- Author: David Bienenfeld, MD; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych(UK) more...
Hostile or threatening behavior may ensue if the malingerer's claims are challenged, or if the physician fails to respond to his/her demands for disability certification, medications, etc.
Malingering behavior typically persists as long as the desired benefit outweighs the inconvenience or distress of seeking medical confirmation of the feigned illness.
While the physician may wish to educate the patient about better ways of achieving goals than by malingering, the reasons are usually more deeply rooted than just a cognitive deficit and require behavioral interventions, psychotherapy, and counseling.
The physician should determine whether revealing the malingering to the family will do more harm than good. If the family is adversely affected by the malingering behavior, it may be helpful for family members to know that the evidence is strong that no physical ailment is causing the patient's distress. They may be encouraged to resist the patient's efforts to manipulate them to accommodate the feigned illness at their own. While malingerers are both resistant to accepting psychotherapy and refractory to its benefits, family members may benefit from family counseling to develop adaptive approaches to the malingering behavior.[5, 12]
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5). Washington DC: American Psychiatric Press Inc; 2013. 726.
Chafetz M, Underhill J. Estimated costs of malingered disability. Arch Clin Neuropsychol. 2013 Nov. 28(7):633-9. [Medline].
Faust D. The detection of deception. Neurol Clin. 1995 May. 13(2):255-65. [Medline].
Resnick PJ. Defrocking the fraud: the detection of malingering. Isr J Psychiatry Relat Sci. 1993. 30(2):93-101. [Medline].
Purcell TB. The somatic patient. Emerg Med Clin North Am. 1991 Feb. 9(1):137-59. [Medline].
Samuel RZ, Mittenberg W. Determination of Malingering in Disability Evaluations. Primary Psychiatry. 2005. 12(12):60-68. [Full Text].
Donaghy M. Symptoms and the perception of disease. Clin Med. 2004 Nov-Dec. 4(6):541-4. [Medline].
Malone RD, Lange CL. A clinical approach to the malingering patient. J Am Acad Psychoanal Dyn Psychiatry. 2007 Spring. 35(1):13-21. [Medline].
Anderson JM. Malingering: A constant challenge in disability arenas. J Controversial Med Claims. May 2008. 15(2):1-9.
Hegedish O, Kivilis N, Hoofien D. Preliminary Validation of a New Measure of Negative Response Bias: The Temporal Memory Sequence Test. Appl Neuropsychol Adult. 2015 Feb 4. 1-7. [Medline].
Chafetz MD. The A-Test: a symptom validity indicator embedded within a mental status examination for Social Security Disability. Appl Neuropsychol Adult. 2012. 19(2):121-6. [Medline].
Udell ET. Malingering behavior in private medical practice. Clin Podiatr Med Surg. 1994 Jan. 11(1):65-72. [Medline].
Voiss DV. Occupational injury. Fact, fantasy, or fraud?. Neurol Clin. 1995 May. 13(2):431-46. [Medline].
McDermott BE, Feldman MD. Malingering in the medical setting. Psychiatr Clin North Am. 2007 Dec. 30(4):645-62. [Medline].
LoPiccolo CJ, Goodkin K, Baldewicz TT. Current issues in the diagnosis and management of malingering. Ann Med. 1999 Jun. 31(3):166-74. [Medline].
Ziegler SJ. Pain, patients, and prosecution: who is deceiving whom?. Pain Med. 2007 Jul-Aug. 8(5):445-6; author reply 447-8. [Medline].