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Current Psychiatry Reports Nov 2016Malingering is the intentional fabrication of medical symptoms for the purpose of external gain. Along similar lines as malingering, factitious disorder is the... (Review)
Review
Malingering is the intentional fabrication of medical symptoms for the purpose of external gain. Along similar lines as malingering, factitious disorder is the intentional creation or exaggeration of symptoms, but without intent for a concrete benefit. The incidence of malingering and factitious disorder in the military is unclear, but likely under reported for a variety of reasons. One should be aware of potential red flags suggesting malingering or factitious disorder and consider further evaluation to look for these conditions. A deliberate and intentional management plan is ideal in these cases. Furthermore, a multi-disciplinary team approach, a non-judgmental environment, and the use of direct but dignity sparing techniques will likely be most "successful" when confronting the patient with malingering or factitious disorder.
Topics: Factitious Disorders; Humans; Malingering; Military Personnel
PubMed: 27752984
DOI: 10.1007/s11920-016-0740-z -
NeuroRehabilitation 2015Youth have been assumed historically to be less capable of deception than adults, even though acts of deception in childhood are not uncommon. Relatively little... (Review)
Review
BACKGROUND
Youth have been assumed historically to be less capable of deception than adults, even though acts of deception in childhood are not uncommon. Relatively little attention has focused on how frequently they feign or exaggerate during healthcare evaluations.
PURPOSE
The current article reviews the literature relevant to using validity tests in children and adolescents, as well as provides a case example of a young adolescent providing noncredible effort and exaggerated symptomatology during neuropsychological evaluation after a mild traumatic brain injury.
CONCLUSION
Numerous case reports and case series have documented clearly that medical and neuropsychological noncredible presentations occur in children, likely more often than many practitioners believe. Thus far, research has found that the base rates of pediatric noncredible presentations are highest in children seen frequently by rehabilitation providers (i.e., children with persistent problems after mild traumatic brain injury and children from families seeking disability benefits on their behalf). Subjective clinical judgment is apt to be ineffective in consistently detecting noncredible presentations. Fortunately, recent research supports the use of several stand-alone validity tests in identifying noncredible pediatric data including the Test of Memory Malingering, Word Memory Test, and Medical Symptom Validity Test. If feigning and exaggeration are not considered in work-ups by rehabilitation practitioners, mismanagement and iatrogenic harm to the child can result.
Topics: Adolescent; Brain Injuries; Child; Humans; Malingering; Neuropsychological Tests
PubMed: 26409492
DOI: 10.3233/NRE-151232 -
Neurophysiologie Clinique = Clinical... Oct 2014The issue of lying occurs in neuropsychology especially when examinations are conducted in a forensic context. When a subject intentionally either presents non-existent... (Review)
Review
The issue of lying occurs in neuropsychology especially when examinations are conducted in a forensic context. When a subject intentionally either presents non-existent deficits or exaggerates their severity to obtain financial or material compensation, this behaviour is termed malingering. Malingering is discussed in the general framework of lying in psychology, and the different procedures used by neuropsychologists to evidence a lack of collaboration at examination are briefly presented and discussed. When a lack of collaboration is observed, specific emphasis is placed on the difficulty in unambiguously establishing that this results from the patient's voluntary decision.
Topics: Deception; Emotions; Humans; Lie Detection; Malingering; Neuropsychological Tests; Neuropsychology; Symptom Assessment
PubMed: 25306079
DOI: 10.1016/j.neucli.2014.04.002 -
The Journal of the American Academy of... Sep 2021
Topics: Forensic Psychiatry; Humans; Malingering; Mental Disorders; Reproducibility of Results
PubMed: 34489244
DOI: 10.29158/JAAPL.210073-21 -
Handbook of Clinical Neurology 2016Functional neurologic disorders are largely genuine and represent conversion disorders, where the dysfunction is unconscious, but there are some that are factitious,... (Review)
Review
Functional neurologic disorders are largely genuine and represent conversion disorders, where the dysfunction is unconscious, but there are some that are factitious, where the abnormality is feigned and conscious. Malingering, which can have the same manifestations, is similarly feigned, but not considered a genuine disease. There are no good methods for differentiating these three entities at the present time. Physiologic studies of functional weakness and sensory loss reveal normal functioning of primary motor and sensory cortex, but abnormalities of premotor cortex and association cortices. This suggests a top-down influence creating the dysfunction. Studies of functional tremor and myoclonus show that these disorders utilize normal voluntary motor structures to produce the involuntary movements, again suggesting a higher-level abnormality. Agency is abnormal and studies shows that dysfunction of the temporoparietal junction may be a correlate. The limbic system is overactive and might initiate involuntary movements, but the mechanism for this is not known. The limbic system would then be the source of top-down dysfunction. It can be speculated that the involuntary movements are involuntary due to lack of proper feedforward signaling.
Topics: Conversion Disorder; Factitious Disorders; Humans; Malingering; Nervous System Diseases; Neurophysiology
PubMed: 27719876
DOI: 10.1016/B978-0-12-801772-2.00006-0 -
The Primary Care Companion For CNS... Feb 2018Factitious disorder can present in multiple health care settings, with patients intentionally producing symptoms to assume the sick role. This assumption of the sick... (Review)
Review
Factitious disorder can present in multiple health care settings, with patients intentionally producing symptoms to assume the sick role. This assumption of the sick role can result in multiple hospitalizations with unnecessary diagnostic workup, as well as invasive diagnostic procedures that can lead to worrisome side effects. Differential diagnoses that should be ruled out include malingering, somatic symptom disorder, and anxiety disorders. For many providers, patients with factitious disorder can be a challenge to treat because the etiology of the disorder remains unclear. There are multiple psychological theories that attempt to explain the motivation and thought process behind the voluntary production of symptoms. Some of these theories have addressed disruptive attachments during childhood, possible intergenerational transfer of the disorder, personal identity conflicts, somatic illness as a form of masochistic activity toward oneself, and intrapsychic conflicts. Confrontation and psychotherapy with a multidisciplinary team has been proposed as a form of treatment. An understanding of the psychological factors associated with factitious disorder can help providers understand the rationale behind the patient's presentation and aid in the formulation of a treatment plan.
Topics: Anxiety Disorders; Diagnosis, Differential; Factitious Disorders; Humans; Malingering
PubMed: 29489075
DOI: 10.4088/PCC.17nr02229 -
Italian Journal of Dermatology and... Dec 2022Self-inflicted skin disorders are artefact diseases inflicted by the use of multiple different means, for various different purposes. They account for about 2% of...
Self-inflicted skin disorders are artefact diseases inflicted by the use of multiple different means, for various different purposes. They account for about 2% of dermatology patient visits, and include disorders with a denied or hidden pathological behavior (factitious disorders) and disorders with a non-denied and non-hidden pathological behavior (compulsive disorders). In turn, factitious skin disorders are subdivided into 2 groups: factitious disorders without an external incentive (considered in a preceding work) and factitious disorders with external incentives. In the second eventuality, the simulator is motivated by illicit intent, wishing to evade civil duties or a prison sentence, for instance, or to exploit situations of an occupational nature, and is fully aware of his action and his intention. Apart of the two groups of pathomimic artefacts and malingering, some self-inflicted dermatoses are due to behavioral disorders involving compulsive habits (tics, psychological excoriations). The great majority of subjects suffering from the latter disturbances are quick to confess their urge to self-inflict lesions. The management, including both psychiatric and dermatological assessment, concludes this second part of the work regarding the self-inflicted cutaneous diseases.
Topics: Humans; Self-Injurious Behavior; Skin; Factitious Disorders; Malingering; Tics
PubMed: 36177780
DOI: 10.23736/S2784-8671.22.07376-5 -
La Clinica Terapeutica 2019The simulation of mental illness, so-called "Malingering", is a very difficult phenomenon for professionals to identify when making an assessment, especially in the... (Review)
Review
The simulation of mental illness, so-called "Malingering", is a very difficult phenomenon for professionals to identify when making an assessment, especially in the medicolegal and forensic psychology and psychiatry fields. When malingering, the subject implements strategies that mimic the symptoms related to a possible psychiatric disease, with the aim of misleading the operator. It is necessary, therefore, to elicit a complete medical history and make a close clinical examination and, especially, to be able to rely on appropriate diagnostic tools. Another important aspect, in the legal medicine, and forensic psychology and psychiatry fields, is the opposite strategy, namely that of dissimulating, or masking, a disease. Several diagnostic tools that the professional clinician can employ to identify dissembling strategies are considered in this article, namely the MMPI- 2, PAI, M- Fast, the SIRS and, finally, the SIMS.
Topics: Adult; Forensic Medicine; Forensic Psychiatry; Humans; Male; Malingering; Mental Disorders; Physical Examination; Psychiatry
PubMed: 30993310
DOI: 10.7417/CT.2019.2123 -
The Journal of the American Academy of... Sep 2017Malingering is a medical diagnosis, but not a psychiatric disorder. The label imputes that an evaluee has intentionally engaged in false behavior or statements. By...
Malingering is a medical diagnosis, but not a psychiatric disorder. The label imputes that an evaluee has intentionally engaged in false behavior or statements. By diagnosing malingering, psychiatrists pass judgment on truthfulness. Evaluees taking exception to the label may claim that the professional has committed defamation of character (libel or slander) when the diagnosis is wrong and costs the claimant money or benefits. Clinicians may counter by claiming immunity or that the diagnosis was made in good faith. This problem has come into focus in military and veterans' contexts, where diagnoses become thresholds for benefits. Through historical and literary examples, case law, and military/veterans' claims of disability and entitlement, the authors examine the potency of the malingering label and the potential liability for professionals and institutions of making this diagnosis.
Topics: Disability Evaluation; Humans; Malingering; Stress Disorders, Post-Traumatic; Veterans
PubMed: 28939732
DOI: No ID Found -
International Journal of Law and... 2017This journal's third article on PTSD in Court focuses especially on the topic's "court" component. It first considers the topic of malingering, including in terms of its... (Review)
Review
This journal's third article on PTSD in Court focuses especially on the topic's "court" component. It first considers the topic of malingering, including in terms of its definition, certainties, and uncertainties. As with other areas of the study of psychological injury and law, generally, and PTSD (posttraumatic stress disorder), specifically, malingering is a contentious area not only definitionally but also empirically, in terms of establishing its base rate in the index populations assessed in the field. Both current research and re-analysis of past research indicates that the malingering prevalence rate at issue is more like 15±15% as opposed to 40±10%. As for psychological tests used to assess PTSD, some of the better ones include the TSI-2 (Trauma Symptom Inventory, Second Edition; Briere, 2011), the MMPI-2-RF (Minnesota Multiphasic Personality Inventory, Second Edition, Restructured Form; Ben-Porath & Tellegen, 2008/2011), and the CAPS-5 (The Clinician-Administered PTSD Scale for DSM-5; Weathers, Blake, Schnurr, Kaloupek, Marx, & Keane, 2013b). Assessors need to know their own possible biases, the applicable laws (e.g., the Daubert trilogy), and how to write court-admissible reports. Overall conclusions reflect a moderate approach that navigates the territory between the extreme plaintiff or defense allegiances one frequently encounters in this area of forensic practice.
Topics: Forensic Psychiatry; Humans; Malingering; Psychiatric Status Rating Scales; Stress Disorders, Post-Traumatic
PubMed: 28366496
DOI: 10.1016/j.ijlp.2017.03.001