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Malingering is the fabrication, intentional production, or significant exaggeration of physical or psychological symptoms or the intentional misattribution of genuine symptoms to an unrelated event or series of events designed to achieve a specific objective such as escaping duty or work; mitigating punishment; obtaining drugs; or receiving unwarranted recompense, such as disability compensation or personal damages award.[1]

Malingering
SpecialtyPsychiatry, Clinical psychology

Malingering is not a medical diagnosis, but may be recorded as a "focus of clinical attention" or a "reason for contact with health services".[2][3] Malingering is typically conceptualized as being distinct from other forms of excessive illness behavior[4] such as somatization disorder and factitious disorder, although not all mental health professionals agree with this formulation.[5]

Failure to detect actual cases of malingering imposes an economic burden on health care systems; workers compensation programs; and disability programs, e.g., Social Security Disability Insurance (United States) and U.S. Department of Veterans Affairs disability benefits. False attribution of malingering often harms genuine patients or claimants.[6][7]

HistoryEdit

AntiquityEdit

In the Hebrew Bible, King David feigns insanity to Achish, king of the Philistines (I Sam. 21:10-15). This is by many supposed not to have been feigned, but real epilepsy or falling sickness, and the Septuagint uses words which strongly indicate this sense.[8] Odysseus was stated to have feigned insanity to avoid participating in the Trojan War.[9] Malingering has been recorded historically as early as Roman times by the physician Galen (Quomodo morbum simulantes sint deprehendendi), who reported two cases. One patient simulated colic to avoid a public meeting, while the other feigned an injured knee to avoid accompanying his master on a long journey.[10]

RenaissanceEdit

During the Renaissance, a treatise on feigned diseases (De iis qui morborum simulant deprehensis) by Giambattista Silvatico, was published at Milan in 1595. Various phases of malingering (les gueux contrefaits) are well represented in the etchings and engravings of Jacques Callot (1592–1635).[11] In his social-climbing manual, Elizabethan George Puttenham recommends that would-be courtiers have "sickness in his sleeve, thereby to shake off other importunities of greater consequence" and suggests feigning a "dry dropsy [...] of some such other secret disease, as the common conversant can hardly discover, and the physician either not speedily heal, or not honestly bewray."[12]

Modern periodEdit

Lady Flora Hastings was accused of adultery stemming from court gossip following abdominal pain. Because she refused to be physically examined by a man for reasons of modesty befitting a lady in her position, the physician assumed her to be pregnant. She later died of stomach cancer.[citation needed]

General George S. Patton, in what became known as 'the Greek Incident', found a soldier in a field hospital but with no wounds, claiming to be suffering from battle fatigue. Upon discovering this and believing that the patient was malingering, Patton flew into a rage, physically assaulted the patient, called him a coward and did not stop until he was physically restrained. The patient was later found to have contracted malaria and to be suffering from dysentery.[citation needed]

Antonio Damasio described a case study in Descartes' Error of his patient, 'Elliot.' He wrote, "Several professionals had declared that his mental faculties were intact-meaning that at the very best Elliot was lazy and at the worst a malingerer." As a result, Elliot's disability benefits were withdrawn. Neuropsychological testing "revealed a superior intellect." Neuropsychological evaluations thought at that time to be sensitive such as the Wisconsin Card Sorting Test did not reveal impairment in function associated with the frontal lobes of brain damage and functional impairment in general. Elliot had previously had surgery to remove a meningioma "the size of a small orange." Following his surgery, he had floundered into a series of poor decisions which ultimately resulted in divorce and bankruptcy from a previously "enviable position." [13]

Few cases are as famous as Harold Garfinkel's study of Agnes Torres. In the 1950s, Agnes feigned symptoms and lied about almost every aspect of her medical history. Fearing doctors at UCLA would refuse her access to her desired sexual reassignment surgery, Garfinkel concluded that she had avoided every aspect of her case which would have indicated gender dysphoria to avoid being treated as an "effeminate homosexual" and a psychiatric patient. She lied that she had not taken hormone therapy and her examining physicians concluded that it would be impossible for someone so young to have stumbled upon therapy and instituted it at such a young age to produce such brilliant feminizing effects. As such they concluded that their patient had testicular feminization syndrome, legitimizing in their professional opinion the validity of her request for sexual reassignment surgery. While not evaluating the patient, Garfinkel commented that the complexity of the deception was of such intricate construction intended towards the singular goal of the particular desired medical intervention.[14]

Society and cultureEdit

The United States Armed ForcesEdit

Malingering is a court-martial offense in the United States Armed Forces under Article 115 of the Uniform Code of Military Justice, which provides that:

Any person subject to this chapter who for the purpose of avoiding work, duty, or service–
(1) feigns illness, physical disablement, mental lapse or derangement; or
(2) intentionally inflicts self-injury;
shall be punished as a court-martial may direct.[15]

Economic costsEdit

According to the Texas Department of Insurance, fraud that includes malingering costs the U.S. insurance industry approximately $150 billion each year.[6][16] Other non-industry sources suggest it may be as low as $5.4 billion, suggesting that insurance companies are over-inflating the seriousness of the problem to divert more law enforcement towards health insurance fraud.[17]

See alsoEdit

ReferencesEdit

  1. ^ World Health Organization, "QC30 Malingering", ICD-11 for Mortality and Morbidity Statistics (04/2019 version), https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1136473465
  2. ^ Bienenfield, David (April 15, 2015). "Malingering". Medscape. WebMD LLC. Archived from the original on December 30, 2016. Retrieved December 30, 2016. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), malingering receives a V code as one of the other conditions that may be a focus of clinical attention. Cite uses deprecated parameter |deadurl= (help)
  3. ^ "ICD-11 - Mortality and Morbidity Statistics". icd.who.int. Retrieved June 18, 2019.
  4. ^ Hamilton, James C.; Hedge, Krystal A.; Feldman, Marc D. "Chapter 37: Excessive Illness Behavior". In Fogel, Barry S.; Greenberg, Donna B. (eds.). Psychiatric Care of the Medical Patient (3rd ed.). Oxford University Press. pp. 743–755. doi:10.1093/med/9780199731855.003.0037. ISBN 9780199731855. OCLC 947145299.
  5. ^ Hamilton, James C.; Feldman, Marc D.; Cunnien, Alan J. (2008). "Chapter 8: Factitious Disorder in Medical and Psychiatric Practices". In Rogers, Richard (ed.). Clinical Assessment of Malingering and Deception (3rd ed.). New York City, NY: Guilford. pp. 128–144. ISBN 9781593856991. OCLC 175174373.
  6. ^ a b Garriga, Michelle (March 2007). "Malingering in the Clinical Setting". Psychiatric Times. 24 (3). Archived from the original on November 19, 2009. Cite uses deprecated parameter |deadurl= (help)
  7. ^ Shapiro, Allan P.; Teasell, Robert W. (March 1998). "Misdiagnosis of chronic pain as hysteria and malingering". Current Pain and Headache Reports. 2 (1): 19–28. doi:10.1007/s11916-998-0059-5.
  8. ^ John McClintock; James Strong, eds. (1894), "Madness", Cyclopaedia of Biblical, Theological and Ecclesiastical Literature, 5, Harper & Brothers, pp. 628b–629a
  9. ^ Hyginus Fabulae 95 Archived February 9, 2013, at the Wayback Machine. Cf. Apollodorus Epitome 3.7 Archived July 3, 2007, at the Wayback Machine.
  10. ^ "Galen on Malingering, Centaurs, Diabetes, and Other Subjects More or Less Related", Proceedings of the Charaka Club, X (1941), p52-55
  11. ^ Garrison, Fielding H. (1921). History of Medicine (3rd ed.). W. B. Saunders. pp. 201, 312. Archived from the original on August 7, 2016 – via Internet Archive. Cite uses deprecated parameter |deadurl= (help)
  12. ^ "The Art of English Posey: a Critical Edition." George Puttenham. Ed. Frank Whigham & Wayne A. Rebhorn. (2007) 379-380.
  13. ^ Damasio, Antonio (1994). "3- A Modern Phineas Gage". Descarte's Error. G. P.Putnam's Sons. pp. 34–51. ISBN 0-399-13894-3.
  14. ^ Garfinkel, Harold (1967). Polity Press (ed.). Studies in Ethnomethodology, Chapter Five: Passing and the Managed Achievement of Sex Status in an Intersex Person, Part 1. Blackwell Publishing. pp. 116–185. ISBN 978-0-7456-0005-5.
  15. ^ 10 U.S.C. § 915: Art. 115. Malingering
  16. ^ Dinsmoor, Robert Scott (2011). "Malingering". In Fundukian, Laurie J. (ed.). The Gale Encyclopedia of Medicine. 4 (4th ed.). Gale. pp. 2737–2739. ISBN 978-1-4144-8646-8.
  17. ^ Brennan, Adrianne M.; Meyer, Stephen; David, Emily; Pella, Russell; Hill, Ben D.; Gouvier, William Drew (February 2009). "The vulnerability to coaching across measures of effort". The Clinical Neuropsychologist. 23 (2): 314–328. doi:10.1080/13854040802054151. PMID 18609324. Archived from the original on December 29, 2016. Retrieved December 29, 2016 – via ResearchGate. Malingering accounts for nearly one-fifth of all medical care cases (i.e., doctor visits, hospitalizations) within the United States and combined medical and legal costs approach five billion dollars annually (Ford, 1983; Gouvier, Lees-Haley, & Hammer, 2003). Cite uses deprecated parameter |deadurl= (help)

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