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Deutsches Arzteblatt International Jun 2020The pathological feigning of disease can be seen in all medical disciplines. It is associated with variegated symptom presentations, self-inflicted injuries, forced but... (Review)
Review
BACKGROUND
The pathological feigning of disease can be seen in all medical disciplines. It is associated with variegated symptom presentations, self-inflicted injuries, forced but unnecessary interventions, unusual and protracted recoveries, and frequent changes of treating physician. Factitious illness is often difficult to distinguish from functional or dissociative disorders on the one hand, and from malingering on the other. Many cases, even fatal ones, probably go unrecognized. The suspicion that a patient's problem may be, at least in part, factitious is subject to a strong taboo and generally rests on supportive rather than conclusive evidence. The danger of misdiagnosis and inappropriate treatment is high.
METHODS
On the basis of a selective review of current literature, we summarize the phenomenology of factitious disorders and present concrete strategies for dealing with suspected factitious disorders.
RESULTS
Through the early recognition and assessment of clues and warning signs, the clinician will be able to judge whether a factitious disorder should be considered as a differential diagnosis, as a comorbid disturbance, or as the suspected main diagnosis. A stepwise, supportive confrontation of the patient with the facts, in which continued therapeutic contact is offered and no proofs or confessions are demanded, can help the patient set aside the sick role in favor of more functional objectives, while still saving face. In contrast, a tough confrontation without empathy may provoke even more elaborate manipulations or precipitate the abrupt discontinuation of care-seeking.
CONCLUSION
Even in the absence of systematic studies, which will probably remain difficult to carry out, it is clearly the case that feigned, falsified, and induced disorders are underappreciated and potentially dangerous differential diagnoses. If the entire treating team successfully maintains an alert, transparent, empathic, and coping-oriented therapeutic approach, the patient will, in the best case, be able to shed the pretense of disease. Above all, the timely recognition of the nature of the problem by the treating team can prevent further iatrogenic harm.
Topics: Diagnosis, Differential; Factitious Disorders; Humans
PubMed: 32897184
DOI: 10.3238/arztebl.2020.0452 -
Psychological Injury and Law 2021
PubMed: 33758641
DOI: 10.1007/s12207-021-09405-1 -
Brain Sciences Jul 2022Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that interferes with multiple aspects of daily functioning. Malingering or feigning of...
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that interferes with multiple aspects of daily functioning. Malingering or feigning of symptoms can be a major challenge during ADHD assessment. Stimulant medication abuse, misuse and diversion may constitute another challenge during management. A literature search of the past 15 years on the topic continued to suggest that there are several reasons for malingering and faking ADHD symptoms. Some of the reasons include the intent to obtain prescriptions for stimulant medications for performance enhancement, to gain access to additional school services and accommodations, to use recreationally and to sell as a street drug. In some countries, patients may receive additional tax or student loan benefits. Several researchers suggested that self-report rating measures are easily simulated by patients without ADHD. They concluded that no questionnaire has proved sufficiently robust against false positives. Some clinical factors that may suggest malingering during the ADHD assessment are highlighted and some available tests to detect malingering are discussed.
PubMed: 36009067
DOI: 10.3390/brainsci12081004 -
Epilepsy & Behavior Reports 2022•Functional (psychogenic) symptoms exist in all specialties.•They are by definition not under voluntary control, unlike factitious disorders and malingering.•The... (Review)
Review
•Functional (psychogenic) symptoms exist in all specialties.•They are by definition not under voluntary control, unlike factitious disorders and malingering.•The diagnostic approach to functional symptoms varies among specialties.
PubMed: 35198949
DOI: 10.1016/j.ebr.2021.100506 -
Psychiatry Journal 2022Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives. Although the Diagnostic... (Review)
Review
Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives. Although the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not list malingering in its diagnostic section and therefore does not identify it as a formal mental disorder, malingering and verified mental illness commonly coexist. Some subtypes of feigning behaviors, such as partial or pure malingering, dissimulation, and false imputation, can be suspected when patients have marked discrepancies between reported stressors and objective findings. The article discusses these three theoretical concepts with their possible clinical aspects, illustrating each phenomenon by clinical case with self-reported and/or observed psychotic symptoms. We summarized relevant findings and provided a review of clinical considerations that physicians can use to aid in the evaluation of psychotic symptoms in the context of those three concepts.
PubMed: 35495616
DOI: 10.1155/2022/3884317 -
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 -
Cureus Jun 2021Malingering is the intentional fabrication of symptoms for material gain. Malingering among frequent utilizers and patients with psychiatric symptoms is suspected to be...
Malingering is the intentional fabrication of symptoms for material gain. Malingering among frequent utilizers and patients with psychiatric symptoms is suspected to be common in emergency settings but difficult to detect and manage. We present a case report of a 50-year-old man feigning psychosis and suicidality in order to obtain shelter. Strategies to identify malingered psychiatric symptoms are presented. Understanding how malingering is adaptational can help clinicians begin to manage these patients and symptoms in a compassionate manner that preserves healthcare resources, improves patient care, and reduces the risk of burnout for clinicians.
PubMed: 34277261
DOI: 10.7759/cureus.15670