Background
Malingering is not considered a mental illness. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), malingering receives a V code as one of the other conditions that may be a focus of clinical attention. The DSM-IV-TR describes malingering as follows:
The essential feature of Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs.[1]
Case study
Mr. A is a 21-year-old man who recently volunteered for the Marines. In boot camp, he comes to the medical officer complaining of "depression." He says he sees Satan every night, telling him to kill himself and his commanding officer. He says he has been visited by Satan every night since he was a child, and that he is convinced he has supernatural powers. He has no history of psychiatric or behavioral problems prior to his enlistment.
On examination, he often bursts into gibberish. When asked what year it is, he says, "1352." When asked what city he is in, he says, "I don't know." The nurse informs the examining physician that this young man was perfectly relaxed and sociable in the waiting room.
Pathophysiology
Malingering is deliberate behavior for a known external purpose. It is not considered a form of mental illness or psychopathology, although it can occur in the context of other mental illnesses.
Epidemiology
Mortality/Morbidity
The total cost of health insurance fraud in the United States (including untruthful claims by patients and medical personnel) was more than $59 billion in 1995, resulting in a cost of $1050 in added premiums for the average American family.[2]
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.
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Anderson JM. Malingering: A constant challenge in disability arenas. J Controversial Med Claims. May 2008;15(2):1-9.
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Ziegler SJ. Pain, patients, and prosecution: who is deceiving whom?. Pain Med. Jul-Aug 2007;8(5):445-6; author reply 447-8. [Medline].
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