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Malingering

Definition . An adaptive response to adverse circumstances requiring the presences of an external incentive for being injured (Labbate

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Malingering

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    1. Malingering What is it?

    2. Definition An adaptive response to adverse circumstances requiring the presences of an external incentive for being injured (Labbate & Miller, 1990) OR Those who intentionally lie about or exaggerate an injury in order to get out of something they dont want to do; shallow conscience Work Sports

    3. They are frustrating They are a challenge They make you 2nd guess your career decision

    4. YOU. Need to be patient Need to trust Need to listen to the pt when talking about their bodies Dont be influenced by past experiences Once you break the trust; you cant get it back

    5. Why do people choose to be a malingering pt? They want to be the hero who is playing hurt Avoid competition again Prevent the loss of a scholarship They want to avoid upsetting mom/dad They arent as good as they use to be in their minds

    6. More reasons Cant compete with the big boys any more Use to gain attention Protection from expectations of others Get even with a coach An excuse for poor performance Doesnt like to practice Dont trust therapist judgment about injury

    7. Basically it boils down to: a need for attention Or fear

    8. Sx Failure of Sx to match objective testing Fails to respond to Rx program Is not reassured by the physician Sx last longer than most pt Detailed description of px

    9. Malingerer is Guilt free Goes to Rx to get out of something An Oscar winner look for this as indicator wants everyone to know they are hurt usually OVER done

    10. Malingerer Learns this behavior From personal experience or seeing someone else get attention b/c of an injury May be spoiled The lies and deceptions were allowed May have been reinforced

    11. Continued Adopted as acceptable; talented athletes who get away w/little or big things Rewarded And willful and intentional

    12. Secondary Gains How can this be possible?

    13. Whos affected by the malingerer? Everyone they know For the typical malingerer the greatest need is attention, and the greatest fear is getting caught Malingering is a consequence of faking, deceit, or selfish manipulation that is related in some way to underlying forms of inadequacy.

    14. Helping Malingerers Knowledge may be more effectively utilized by preventing the Rx team from being exploited by such athletes. @ some point, cost-effectiveness must be evaluated & a decision made as to whether or not the time & energy required for changing a particular athlete is worth it.

    15. Helping Malingerers During interviews, verbal communication, & Rx sessions, it would be helpful to observe: The extent of narcissistic behavior Self-centered, shows low interest in pain, demanding, never receives the same care Tendency to avoid talking about the disability Watch eye contact, avoidance personnel, failure to keep appt., criticism of Rx

    16. Helping Malingerers Lack of responsibility to team mates or coworkers Check for consistent/inconsistent behaviors Lack of true emotional involvement Lack of cooperation with Dx

    17. Helping Strategies Attempt to understand individual & reasons for behavior listening Sit ? & confront pt honestly & directly; encourage honestly & openness Empathy Sympathy

    18. Helping Strategies Behavior is done b/c it produces gains Try to determine if it is caused by fear, need for help, need to reduce pressure, or need of attention Explain your frustration, lost or still searching for answer; ask for their thoughts/suggestions; play the I may be failing to do something card

    19. Helping Strategies Est. & record specific rehabilitation & time; define everyones roles Implement rewards for desired behavior & take away privileges for undesirable behaviors REMEMBER

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