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MALINGERING

MALINGERING. CAPT WEAR Psychiatry Department NOMI. Learning Objectives. Understand the definition of malingering Differentiate malingering from similar disorders Understand the role of the flight surgeon in making recommendations for disposition. MALINGERING.

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MALINGERING

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  1. MALINGERING CAPT WEAR Psychiatry Department NOMI

  2. Learning Objectives • Understand the definition of malingering • Differentiate malingering from similar disorders • Understand the role of the flight surgeon in making recommendations for disposition

  3. MALINGERING The intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives.

  4. Examples of Incentives • avoiding work • obtaining financial compensation • avoiding military duty • evading criminal prosecution • obtaining drugs • may be adaptive (POW)

  5. Malingering vs. Factitious Disorder In malingering, the motivation for symptom production is an external incentive whereas in factitious disorder the external incentive is absent. In factitious disorder, there is a need to maintain the sick role. This is also known as Munchausen’s Disease.

  6. Malingering vs Other What differentiates malingering from Conversion Disorder and other Somatoform Disorders is the intentional production of symptoms.

  7. Great Malingerers • Ulysses • Eddie Murphy

  8. Simulation: “faking bad” Dissimulation: “faking good”

  9. Suspect Malingering if: • Medicolegal context (referred by an attorney) • Marked discrepancy between the person’s claimed stress or disability and the objective findings • Lack of cooperation during the diagnostic evaluation and in complying with the prescribed treatment • The presence of Antisocial PD

  10. Your Role • Be aware of your own feelings (angry, betrayed) • Don’t Rx with drugs for vague complaints • It IS NOT your job to diagnose malingering: You can always state something like: “I am unable to find a clear underlying physiologic cause for the symptoms. . .” or, ““I cannot find objective substantiation for the stated symptoms . . .”

  11. “Skepticism is the chastity of the intellect . . . and it is prudent to not sacrifice it too soon. . .”

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