe environmental stress such as a tornado, an airplane crash, or military combat. Symptoms include anxiety, insomnia, flashbacks, and nightmares. Patients with PTSD are unnecessarily vigilant; they may experience survivor guilt, and they sometimes cannot concentrate or experience joy.

malingering

 [mah-ling´ger-ing]
willful, deliberate, and fraudulent feigning or exaggeration of the symptoms of illness or injury to attain a consciously desired end.

ma·lin·ger·ing

(mă-ling'gĕr-ing),
Feigning illness or disability to escape work, excite sympathy, or gain compensation.
[Fr. malingre, poor, weakly]

malingering

/ma·lin·ger·ing/ (mah-ling´ger-ing) willful, fraudulent feigning or exaggeration of the symptoms of illness or injury to attain a consciously desired end.

malingering

[məling′gəring]
Etymology: Fr, malingre, puny, weak
a willful and deliberate feigning of the symptoms of a disease or injury to gain some consciously desired end. malinger, v., malingerer, n.

malingering

The wilful production of symptoms, or the fraudulent simulation of illness or exaggeration of the symptoms of a minor illness or injury, usually for specific external incentives, such as the collection of benefits or to avoid work or school.

Types of malingering
• Anticipation of collecting insurance benefits.
• Malingering with psychological underpinnings, either:
   — Endogenous (e.g., factitious dermatitis); or
   — Exogenous origin (e.g., Munchausen syndrome).

malingering

Occupational medicine The willful production of symptoms for specific external incentives, or the fraudulant simulation of illness or exaggeration of the Sx of a minor illness or injury, usually to avoid work or school. See Factitious disease(s. ). Cf Munchausen syndrome.

ma·lin·ger·ing

(mă-ling'gĕr-ing)
Feigning illness or inability to work resulting from an ulterior motive, such as to collect insurance benefits.
[Fr. malingre, poor, weakly]

malingering

A pretence to be suffering from a disease, or the simulation of signs of disease, so as to gain some supposed advantage such as avoidance of work or of presumed danger, or to obtain money by fraudulent claims for compensation. See also MUNCHAUSEN'S SYNDROME.

malingering

Feigning illness or disability (often for the purpose of gaining compensation or avoiding duty). See optokinetic nystagmus test; tunnel vision.

ma·lin·ger·ing

(mă-ling'gĕr-ing)
Feigning illness or disability to escape work, excite sympathy, or gain compensation.
[Fr. malingre, poor, weakly]

malingering,

n the feigning of illness.
References in periodicals archive ?
Functional analysis of malingering in the emergency department.
Utility of the Trail Making Test in the assessment of malingering in a sample of mild traumatic brain injury litigants.
Malingering is intentional production of false or exaggerated symptoms motivated by external incentives, such as obtaining compensation or drugs, avoiding work or military duty (4).
In the malingering subgroup and the educational deficit subgroup, there was no significant difference among different scores.
Besides the neuropsychologist, anyone involved with counseling or treatment of offender populations would profit from Robert Denney's chapter "Assessment of Malingering in Criminal Forensic Neuropsychological Settings.
If you look at the base rates of malingering or symptom exaggeration by referral type, Mittenberg and his colleagues report 30.
Clinicians most often encounter malingering in the treatment of individuals whose conditions are most easily faked, such as chronic pain, psychiatric illness, and cognitive deficits (Rogers, 1998).
Only he knows for sure, but malingering is a rational behavior with the facility's existing light duty system.
Warning flags for malingering include persistent noncompliance during prescribed evaluation or treatment, striking inconsistency between physical findings and stated symptoms, and an attorney or insurance company referring the patient to you.
Those used to measure post-injury malingering included detachment, learned helplessness, entitlement, and manipulation.
In the present study we wanted to test the hypothesis that one potential characteristic of someone who is malingering is that they have difficulty inhibiting irrelevant information.