Malingering

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Malingering

• Treena Klassen Regional Educator Mental
  Health
• December 2004

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Malingering

• Intentional production of false or grossly
  exaggerated physical or psychological symptoms,
  motivated by external incentives
• (DSM IV-TR)

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Adaptive Malingering

• Malingering may represent adaptive behavior under
  some circumstances

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Suspect Malingering When

1. Medico legal presentation
2. Marked discrepancy
3. Lack of Cooperation
4. Presence of Antisocial Personality Disorder

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Differentiating Malingering
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Assessing Response Styles

• Suspect Genuine Psychiatric Illness When
• Defensive
• Honest

• Suspect Malingering When
• Irrelevant Responding
• Random Responding
• Hybrid Responding

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Clinical Assessment of Malingering

• Psychological or physical symptoms are clearly
  under voluntary control as manifested by one or
  more indicators
• Patient acknowledgment
• Inconsistent symptoms
• Illness production
• Paraphernalia or substances
• Laboratory testing

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Clinical Assessment of Malingering Cont

• Clinical certainity that illness production
  occurs in response to
• 1. Pursuit of financial gain, shelter, or
  drugs, etc.
• 2. Avoidance of work, military duty,
  prosecution or legal consequences

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Clinical Assessment of Malingering Cont

• C. Another disorder, if present, cannot explain
  current symptoms
• D. Evidence of desire to assume the sick role,
  if present, cannot explain the totality of
  current symptoms

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Interview Methods

1. Open-ended questions
2. Questions about hallucinations
3. Do not let your irritability show
4. See client quickly
5. Good rapport
6. Suspect malingering

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Interview Methods

1. Gather as much data as possible
2. Ask questions about a different illness than the
   one the malinger is portraying.
3. Ask questions about improbable symptoms.

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Clues to Malingered Psychoses

• Malingerers may overact their part
• Malingerers are eager to call attention to their
  illnesses in contrast to schizophrenics, who are
  often reluctant to discuss their symptoms
• It is more difficult for malingerers to
  successfully imitate the form, than the content
  of schizophrenic thinking

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Clues to Malingered Psychoses (2)

• Malingerers may claim the sudden onset of a
  delusion
• Behavior is unlikely to conform to his alleged
  delusions acute schizophrenic behavior usually
  does.

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Clues to Malingered Psychoses (3)

• May tell a far-fetched story to fit the facts of
  his crimes into a mental disease model
• Tend to present themselves as blameless within
  their feigned illnesses
• More likely to repeat questions or answers slowly
• Absence of any active or subtle signs of
  psychosis at the time of the evaluation

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Examples of Feedback with Malingering

1. Some of the problems you describe are rarely
   seen in psychiatric patients. I am worried that
   you might be trying to make thinks seem worse
   than they are.
2. Earlier in the evaluation you told me, now you
   are telling me I am having trouble putting this
   together.
3. Although you have told me about (I.e.,
   description of current problems), when I observed
   you, you have not appeared

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Examples of Feedback with Malingering (2)

1. I dont want to hurt your feelings, but I just
   dont think things are quite as bad as you tell
   me they are.
2. According to you, you have (I.e., current
   problems), but according to (I.e., reliable
   information) you are Can you help me understand
   this?

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Negative Feedback

• You havent told me the whole truth.
• You are lying.
• Your wasting my time.

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Conclusion

• If in doubt you must assume the patient is not a
  malingerer.
• All efforts must be made not stigmatize the
  genuinely mentally ill as this further impedes
  treatment measures.

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