Malingering

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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, response to (attempt to lessen) external stress factors, or attempting to obtain medications or to lighten criminal sentences. Because malingerers are usually seeking some sort of primary or secondary gain, this disorder remains separate of Somatization disorders and factitious disorder in which the gain is not obvious.

[edit] Diagnosis and Detection

[edit] Diagnosis

[edit] DSM-IV-TR

The DSM-IV-TR states that malingering is suspected if one or more of the following are observed^1:

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

[edit] Detection

Detection by clinicians is rare although the frequency of discovery by clinicians is 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:

• Computerized Assessment of Response Bias (CARB)
• Minnesota Multiphasic Personality Inventory (MMPI)
• The Test of Memory Malingering (TOMM)

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

• California Verbal Learning Test (CVLT)
• Functional Capacity Evaluations
• Millon Clinical Multiaxial Inventory (MCMI)
• Portland Digit Recognition Test (PDRT)
• Rey-15 Item Memory Test
• Stroop test
• Wechsler Memory Scale (WMS)
• Wisconsin Card Sorting Test (WCST)
• Word Memory Test (WMT)
• Wechsler Adult Intelligence Scale (WAIS)

[edit] See also

• Factitious disorder
• Ganser syndrome
• Munchausen syndrome

[edit] References

¹ DSM-IV-TR, American Psychiatric Association, 2000 Halligan, P.W., Bass, C., & Oakley, D.A. (Eds.) (2003). Malingering and Illness Deception. Oxford University Press, UK.