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Malingering Treatment & Management

  • Author: David Bienenfeld, MD; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych(UK)  more...
 
Updated: Apr 15, 2015
 

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).

Invasive diagnostic maneuvers do more harm than good. Hospitalization is almost never indicated since individuals intend no harm to themselves and a hospital stay rewards the undesirable behavior.

The likelihood of success with such approaches is inversely related to the rewards for the malingering behavior.[12, 13, 14, 8]

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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.[15, 14, 8]

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Contributor Information and Disclosures
Author

David Bienenfeld, MD Professor, Departments of Psychiatry and Geriatric Medicine, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Iqbal Ahmed, MBBS, FRCPsych(UK) Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Uniformed Services University of the Health Sciences; Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych(UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Neuropsychiatric Association, American Society of Clinical Psychopharmacology, Royal College of Psychiatrists, American Association for Geriatric Psychiatry, American Psychiatric Association

Disclosure: Nothing to disclose.

Additional Contributors

Barry I Liskow, MD Professor of Psychiatry, Vice Chairman, Psychiatry Department, Director, Psychiatric Outpatient Clinic, The University of Kansas Medical Center

Disclosure: Nothing to disclose.

References
  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5). Washington DC: American Psychiatric Press Inc; 2013. 726.

  2. Chafetz M, Underhill J. Estimated costs of malingered disability. Arch Clin Neuropsychol. 2013 Nov. 28(7):633-9. [Medline].

  3. Faust D. The detection of deception. Neurol Clin. 1995 May. 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. 1991 Feb. 9(1):137-59. [Medline].

  6. Samuel RZ, Mittenberg W. Determination of Malingering in Disability Evaluations. Primary Psychiatry. 2005. 12(12):60-68. [Full Text].

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

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

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

  10. 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].

  11. 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].

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

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

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

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

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

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