Malingering is an important topic found on the ABPN psychiatry board exam. The following is a summary of the topic for psychiatry board preparation.
The primary feature of malingering in psychiatry is for the patient to intentionally fake or grossly exaggerate psychotic symptoms to receive an obvious external incentive (I.e., avoiding work, avoiding criminal prosecution, financial compensation, obtaining medications).
Suspicion of malingering should be made when any combination of these are present:
– Medical-legal context (patient referred by an attorney for evaluation)
– Marked discrepancy between the claimed distress or disability and objective findings
– Non-compliance with diagnostic evaluation and treatments
– Antisocial personality disorder
Malingering psychiatry patients typically are reluctant to accept diagnosis and treatment. They reveal clear-cut goals. Ganser’s syndrome is a form of malingering where individuals fake psychosis (often to escape prosecution or incarceration).
There are also six signs of possible malingering: rare symptoms, improbable and absurd responses, indiscriminant symptom endorsement, unlikely symptom combinations, contradictory symptoms, and symptom severity.
In treating the individual with malingered psychosis, providers should follow the ABCs: Avoid accusations of lying, Beware of countertransference (readily picked up by the malingerer and may inflame the interaction), seek Clarification (not confrontation), and “s” is to ensure adequate security measures are in place.
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Greenberg, Donna M.D. (05/2012). Somatization: Epidemiology, pathogenesis, clinical features, medical evaluation, and diagnosis. UpToDate, Inc. Retrieved from http://www.uptodate.com/home/index.html.
McCullumsmith, M.D., PhD., and Charles Ford, M.D. Simulated Illness: The Factitious Disorders and Malingering. Psychiatric Clinics of North America. (Volume 34, Issue 3). (September 2011). W.B. Saunders Company. Retrieved from http://www.mdconsult.com.
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