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Malingering

Malingering

Definition

The central theme to all definitions of malingering is that the term applies to persons who deliberately pretend to have an illness or disability in order to receive financial or other gain, or to avoid punishment or responsibility.

Description

Personal gain is always the motivation for malingering. Some external reward is sought and is the rationale for feigning an illness. For example, the criminal who does not want to pay for his/her crime, the soldier who does not want to fight, or the person who wishes to be paid for a nonexistent disability all may be tempted to feign an illness.

Malingering can take many forms. However, as specifically related to mental illness, the tendency is to fake more common disorders such as major depressive disorder , post-traumatic stress disorder , and panic disorder with agoraphobia . With very little coaching or research, even a beginner can simulate symptoms of these disorders. Generalized symptoms such as headaches, dizziness, low back pain, stomach pain, etc., are easily manufactured, and x rays, magnetic resonance imaging (MRIs), or CAT scans (computed axial tomography) are unable to determine a physical cause.

Malingerers tend to avoid symptoms such as those associated with more serious psychiatric disorders, because the pretense is very difficult to maintain and objective measures could detect the difference. For example, hearing voices and seeing demons, or living with the idea that others can hear unspoken thoughts, would become a difficult act to maintain over time. On the other hand, to feign a sad mood, loss of interest in formerly enjoyed activities, or a low energy level may not be so difficult to demonstrate. Likewise, responding positively to a series of questions about having heart palpitations, sweating, dizziness, or fear of impending death, could be done readily.

The concept that fakers use less severe symptoms to escape detection was validated in 2001 in a research study. Individuals were asked to fake mental illnesses in such a way as to avoid detection by sophisticated psychological tests. All or portions of the following tests were employed in the research: the Structured Inventory of Malingered Symptomatology, the Psychopathic Personality Inventory, the M-Test, and the Trauma Symptom Inventory. Slightly over 11% of the 540 research participants successfully avoided detection and were diagnosed with real disorders instead of with malingering. Questionnaires completed by those who successfully faked symptoms showed that they avoided detection by endorsing fewer actual symptoms, staying away from unduly strange or bizarre symptoms, and responding based upon personal experience.

Although ordinarily an intended fraud, malingering may serve an adaptive purpose under circumstances of duress, such as while being held captive. Faking an illness at such a time may allow a person to avoid cooperating with their captors or to avoid punishment.

Causes and symptoms

Lying for personal benefit has existed since the beginning of time. As previously stated, personal gain is the goal of the malingerer.

The symptoms may vary a great deal from person to person.

Demographics

Due to the difficulty of determining and exposing malingering, the incidence is unknown.

Diagnosis

When attempting to diagnose malingering, mental health professionals have three possibilities to consider. First, there is the possibility that the illness feigned by the malingerer is real. However, once it is determined that the disorder has no basis in fact, the professional is left with two viable diagnoses: factitious disorder and malingering. Factitious disorder is a legitimate malady, but malingering is not. Both have to do with feigned illnesses.

Unlike malingering, the individual with factitious disorder produces fake symptoms to fulfill the need to maintain the "sick role"a sort of emotional gain. Being "sick" gives the person with factitious disorder attention from physicians and sympathy from friends and loved ones. Thus, this individual's goal is not the same as the malingerer's.

With malingering, motivation is always external and is designed to accomplish one of three things: (1) evade hard or dangerous situations, punishment, or responsibility; (2) gain rewards such as free income, source for drugs, sanctuary from police, or free hospital care; or (3) avenge a monetary loss, legal ruling, or job termination.

Mental health practitioners become alert to the possibility of malingering when circumstances exist that might help promote such a facade. Malingering is suspected when any combination of events such as the following occur:

  • A person is referred by his/her attorney for an evaluation.
  • There is a noticeable and distinct difference between the level of distress or disability claimed by the person when compared to information obtained by objective means. (Objective means could take the form of personal observation, task performance ability by the person, or a psychological test like those mentioned above.)
  • There is a lack of cooperation from the individual.
  • Adiagnosis of antisocial personality disorder exists.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association,2000.

Kaplan, Harold I., M.D., and Benjamin J. Sadock, M.D., "Malingering." In Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry. 8th edition. Lippincott, Williams and Wilkins, 1998.

PERIODICALS

Edens, John F., Laura S. Guy, Randy K. Otto, Jacqueline K. Buffington, Tara L. Tomicic, and Norman G. Poythress. "Factors differentiating successful versus unsuccessful malingerers." Journal of Personality Assessment. 77, no. 2 (2001): 333-338.

ORGANIZATIONS

American Psychiatric Association. 1400 K Street NW, Washington D.C. 20005. <http://www.psych.org>.

Jack H. Booth, Psy.D.

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Malingering

Malingering

Definition

In the context of medicine, malingering is the act of intentionally feigning or exaggerating physical or psychological symptoms for personal gain.

Description

People may feign physical or psychological illness for any number of reasons. Faked illness can get them out of work, military duty, or criminal prosecution. It can also help them obtain financial compensation through insurance claims, lawsuits, or workers' compensation. Feigned symptoms may also be a way of getting the doctor to prescribe certain drugs.

According to the American Psychiatric Association, patients who malinger are different from people who invent symptoms for sympathy (factitious diseases). Patients who malinger clearly have something tangible to gain. People with factitious diseases appear to have a need to play the "sick" role. They may feign illness for attention or sympathy.

Malingering may take the form of complaints of chronic whiplash pain from automobile accidents. Whiplash claims are controversial. Although some people clearly do suffer from whiplash injury, others may be exaggerating the pain for insurance claims or lawsuits. Some intriguing scientific studies have shown that chronic whiplash pain after automobile accidents is almost nonexistent in Lithuania and Greece. In these countries, the legal systems do not encourage personal injury lawsuits or financial settlements. The psychological symptoms experienced by survivors of disaster (post-traumatic stress disorder ) are also faked by malingerers.

Causes and symptoms

People malinger for personal gain. The symptoms may vary. Generally malingerers complain of psychological disorders such as anxiety. They may also complain of chronic pain for which objective tests such as x rays can find no physical cause. Because it is often impossible to determine who is malingering and who is not, it is impossible to know how frequently malingering occurs.

Diagnosis

Malingering may be suspected:

  • When a patient is referred for examination by an attorney
  • When the onset of illness coincides with a large financial incentive, such as a new disability policy
  • When objective medical tests do not confirm the patient's complaints
  • When the patient does not cooperate with the diagnostic work-up or prescribed treatment
  • When the patient has antisocial attitudes and behaviors (antisocial personality).

The diagnosis of malingering is a challenge for doctors. On the one hand, the doctor does not want to overlook a treatable disease. On the other hand, he or she does not want to continue ordering tests and treatments if the symptoms are faked. Malingering is difficult to distinguish from certain legitimate personality disorders, such as factitious diseases or post-traumatic distress syndrome. In legal cases, malingering patients may be referred to a psychiatrist. Psychiatrists use certain written tests to try to determine whether the patient is faking the symptoms.

Treatment

In a sense, malingering cannot be treated because the American Psychiatric Association does not recognize it as a personality disorder. Patients who are purposefully faking symptoms for gain do not want to be cured. Often, the malingering patient fails to report any improvement with treatment, and the doctor may try many treatments without success.

Resources

ORGANIZATIONS

American Psychiatric Association. 1400 K Street NW, Washington DC 20005. (888) 357-7924. http://www.psych.org.

KEY TERMS

Antisocial personality A personality characterized by attitudes and behaviors at odds with society's customs and moral standards, including illegal acts.

Factitious diseases Conditions in which symptoms are deliberately manufactured by patients in order to gain attention and sympathy. Patients with factitious diseases do not fake symptoms for obvious financial gain or to evade the legal system.

Post traumatic stress disorder (PTSD) A disorder that occurs among survivors of severe environmental stress such as a tornado, an airplane crash, or military combat. Symptoms include anxiety, insomnia, flashbacks, and nightmares. Patients with PTSD are unnecessarily vigilant; they may experience survivor guilt, and they sometimes cannot concentrate or experience joy.

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Malingering

Malingering

Why Do Some People Malinger?

Telling Malingering from a Real Illness

Malingering (ma-LING-er-ing) means intentionally pretending to be sick or injured to avoid work or responsibility. The illnesses faked may be physical, such as the flu, or mental, such as depression*. Similarly, a person may pretend to have severe back pain due to an injury. Sometimes a person may actually have a mild illness or injury and exaggerate the symptoms

* depression
(de-PRESH-un) is a mental state characterized by feelings of sadness, despair, and discouragement.

KEYWORDS

for searching the Internet and other reference sources

Deception

Factitious disorder

Faking illness

Munchausen syndrome

Why Do Some People Malinger?

Although there are rare instances in which malingering may have a positive or useful purpose, such as faking illness as a prisoner of war, it is generally considered to be unacceptable behavior. Why then do people sometimes act this way?

People may fake a disorder for many reasons. They may wish to shirk military service or jury duty or avoid going on trial for some criminal act. Some people feign illness to get extra time off from school or their job. Others may fake or exaggerate an injury or disease to get undeserved money from an insurance company. Some people may malinger to get extra attention, sympathy, or help from family or coworkers.

Telling Malingering from a Real Illness

As long as there have been malingerers, there have likely been others who understood what they were up to. The Greek physician Galen, who lived in the second century A.D., wrote, People for many reasons may pretend to be ill; it is desirable, then, that the physician should be able to arrive at the truth in such cases. Using their experience with actual diseases, he said, physicians need to distinguish tricks of the malingerer from the true signs of disease.

Physicians today face many of the same basic problems with malingering that Galen did. To tell malingering from a real illness, doctors need to perform a thorough physical examination that may include tests to find out whether or not the symptoms a person claims to have are real and are a true sign of disease or injury. Doctors also need to be aware of circumstances in their patients lives, such as unwanted work or duties, that might cause them to fake a disorder.

Certain mental disorders could be confused with malingering. For example, in hypochondria*, conversion disorder*, and Munchausen syndrome*.

* hypochondria
(hy-po-KONdree-a) is a mental disorder in which people believe that they are sick, but their symptoms are not related to any physical illness.
* conversion disorder
is a mental disorder in which psychological symptoms are converted to physical symptoms, such as blindness, paralysis, or seizures. A person with conversion disorder does not intentionally produce symptoms.
* Munchausen syndrome
(MOON-chow-zen SIN-drome) is a mental disorder in which a person pretends to have symptoms or causes symptoms of a disease in order to be hospitalized or receive tests, medication, or surgery.

syndrome, the patients symptoms may not arise from actual physical conditions, yet these mental disorders are not the same as malingering. When people miss work or school because of physical symptoms that occur because of stressful changes or emotional upsets in their lives, they are not considered to be malingering. Individuals who are malingering know they are not sick and intentionally pretend to be ill.

See also

Conversion Disorder

Hypochondria

Munchausen Syndrome

School Avoidance

Somatoform Disorders

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malingering

malingering (mă-ling-er-ing) n. pretending to be ill, usually in order to avoid work or to gain attention. It may be a sign of mental disorder (see Munchausen's syndrome).

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