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Malingering
ICD-10 Z76.5
ICD-9 V65.2
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Malingering is a medical and psychological term that refers to an individual faking the symptoms of mental or physical disorders for a myriad of reasons such as fraud, dereliction of responsibilities, or attempting to obtain medications or to lighten criminal sentences. Because malingerers are not seeking primary or secondary gain, this disorder remains separate of Somatization disorders.


Diagnosis and Detection

Diagnosis

DSM-IV-TR

The DSM-IV-TR (see also: DSM cautionary statement) states that malingering is suspected if one or more of the following are observed1:

  1. Medicolegal context of presentation
  2. Marked discrepancy between the person’s claimed stress of disability and the objective findings
  3. Lack of cooperation during the diagnostic evaluation and in complying with prescribed treatment regimen
  4. The presence of Antisocial Personality Disorder

Detection

Detection by clinicians is rare although the frequency of discovery by clinicians in on the rise as detection methods improve. When malingering takes on a legal context it is more common either for private investigators to find evidence of malingering (say, videotaping a "paralysed" person walking around their home), or reports from friends, colleagues, or family members.

If a psychiatrist or neuropsychologist suspects malingering in a case of possible brain damage (i.e. caused by head trauma or stroke), they may look for a discrepancy between the patient's reported functions of daily living and their performance on neuropsychological tests. In theory, any neuropsychological test could be used in this way, depending on the context. No one test, administered by itself, can proffer a diagnosis of malingering, so a neuropsychological examination typically consists of a battery of tests. The three main tests used to determine malingering are:

The following tests, also used by other subspecialties of psychology, have found recent application in the identification of malingerers in the clinical setting:

See also

References

1 DSM-IV-TR, American Psychiatric Association, 2000


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