eMedicine Specialties > Psychiatry > Psychosomatic

Malingering: Follow-up

Author: David Bienenfeld, MD, Vice-Chair, Program Director, Professor, Department of Psychiatry, Wright State University School of Medicine
Contributor Information and Disclosures

Updated: Jul 17, 2008

Follow-up

Complications

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.

Prognosis

Malingering behavior typically persists as long as the desired benefit outweighs the inconvenience or distress of seeking medical confirmation of the feigned illness.

Patient Education

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. 

See Medscape's Patient-Provider Relations in Psychiatry & Mental Health Resource Center.

Family education

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.5,9

Miscellaneous

Medicolegal Pitfalls

Because malingering for the purpose of compensation constitutes criminal behavior, document the diagnosis meticulously. When in doubt, assuming that the patient is not malingering is a better course of action.12

 


More on Malingering

Overview: Malingering
Differential Diagnoses & Workup: Malingering
Treatment & Medication: Malingering
Follow-up: Malingering
Multimedia: Malingering
References
[ CLOSE WINDOW ]

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Washington DC: American Psychiatric Press Inc; 2000:683.

  2. LoPiccolo CJ, Goodkin K, Baldewicz TT. Current issues in the diagnosis and management of malingering. Ann Med. Jun 1999;31(3):166-74. [Medline].

  3. Faust D. The detection of deception. Neurol Clin. May 1995;13(2):255-65. [Medline].

  4. Resnick PJ. Defrocking the fraud: the detection of malingering. Isr J Psychiatry Relat Sci. 1993;30(2):93-101. [Medline].

  5. Purcell TB. The somatic patient. Emerg Med Clin North Am. Feb 1991;9(1):137-59. [Medline].

  6. Donaghy M. Symptoms and the perception of disease. Clin Med. Nov-Dec 2004;4(6):541-4. [Medline].

  7. Malone RD, Lange CL. A clinical approach to the malingering patient. J Am Acad Psychoanal Dyn Psychiatry. Spring 2007;35(1):13-21. [Medline].

  8. Anderson JM. Malingering: A constant challenge in disability arenas. J Controversial Med Claims. May 2008;15(2):1-9.

  9. Udell ET. Malingering behavior in private medical practice. Clin Podiatr Med Surg. Jan 1994;11(1):65-72. [Medline].

  10. Voiss DV. Occupational injury. Fact, fantasy, or fraud?. Neurol Clin. May 1995;13(2):431-46. [Medline].

  11. McDermott BE, Feldman MD. Malingering in the medical setting. Psychiatr Clin North Am. Dec 2007;30(4):645-62. [Medline].

  12. Ziegler SJ. Pain, patients, and prosecution: who is deceiving whom?. Pain Med. Jul-Aug 2007;8(5):445-6; author reply 447-8. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

malingering, false symptoms, exaggerated symptoms, accident neurosis, compensation neurosis, faking, fraud, lying, factitious disorder, FD, hypochondriasis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

David Bienenfeld, MD, Vice-Chair, Program Director, Professor, Department of Psychiatry, Wright State University School of Medicine
David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry
Disclosure: Nothing to disclose.

Medical Editor

Barry I Liskow, MD, Professor of Psychiatry, Vice Chairman, Psychiatry Department, Director, Psychiatric Residency Program, University of Kansas School of Medicine; Director, Psychiatric Outpatient Clinic, The University of Kansas Medical Center
Barry I Liskow, MD is a member of the following medical societies: American Academy of Clinical Psychiatrists, American Academy of Psychiatrists in Alcoholism and Addictions, American Medical Association, American Psychiatric Association, and Research Society on Alcoholism
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Iqbal Ahmed, MBBS, Professor, Department of Psychiatry, John A Burns School of Medicine, University of Hawaii
Iqbal Ahmed, MBBS is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Speaking and teaching; Northstar Grant/research funds Research; Novartis Grant/research funds research; Pfizer  Speaking and teaching; Sanofi-avetis Grant/research funds research; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.