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.

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994.

Resnick, Phillip J. "Malingered Psychosis." In Clinical Assessment of Malingering and Deception. 2nd ed. Ed. Richard Rogers. New York: Gilford Publications, 1997.

PERIODICALS

Klass, Peri. "How Sick Is It to Want to Be Sick?" Discover 78 (Jan. 1986): 20-21.

Resnick, Phillip J. "Defrocking the Fraud." Israel Journal of Psychiatry and Related Sciences 30 (1993): 93-101.

Schrader, H., et al. "Natural Evolution of Late Whiplash Syndrome Outside the Medicolegal Context." The Lancet 347 (4 May 1996): 1207-1211.

"Two New Studies Question Basis for Whiplash Claims." The Back Letter 12 (Dec. 1997): 133-34.

ORGANIZATIONS

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

Robert Scott Dinsmoor

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.