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Malingering - Malingering Symptom, Cause, Treatment
Malingering is characterized by a deliberate fabrication of psychiatric or physical complaints for clear secondary gain such as material reward (e.g. controlled substances, money) or punishment avoidance. Malingering is a medical and psychological term that refers to an individual faking the symptoms of mental or physical disorders for a myriad of reasons such as fraud, dereliction of responsibilities, response to (attempt to lessen) external stress factors, or attempting to obtain medications or to lighten criminal sentences. Perhaps one of the most underdiagnosed Syndromes of our time. Because malingerers are usually seeking some sort of primary or secondary gain, this disorder remains separate of Somatization disorders and factitious disorder in which the gain is not obvious.
Symptoms of Malingering
A patient may simulate symptoms of a specific disorder or deny the existence of the problem that may explain the symptoms. Malingering is not easy to diagnose because of the difficulty in gathering overt evidence; also, symptoms are emotional and mental. Malingering is deliberate behavior for a known external purpose. Malingering is intentional production of false or exaggerated symptoms motivated by external incentives, such as obtaining compensation or drugs, avoiding work or military duty, or evading criminal prosecution. Malingering is not considered a mental illness.
Causes of Malingering
In some cases, the patient may be seeking a reward (time off work or financial gain); in others, the patient may think that the symptoms will eventually arise sometime in the future. 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
Treatment of Malingering
If the patient has legal problems, potential for financial reward, antisocial personality disorder; if the patient's story is incongruent with known facts or other informant accounts; if the patient will not cooperate while being evaluated. Clinical hints that a patient may be malingering include the presence of an antisocial personality or chemical dependency issue, noncompliance with the evaluation and treatment process, a medicolegal context to the presentation (e.g. referral by an attorney), and a marked disparity between subjective complaints and objective exam findings. Foremost among consideration, Factitious Disorder is a condition in which the patient also exaggerates or feigns symptoms to achieve a less obvious primary gain; that is, a primitive desire to satisfy attention needs by playing sic. Regarding the latter criterion, differential diagnosis can be tricky. Other treatment are includes
- Do not accuse the patient directly of faking an illness. Hostility, breakdown of the doctor-patient relationship, lawsuit against the doctor, and, rarely, violence may result.
- The more advisable approach is to confront the person indirectly by remarking that the objective findings do not meet the physician's objective criteria for diagnosis. Allow the person who is malingering the opportunity to save face.
- Alternatively, the physician may inform people who are malingering that they are required to undergo invasive testing and uncomfortable treatments (provided, of course, that such warning is true).
- The likelihood of success with such approaches is inversely related to the rewards for the malingering behavior.
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