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Malingering Diagnosis

(Also Known As: Fabricated Mental Illness Diagnosis, Faked Mental Illness Diagnosis, Munchausen Syndrome Diagnosis, Factitious Disorder Diagnosis)

(Reviewed by: Paul Peterson, Licensed Therapist)

How is Malingering Diagnosed?

The diagnosis of malingering is usually subject to detailed investigation since the malingerer will often lie about their symptoms. Malingering is called fabricated mental illness because the patient will usually do everything to fabricate their symptoms in order to obtain financial gains. Malingering can be clinically diagnosed through clinical history and physical assessments as follows: 5

History

  • Malingering can be suspected to be present under the combination of the following conditions:
    • There is lack of cooperation by the person to comply to the prescribed treatment and during evaluation.
    • Once there is a medico-legal presentation, such as the patient is referred by an attorney, or when the patient is claiming for a compensation for their injury.
    • There is discrepancy with the presented symptoms from the objective findings made from medical evaluation.
    • Antisocial personality disorder or histrionic personality is prevalent.
  • Malingering can be diagnosed with long direct observation since malingerers will find it difficult to be consistent with their acts of exaggerated symptoms for an extended period of time.
  • Prolonged interview and examination can induce fatigue and will diminish the ability of a suspected malingerer to maintain their deception.
  • A malingerer usually lacks knowledge on the nuances of their feigned disorder.
  • Persons suspected of malingering psychotic disorders can often exaggerate hallucinations and delusions; however, they are unable to mimic the formal thought disorders of mental illnesses.
  • The goal for fabricated mental illness is to obtain financial compensation.

Physical

There can be no anatomical distribution on the deficit presented during the physical examination.

Mental Status Examination

  • May exhibit irritation and hostile mood.
  • The person has marked evasive attitude towards the examining physician
  • The thought process is rational marked with preoccupation with the illness or injury they are claiming.
  • A malingerer may threaten suicide when the veracity of their claim is challenged or their response seems to be inadequate.
  • Malingerers who claim to have psychotic behavior will have the inability to feign concrete thinking with impaired interpersonal relatedness. They tend to over exaggerate delusions and hallucinations, with the inability to mimic formal thought disorders.

Differential Diagnosis

Malingering is considered to be a diagnosis of exclusion. 6 This is because malingering is not a true clinical illness and can possibly include numerous disorders. One should note that there is an intentional misrepresentation of the illness by the malingerer and it requires the realization that the patient may have a secondary gain by feigning their illness. Malingering has a self serving goal and it is defined by the Diagnostic and Statistical Manual of Mental Disorder IV to be endowed with voluntary control on the manifestations of the symptoms in pursuit of a recognizable goal.

Malingering should be differentiated with the following disorders:

  • Malingering is most difficult to differentiate with conversion disorder where the act of malingering is based on unconscious motivation, representing a true psychiatric disorder. Conversion disorder is associated with head injury, manic depression, epilepsy, psychosis, schizophrenia, drug abuse and alcoholism. This condition leads to the manifestations of symptoms such as paralysis, anesthesia, seizures, diplopia, unexplained blindness, generalized pain, amnesia and gait problems.
  • Somatization disorder is characterized with multiple physical symptoms with no underlying psychiatric and physical disease.
  • Factitious disorder does not have an apparent goal, other than assuming the role of a patient. True psycho-physiological symptoms may coexist with factitious disorder. Its diagnostic features include history of hospitalization with the person’s eagerness to assume the role of a patient.
  • Hypochondriasis is a disorder characterized by the manifestations of physical symptoms that are disproportionate to the demonstrated disease, with the person having the conviction of being sick and a pre-occupation with physical health and appearance. The patient has repeat visits to the doctor with repeated procedures and return of symptoms.

Establishing the Diagnosis

If any of the 4 differential diagnoses above have not been established and there is a high suspicion of malingering, the diagnosis can be gradually implied in a subtle manner so that the physician is aware of the absence of medical illness with the symptoms not consistent with the implied medical illness.

Could You Have Malingering?

Malingering Topics

Related Conditions

Antisocial Personality Disorder – conduct disorder, sociopaths, psychopaths, deceitful, manipulative, behavior disorder
Factitious Disorder – feigning symptoms, exaggerates physical and psychological condition,
Hypochondriasis – fear of having serious disease, misinterpretation of body symptoms
Munchausen Syndrome – chronic factitious disorder, faking/feigning of psychological and mental illness, severe