Malingering / definition and how assessed . .

Discussion in 'Fibromyalgia Main Forum' started by bakron, Aug 5, 2003.

  1. bakron

    bakron New Member

    "Malingering is <b>intentional production of false or exaggerated symptoms motivated by external incentives</b>, such as obtaining compensation or drugs, avoiding work or military duty, or evading criminal prosecution. It is not considered a mental illness. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), malingering receives a V code as one of the other conditions that may be a focus of clinical attention.

    Malingering is deliberate behavior for a known external purpose. It is not considered a form of mental illness or psychopathology, although it can occur in the context of other mental illnesses.

    The total cost of health insurance fraud in the United States (including untruthful claims by patients and medical personnel) was more than $59 billion in 1995, resulting in a cost of $1050 in added premiums for the average American family.

    Strongly suspect malingering in the presence of any combination of the following:
    <ul>
    <li>Medicolegal presentation (eg, an attorney refers patient, a patient is seeking compensation for injury)

    <li>Marked discrepancy between the claimed distress and the objective findings

    <li>Lack of cooperation during evaluation and in complying with prescribed treatment

    <li>Presence of an antisocial personality disorder

    <li>Malingering often is associated with an antisocial personality disorder and a histrionic personality style.

    <li>Prolonged direct observation can reveal evidence of malingering because it is difficult for the person who is malingering to maintain consistency with the false or exaggerated claims for extended periods.

    <li>The person who is malingering usually lacks knowledge of the nuances of the feigned disorder. For example, someone complaining of carpal tunnel syndrome may be referred to occupational therapy, where the person who is malingering would be unable to predict the effect of true carpal tunnel syndrome on tasks in the wood shop.

    <li>Prolonged interview and examination of a person suspected of a malingering disorder may induce fatigue and diminish the ability of the person who is malingering to maintain the deception.

    <li>Rapid firing of questions increases the likelihood of contradictory or inconsistent responses.

    <li>Asking leading questions may induce the person to endorse symptoms of a different illness.

    <li>Questions about improbable symptoms may yield positive responses. However, because some of these techniques may induce similar responses in some patients with genuine psychiatric disorders, exercise caution in reaching a conclusion of malingering.

    <li>Persons malingering psychotic disorders often exaggerate hallucinations and delusions but cannot mimic formal thought disorders.

    <li>They usually cannot feign blunted affect, concrete thinking, or impaired interpersonal relatedness.

    <li>They frequently assume that dense amnesia and disorientation are features of psychosis.
    </ul>
    It should be noted that these descriptions also may apply to some patients with genuine psychiatric disorders. For example, individuals with a delusional disorder can have unshakable beliefs and bizarre ideas without formal thought disorder or affective blunting.

    The most common goals of people who malinger in the ED are obtaining drugs and shelter. In the clinic or office, the most common goal is financial compensation.

    Physical: Typically, deficits on physical examination do not follow known anatomical distributions. A patient's attitude toward the examining physician often is vague or evasive."

    (From "emedicine")
  2. Takesha

    Takesha New Member

    Wait until Hippo reads this...can you imagine being accused of this? No wonder Madwolfs replied the was he did. Thanks for this post, I and my SO just thought that malingering was "goofing off", and couldn't figure out why a Doc. would say such a thing...You know I challenge myself to learn something new everyday, but on somedays there are just some things I find out I'd rather not know! GRRRRR, this makes me really mad, and I am going to copy it to file. Thanks.
    Takesha
  3. donna13210

    donna13210 Member

    I'm confused about the purpose of this post?

    Forgive me if I am missing something!

    Thanks
  4. bakron

    bakron New Member

    “Hippo” posted requesting information from “Madwolf” on how malingering was determined. That's all. I just placed the information in a separate post.
  5. gracie97

    gracie97 New Member

    People who have chronic pain problems such as FMS seem to often be suspected of malingering.

    Even though the pain and other symptoms may be real and the expression of them honest, it's useful to know these things in order to avoid the appearance of malingering.