Malingering

the feigning of sickness or certain disease symptoms. Malingering may be premeditated or pathological. Premeditated malingering is usually characterized by mercenary motives, including the obtaining of disability benefits or evasion of military service. Pathological malingering is brought on by a diseased state and is, in essence, a symptom of such diseases as hysteria.

Malingering should not be confused with autosuggestion, aggravation, or maiming. In cases of autosuggestion, an individual, usually a mentally disturbed person, is sincerely convinced that he has a severe somatic ailment, for example, cancer. Aggravation is an exaggeration of the symptoms of an existing disease. Maiming is an artificially produced injury or illness. Dissimulation is the premeditated suppression, concealment, or attenuation of a disease, for example, for the purpose of passing a medical upon applying for a job or for admission to an academic institution.

Under Soviet law, malingering is punishable criminally if it is used as a means of evading a regular call to active military service (art. 17 of the Law of Criminal Responsibility for State Crimes; art. 80 of the Criminal Code of the RSFSR) or of evading the performance of military duties (art. 13 of the Law of Criminal Responsibility for Military Crimes; art. 249 of the Criminal Code of the RSFSR).

Dissimulation is not punishable criminally but may entail specific legal consequences, for example, being fired from work.

malingering

Malingering

Definition

In the context of medicine, malingering is the act of intentionally feigning or exaggerating physical or psychological symptoms for personal gain.

Description

People may feign physical or psychological illness for any number of reasons. Faked illness can get them out of work, military duty, or criminal prosecution. It can also help them obtain financial compensation through insurance claims, lawsuits, or workers' compensation. Feigned symptoms may also be a way of getting the doctor to prescribe certain drugs.According to the American Psychiatric Association, patients who malinger are different from people who invent symptoms for sympathy (factitious diseases). Patients who malinger clearly have something tangible to gain. People with factitious diseases appear to have a need to play the "sick" role. They may feign illness for attention or sympathy.Malingering may take the form of complaints of chronic whiplash pain from automobile accidents. Whiplash claims are controversial. Although some people clearly do suffer from whiplash injury, others may be exaggerating the pain for insurance claims or lawsuits. Some intriguing scientific studies have shown that chronic whiplash pain after automobile accidents is almost nonexistent in Lithuania and Greece. In these countries, the legal systems do not encourage personal injury lawsuits or financial settlements. The psychological symptoms experienced by survivors of disaster (post-traumatic stress disorder) are also faked by malingerers.

Causes and symptoms

People malinger for personal gain. The symptoms may vary. Generally malingerers complain of psychological disorders such as anxiety. They may also complain of chronic pain for which objective tests such as x rays can find no physical cause. Because it is often impossible to determine who is malingering and who is not, it is impossible to know how frequently malingering occurs.

Diagnosis

Malingering may be suspected:

When a patient is referred for examination by an attorney
When the onset of illness coincides with a large financial incentive, such as a new disability policy
When objective medical tests do not confirm the patient's complaints
When the patient does not cooperate with the diagnostic work-up or prescribed treatment
When the patient has antisocial attitudes and behaviors (antisocial personality).

The diagnosis of malingering is a challenge for doctors. On the one hand, the doctor does not want to overlook a treatable disease. On the other hand, he or she does not want to continue ordering tests and treatments if the symptoms are faked. Malingering is difficult to distinguish from certain legitimate personality disorders, such as factitious diseases or post-traumatic distress syndrome. In legal cases, malingering patients may be referred to a psychiatrist. Psychiatrists use certain written tests to try to determine whether the patient is faking the symptoms.

Treatment

In a sense, malingering cannot be treated because the American Psychiatric Association does not recognize it as a personality disorder. Patients who are purposefully faking symptoms for gain do not want to be cured. Often, the malingering patient fails to report any improvement with treatment, and the doctor may try many treatments without success.

Resources

Organizations

American Psychiatric Association. 1400 K Street NW, Washington DC 20005. (888) 357-7924. http://www.psych.org.

Key terms

Antisocial personality — A personality characterized by attitudes and behaviors at odds with society's customs and moral standards, including illegal acts.Factitious diseases — Conditions in which symptoms are deliberately manufactured by patients in order to gain attention and sympathy. Patients with factitious diseases do not fake symptoms for obvious financial gain or to evade the legal system.Post traumatic stress disorder (PTSD) — A disorder that occurs among survivors of severe environmental stress such as a tornado, an airplane crash, or military combat. Symptoms include anxiety, insomnia, flashbacks, and nightmares. Patients with PTSD are unnecessarily vigilant; they may experience survivor guilt, and they sometimes cannot concentrate or experience joy.

malingering

[mah-ling´ger-ing] willful, deliberate, and fraudulent feigning or exaggeration of the symptoms of illness or injury to attain a consciously desired end.

ma·lin·ger·ing

(mă-ling'gĕr-ing), Feigning illness or disability to escape work, excite sympathy, or gain compensation. [Fr. malingre, poor, weakly]

malingering

The wilful production of symptoms, or the fraudulent simulation of illness or exaggeration of the symptoms of a minor illness or injury, usually for specific external incentives, such as the collection of benefits or to avoid work or school.
Types of malingering
• Anticipation of collecting insurance benefits.
• Malingering with psychological underpinnings, either:
— Endogenous (e.g., factitious dermatitis); or
— Exogenous origin (e.g., Munchausen syndrome).

malingering

Occupational medicine The willful production of symptoms for specific external incentives, or the fraudulant simulation of illness or exaggeration of the Sx of a minor illness or injury, usually to avoid work or school. See Factitious disease(s. ). Cf Munchausen syndrome.

ma·lin·ger·ing

(mă-ling'gĕr-ing) Feigning illness or inability to work resulting from an ulterior motive, such as to collect insurance benefits. [Fr. malingre, poor, weakly]

malingering

A pretence to be suffering from a disease, or the simulation of signs of disease, so as to gain some supposed advantage such as avoidance of work or of presumed danger, or to obtain money by fraudulent claims for compensation. See also MUNCHAUSEN'S SYNDROME.

malingering

Feigning illness or disability (often for the purpose of gaining compensation or avoiding duty). See optokinetic nystagmus test; tunnel vision.

ma·lin·ger·ing

(mă-ling'gĕr-ing) Feigning illness or disability to escape work, excite sympathy, or gain compensation. [Fr. malingre, poor, weakly]

malingering

ma·lin·ger

Malingering

Malingering

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Definition

Description

Causes and symptoms

Diagnosis

Treatment

Resources

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Key terms

malingering

ma·lin·ger·ing

malingering

malingering

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Synonyms for malingering

noun evading duty or work by pretending to be incapacitated

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