The main characteristic of malingering is the presence of physical or psychological symptoms feigned or intentionally produced. This diagnosis can be reached by simple direct observation or by the exclusion of other causes, although in many cases it is still controversial since it is never possible to rule out 100% that the patient does not actually have the symptomatology that it reflects.
The patient feigns these symptoms in order to assume the role of the patient. However, it does not seek to obtain any benefit. This differentiates it from simulation acts. In the simulation, the patient also produces the symptoms intentionally, but their objective is easily recognizable when their circumstances are known.
For example, the production of symptoms intentionally to avoid a judicial hearing or in the past, when incorporation was mandatory to provide military service. In the same way, a hospitalized mental patient can simulate an aggravation of his illness to avoid his transfer to another less desirable institution. This would also be an act of simulation.
On the other hand, in malingering disorder, there is a psychological need to assume the role of the patient, as evidenced by the absence of external incentives.
The patient feigns these symptoms in order to assume the role of the patient. However, it does not seek to obtain any benefit.
By definition, the diagnosis of Malingering disorder always involves a certain degree of psychopathology (something is not right in the mind of that person, in other words). It should be noted that the presence of Malingering symptoms does not exclude the existence of other physical or psychological symptoms. As we have ventured before, in many cases the issue is pellagra.
Clinical Criteria To Diagnose A Malingering Disorder
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) includes the following criteria for the psychologist or psychiatrist to make the diagnosis of Malingering disorder:
- Pretended or intentional production of physical or psychological signs or symptoms.
- The subject seeks to assume the role of the sick.
- The absence of external incentives for behavior (eg, an economic gain, avoiding legal responsibility or improving physical well-being, as in the case of simulation).
The DSM-IV also performs the following classification of Malingering disorders:
- The symptoms and signs that predominate in the clinical picture are the psychological ones.
- The signs and symptoms that predominate in the clinical picture are the physical ones.
- There is a combination of psychological and physical signs and symptoms without predominating in one clinical picture over others.
As we said, the essential characteristic of this disorder is the intentional production of physical or psychological signs or symptoms. These symptoms can be invented (eg, when the patient complains of pain in the abdomen without actually suffering it) or falsified (eg, in the case of abscesses produced by the injection of saliva under the skin).
The symptomatology may also be an exaggeration or exacerbation of a pre-existing physical disorder (eg, the simulation of delusional ideas when there is a history of a psychotic disorder). Also, the symptomatology can be a combination or variation of all the previous ones.
For this disorder to occur, the patient must fully assume the role or role of the sick person. In addition, there are no external incentives (gains) that justify the symptoms (eg, an economic gain, avoid legal responsibility or improve physical well-being, as in simulation acts).
What characteristics do people have?
People with this disorder usually explain their story with staging and an excessively dramatic air. However, if asked in more detail, their answers are vague and inconsistent. These people tend to get carried away by a tendency to lie that escapes their control. These lies are pathological. These lies usually get the attention of the interviewer and refer to any aspect of their history or symptoms.
Often, these people have extensive knowledge about medical terminology and work performed in hospitals. Their complaints often include issues such as pain and are analgesic claimants. When the doctor has explored their physical discomfort and the result has been negative, they begin to complain about other physical problems and produce more factitious symptoms.
People with a malingering disorder are often the subject of multiple explorations and surgical interventions. On the other hand, when they are in the hospital they do not usually receive many visits.
Sometimes, it is possible to surprise the person at the moment in which his factitious symptoms take place. When they are made to see that they are faking, they either deny it or quickly leave the hospital, even against the medical prescription.
Malingering disorders with a predominance of psychological signs and symptoms
This subtype of factitious disorder is a clinical picture in which psychological signs and symptoms predominate. The main symptoms consist of the intentional production or pretense of psychological symptoms, suggestive of mental illness. The apparent objective of the individual is to assume the role of “patient”. On the other hand, it is not understandable in light of their environmental circumstances (unlike what happens in the simulation).
The disorder is often recognized by a wide range of symptoms that often do not correspond to a typical syndromic pattern. These symptoms have a clinical course and an unusual therapeutic response. They get worse when the person is aware that it is observed. This type of patients usually complains of depression and suicidal ideation due to the death of the spouse (which is not confirmed by family members), memory loss, hallucinations or delusions, symptoms of post-traumatic stress disorder and dissociative symptoms.
The apparent objective of the individual is to assume the role of “patient”.
On the contrary, it may also be extremely negative and uncooperative people with the doctor’s interview. The psychological symptoms reveal, in general, the concept that the patient has of mental illness and, therefore, it may not coincide with any of the known diagnostic categories.
Malingering disorders with a predominance of physical signs and symptoms
This type consists of a clinical picture in which the signs and symptoms of an apparent physical illness predominate. The common clinical problems that can be simulated or provoked are infections (eg, abscesses), difficulty in healing wounds, pain, hypoglycemia, anemia, hemorrhages, rash, neurological symptoms, vomiting, diarrhea, fever of unknown origin and symptoms of autoimmune or connective tissue disorders.
The most severe and chronic form of this disorder has been called ” Munchausen syndrome “. The Munchausen syndrome consists of repeated hospitalization, pilgrimage (trips) and fantastic pseudology. All organic systems are potential targets and the presentation of symptoms is only limited by the medical knowledge, sophistication, and imagination of the individual.
Malingering disorders with a combination of psychological and physical signs and symptoms
This subtype consists of a clinical picture in which a combination of psychological and physical signs and symptoms appears, but none of them predominates over the others. The most severe and chronic form of this disorder has been called “Munchausen syndrome” to which we have referred before, but with the aforementioned combination of symptoms.
What is the course and evolution of Malingering disorder?
The course of the Malingering disorder is intermittent episodes. Less common is the single episode or chronic illness, which does not subside. The beginning of the disease takes place in the first years of adult life. It often coincides with hospitalization for an identifiable physical illness or mental disorder.
In the chronic form of the disorder, successive hospitalizations are almost transformed into a lifestyle. As we have seen throughout this article, Malingering disorder involves the intentional production of symptoms in order to adopt the role of “sick”. However, unlike the simulation, the person with this disorder does not get any benefit for playing this role: hence, suspicions and diagnosis in this sense tend to be late.