eMedicine Specialties > Psychiatry > Psychosomatic

Malingering: Treatment & Medication

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

Treatment

Medical Care

  • Do not accuse the patient directly of faking an illness. Hostility, breakdown of the doctor-patient relationship, lawsuit against the doctor, and, rarely, violence may result.
  • The more advisable approach is to confront the person indirectly by remarking that the objective findings do not meet the physician's objective criteria for diagnosis. Allow the person who is malingering the opportunity to save face.
  • Alternatively, the physician may inform people who are malingering that they are required to undergo invasive testing and uncomfortable treatments (provided, of course, that such warning is true).
  • The likelihood of success with such approaches is inversely related to the rewards for the malingering behavior.9,10,11,7

Consultations

People who malinger almost never accept psychiatric referral, and the success of such consultations is minimal. Avoid consultations to other medical specialists because such referrals only perpetuate malingering. However, in cases of serious uncertainty about the presence of genuine psychiatric illness, suggest psychiatric consultation.

Psychiatric consultation may be suggested as an augmentation to dealing with an acknowledged symptom. For example, the primary physician might propose, "Your pain has to be causing your system a great deal of stress, and we know that only makes the pain worse. Consultation from a psychiatrist might help us with your pain by reducing the stress." Without being confrontational, the physician must remain honest.2,11,7

More on Malingering

Overview: Malingering
Differential Diagnoses & Workup: Malingering
Treatment & Medication: Malingering
Follow-up: Malingering
Multimedia: Malingering
References
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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].

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Further Reading

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Keywords

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

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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.

 
 
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