Malingering

Malingering is pretending to be sick when you aren’t or pretending to be sicker than you are.

Definition

Malingering is the purposeful production of falsely or grossly exaggerated complaints with the goal of receiving a reward. These may include money, insurance settlement, drugs or the avoidance of punishment, work, jury duty, the military or some other kind of service.

A malingerer may respond to items in a certain manner to attain release from incarceration. One example is the case of Ganser syndrome, which is when a person tailors their answers to fake psychosis. This syndrome is also known as approximation, or nonsense syndrome.

Malingering can lead to abuse of the medical system, with unnecessary tests being performed and time being wasted by the clinician as opposed to those with legitimate health problems.

A malingerer may attempt to raise the temperature of a thermometer through heat from a lamplight or alter a urine sample by adding sand to it; however, if the malingerer is more discreet, the clinician will have great difficulty gathering evidence for an accurate diagnosis.

Symptoms

Malingering can exist in a variety of intensities, from pure (in which all symptoms are falsified) to partial, in which symptoms are exaggerated. 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 should not be confused with factitious disorder (in which motive is the desire to occupy a sick role, rather than some form of material gain) and somatoform disorders (in which symptoms are not produced willfully), though misdiagnosis is bound to occur.

Causes

In some cases, the patient may be seeking a reward (time off work or financial gain); in others, the patient may falsify their symptoms because they think that the symptoms will inevitably arise sometime in the future. 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.

Treatments

Treatment lies in the clinician being able to detect the disorder. Cues for the clinician include: 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.

Psychological evaluation is also recommended as a way to diagnose malingering, in particular, the Minnesota Multiphasic Personality Inventory (MMPI-2) as this measure has validity scales of value for this purpose. The MMPI-2 provides objective, scientifically based information about whether an individual has responded honestly to the test, or whether he or she has exaggerated or minimized psychological problems (possibly to obtain an external incentive, such as money damages in a personal injury lawsuit).

The difficulty with treatment is that people who malinger almost never accept psychiatric referral, and the success of such consultations is minimal. Avoid consultations to other medical specialists because such referrals only perpetuate malingering. However, in cases of serious uncertainty about the presence of genuine psychiatric illness, suggest psychiatric consultation. 

Sources

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders
  • DSM-IV(TM) Made Easy: The Clinician's Guide to Diagnosis
Last reviewed 02/17/2015