by McCoy K

Malingering

Definition

Malingering is when a person intentionally exaggerates or makes up a physical or psychological illness or injury to seek personal gain such as paid sick leave, avoiding work, financial compensation, sympathy, or drugs. It is a voluntary behavior that is not considered a mental illness.

Causes

There is no physical or mental cause for malingering. It is solely caused by external motivating factors (personal gains) that varies from person to person.

Risk Factors

Malingering is most common in the school or work environment. It tends to occurs when there are legal disputes that involve money and medical issues.
People with certain mental illnesses such as antisocial personality disorder may be more likely to participate in malingering.

Symptoms

Patient-reported symptoms will vary among people since they are based on the personal gain goals. The reported symptoms may seem inconsistent with general behavior.

Diagnosis

There is no way to definitively diagnose malingering. Careful questions may lead doctors to suspect malingering. They will look for suspicious behaviors such as:
  • Inconsistency between reported symptoms and physical findings on a medical exam
  • Unwillingness to have recommended tests
  • Failure to comply with prescribed treatments
The doctor may also rule out true physical or mental causes of reported symptoms to make sure a medical condition is not present. Psychological assessments can also help rule out other disorders, such as Munchausen's syndrome .

Treatment

Since it is not a true illness, there is no real treatment for malingering. When malingering is suspected, the doctor may:
  • Discuss the findings—if malingering is suspected, the doctor may confront the patient
  • Psychiatric consultation—a referral to a mental health professional may be given if a psychiatric disorder is suspected

Prevention

Malingering is not a mental disorder. It can be prevented by making the decision not to exaggerate or make up symptoms for personal gain.

RESOURCES

Mental Health America http://www.mentalhealthamerica.net

Psychiatry.org - American Psychiatric Association http://www.psychiatry.org

CANADIAN RESOURCES

Canadian Mental Health Association http://www.cmha.ca

Canadian Psychiatric Association http://www.cpa-apc.org

References

Greer S, Chambliss L. What physical exam techniques are useful to detect malingering? J Fam Pract. 2005;54.

Rogers R. Clinical Assessment of Malingering and Deception. New York, NY: Guilford Press; 1988.

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