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Nature Reviews. Neurology Apr 2023Functional neurological disorder (FND) is one of the commonest reasons that people seek help from a neurologist and is for many people a lifelong cause of disability and... (Review)
Review
Functional neurological disorder (FND) is one of the commonest reasons that people seek help from a neurologist and is for many people a lifelong cause of disability and impaired quality of life. Although the evidence base regarding FND pathophysiology, treatment and service development has grown substantially in recent years, a persistent ambivalence remains amongst health professionals and others as to the veracity of symptom reporting in those with FND and whether the symptoms are not, in the end, just the same as feigned symptoms or malingering. Here, we provide our perspective on the range of evidence available, which in our view provides a clear separation between FND and feigning and malingering. We hope this will provide a further important step forward in the clinical and academic approach to people with FND, leading to improved attitudes, knowledge, treatments, care pathways and outcomes.
Topics: Humans; Malingering; Quality of Life; Conversion Disorder; Disabled Persons
PubMed: 36797425
DOI: 10.1038/s41582-022-00765-z -
Frontiers of Neurology and Neuroscience 2018This chapter is aimed at highlighting the recent findings concerning physiopathology, diagnosis, and management of conversion, factitious disorder, and malingering.... (Review)
Review
This chapter is aimed at highlighting the recent findings concerning physiopathology, diagnosis, and management of conversion, factitious disorder, and malingering. Conversion disorder is the unintentional production of neurological symptom, whereas malingering and factitious disorder represent the voluntary production of symptoms with internal or external incentives. They have a close history and this has been frequently confounded. Practitioners are often confronted to medically unexplained symptoms; they represent almost 30% of neurologist's consultation. The first challenge is to detect them, and recent studies have confirmed the importance of "positive" clinical bedside signs based on incoherence and discordance, such as the Hoover's sign for the diagnosis of conversion disorder. Functional neuroimaging has allowed a better understanding of the pathophysiology, and highlighted abnormal cerebral activation patterns in conversion disorder in relation to motor, emotional, and limbic networks, different from feigners. This supports the theory evoked by Charcot of a "psychodynamic lesion," which is also reflected by the new term introduced in the DSM-5: functional neurological disorder. Multidisciplinary therapy is recommended with behavioral cognitive therapy, antidepressant to treat frequent comorbid anxiety or depression, and physiotherapy. Factitious disorder and malingering should be clearly delineated from conversion disorder. Factitious disorder should be considered as a mental illness and more research on its physiopathology and treatment is needed, when malingering is a non-medical condition encountered in medico-legal cases.
Topics: Conversion Disorder; Factitious Disorders; Humans; Malingering; Medically Unexplained Symptoms
PubMed: 29151092
DOI: 10.1159/000475699 -
Practical Neurology Apr 2019Although exaggeration or amplification of symptoms is common in all illness, deliberate deception is rare. In settings associated with litigation/disability evaluation,... (Review)
Review
Although exaggeration or amplification of symptoms is common in all illness, deliberate deception is rare. In settings associated with litigation/disability evaluation, the rate of malingering may be as high as 30%, but its frequency in clinical practice is not known. We describe the main characteristics of deliberate deception (factitious disorders and malingering) and ways that neurologists might detect symptom exaggeration. The key to establishing that the extent or severity of reported symptoms does not truly represent their severity is to elicit inconsistencies in different domains, but it is not possible to determine whether the reports are intentionally inaccurate. Neurological disorders where difficulty in determining the degree of willed exaggeration is most likely include functional weakness and movement disorders, post-concussional syndrome (or mild traumatic brain injury), psychogenic non-epileptic attacks and complex regional pain syndrome type 1 (especially when there is an associated functional movement disorder). Symptom amplification or even fabrication are more likely if the patient might gain benefit of some sort, not necessarily financial. Techniques to detect deception in medicolegal settings include covert surveillance and review of social media accounts. We also briefly describe specialised psychological tests designed to elicit effort from the patient.
Topics: Animals; Behavior; Cognition; Factitious Disorders; Female; Humans; Malingering; Middle Aged; Movement Disorders; Nervous System Diseases; Young Adult
PubMed: 30425128
DOI: 10.1136/practneurol-2018-001950 -
Asian Journal of Psychiatry Apr 2020Since time immemorial, humans have tried to feign physical and mental illnesses for various reasons. This led to the development of the concept of illness deception or... (Review)
Review
Since time immemorial, humans have tried to feign physical and mental illnesses for various reasons. This led to the development of the concept of illness deception or malingering when one tries to assume a sick role and feigns signs and symptoms to gain external incentives. The conceptual framework of malingering has undergone several changes and there is sufficient evidence to demonstrate that malingering exists. However, the diagnosis of malingering has not yet been established in the mainstream psychiatric nosological systems and still it is present in the appendices as an additional area requiring attention. This is due to the poor construct validity of the diagnosis, problems in defining malingering, problems in assessment by psychological tests and clinical assessment methodology, no well-established guidelines to detect malingering and issues related to labelling/reporting malingering. Because of several controversies in multiple domains of assessment and ethical-social issues, malingering as a distinct entity is grossly neglected. In the upcoming arena of law suits and consumer benefits suits, it is extremely important to have a better understanding of the conceptual issues related to malingering and the controversies related to it. In this review, a brief overview of evolution of concepts and controversies related to malingering is described.
Topics: Humans; Malingering; Models, Psychological
PubMed: 32088586
DOI: 10.1016/j.ajp.2020.101952 -
Archives of Clinical Neuropsychology :... Aug 2020Empirically informed neuropsychological opinion is critical for determining whether cognitive deficits and symptoms are legitimate, particularly in settings where there...
OBJECTIVES
Empirically informed neuropsychological opinion is critical for determining whether cognitive deficits and symptoms are legitimate, particularly in settings where there are significant external incentives for successful malingering. The Slick, Sherman, and Iversion (1999) criteria for malingered neurocognitive dysfunction (MND) are considered a major milestone in the field's operationalization of neurocognitive malingering and have strongly influenced the development of malingering detection methods, including serving as the criterion of malingering in the validation of several performance validity tests (PVTs) and symptom validity tests (SVTs) (Slick, D.J., Sherman, E.M.S., & Iverson, G. L. (1999). Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist, 13(4), 545-561). However, the MND criteria are long overdue for revision to address advances in malingering research and to address limitations identified by experts in the field.
METHOD
The MND criteria were critically reviewed, updated with reference to research on malingering, and expanded to address other forms of malingering pertinent to neuropsychological evaluation such as exaggeration of self-reported somatic and psychiatric symptoms.
RESULTS
The new proposed criteria simplify diagnostic categories, expand and clarify external incentives, more clearly define the role of compelling inconsistencies, address issues concerning PVTs and SVTs (i.e., number administered, false positives, and redundancy), better define the role of SVTs and of marked discrepancies indicative of malingering, and most importantly, clearly define exclusionary criteria based on the last two decades of research on malingering in neuropsychology. Lastly, the new criteria provide specifiers to better describe clinical presentations for use in neuropsychological assessment.
CONCLUSIONS
The proposed multidimensional malingering criteria that define cognitive, somatic, and psychiatric malingering for use in neuropsychological assessment are presented.
Topics: Cognition Disorders; Cognitive Dysfunction; Humans; Malingering; Neuropsychological Tests; Neuropsychology; Reproducibility of Results
PubMed: 32377667
DOI: 10.1093/arclin/acaa019 -
Journal of Forensic Sciences Apr 1982Malingering, also called shamming illness or goldbricking, is the false and fraudulent simulation or exaggeration of physical or mental disease or defect, performed in... (Review)
Review
Malingering, also called shamming illness or goldbricking, is the false and fraudulent simulation or exaggeration of physical or mental disease or defect, performed in order to obtain money or drugs or to evade duty or criminal responsibility, or for other reasons that may be readily understood by an objective observer from the individual's circumstances, rather than from learning the individual's psychology. Malingering is seen in apparently normal children, students, test subjects, spouses, and adults. It is not a mental disorder. Malingering may coexist with the antisocial personality disorder, with various factitious disorders, such as the Ganser Syndrome and the Munchausen Syndrome, with the hysterias and with traumatic neuroses and other mental disorders. A review of definitions and a medicolegal discussion are presented. Malingering is an act, which is distinguished from a legal or mental status. Failure to distinguish act from status accounts for the wide disparities in definitions of malingering.
Topics: Factitious Disorders; Forensic Psychiatry; Fraud; Humans; Hysteria; Malingering; Stress Disorders, Post-Traumatic
PubMed: 7047677
DOI: No ID Found -
The Journal of the American Osteopathic... Apr 1989Malingering adds to the cost of medicine. Unnecessary tests, exhaustive evaluations, and repeated referrals are part of the cost. In noneconomic terms, malingering... (Review)
Review
Malingering adds to the cost of medicine. Unnecessary tests, exhaustive evaluations, and repeated referrals are part of the cost. In noneconomic terms, malingering erodes trust and confidence in the physician-patient relationship. This article explores means whereby the physician can detect the malingerer. Once the physician is convinced of the disingenuous nature of the symptoms, intervention is indicated. Suggestions for confronting the malingerer are reviewed.
Topics: Diagnosis, Differential; Humans; Malingering
PubMed: 2661507
DOI: No ID Found -
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 -
The Clinical Journal of Pain 2004Malingering--the willful, deliberate, and fraudulent feigning or exaggeration of illness--was originally described as a means of avoiding military service. In... (Review)
Review
Malingering--the willful, deliberate, and fraudulent feigning or exaggeration of illness--was originally described as a means of avoiding military service. In present-day clinical practice, malingering may occur in circumstances where the person wishes to avoid legal responsibility or in situations where compensation or some other benefit might be obtained. In law, the term malingering is used in relation to persons to whom military regulations apply; in other situations, malingering is regarded as fraud and may lead to charges of perjury or criminal fraud. Assertions that an individual is malingering are particularly common in clinical settings where the complaint is of a subjective nature and is not accompanied by objectively demonstrable organic abnormalities. This may occur in relation to complaints of pain in situations where the person is entitled to receive pain-contingent compensation or is suing for damages. In this article, we will review the literature on pain and malingering and discuss attempts that have been made to develop methods and guidelines for the detection of malingered pain. There are, however, no valid clinical methods of assessment of possible malingering of pain. In our view, the ultimate issue of the veracity of the plaintiff is for the Court to decide, and epithets such as "malingerer" have no place in reports prepared for legal purposes by health care professionals.
Topics: Disability Evaluation; Expert Testimony; Facial Expression; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Malingering; Nerve Block; Neuropsychological Tests; Pain; Pain Measurement; Surveys and Questionnaires; Thermography
PubMed: 15502686
DOI: 10.1097/00002508-200411000-00007 -
The Psychiatric Clinics of North America Dec 2007Malingering of mental illness has been studied extensively; however, malingered medical illness has been examined much less avidly. While in theory any ailment can be... (Review)
Review
Malingering of mental illness has been studied extensively; however, malingered medical illness has been examined much less avidly. While in theory any ailment can be fabricated or self-induced, pain--including lower back pain, cervical pain, and fibromyalgia--and cognitive deficits associated with mild head trauma or toxic exposure are feigned most frequently, especially in situations where there are financial incentives to malinger. Structured assessments have been developed to help detect both types of malingering; however, in daily practice, the physician should generally suspect malingering when there are tangible incentives and when reported symptoms do not match the physical examination or no organic basis for the physical complaints is found.
Topics: Ambulatory Care Facilities; Diagnosis, Differential; Disability Evaluation; Drug Therapy; Humans; Malingering; Mental Disorders; Pain; Sick Role
PubMed: 17938038
DOI: 10.1016/j.psc.2007.07.007