Malingering VS Factitious Disorders

DSM-IV-TRTM

American Psychiatric Association: Diagnostic and statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric

Association, 2000

Russell L. Smith, MS, LPA, HSP-PA, CCBT, MAC, FABFCE, NCP

INTENTIONALLY produced physical or psychological symptoms:

FACTITIOUS DISORDER MOTIVATED BY A

PSYCHOLOGICAL NEED TO ASSUME THE SICK ROLE

NOT USUALLY AWARE OF THE MOTIVATION

MALINGERING MOTIVATED BY EXTERNAL

INCENTIVES GOAL IS APPARENT AND

THEY CAN STOP WHEN SYMPTOMS ARE NO LONGER USEFUL

... To Assume the SICK ROLE ...

SUBJECTIVE COMPLAINTS (E.G., PAIN)

FALSIFICATION OF OBJECTIVE SIGNS (E.G., MANIPULATING

THERMOMETER) SELF-INFLICTED CONDITIONS

(E.G., INJECTING SALIVA INTO SKIN)

EXAGERATION OR EXACERBATION OF PEREXISTING MEDICAL CONDITION (E.G., FAKE SEIZURE)

Factitious Disorder

300.16 With Predominantly Psychological Signs and Symptoms ~ claim depression and

suicidal ideation ~ memory loss ~ hallucinations or

delusions ~ symptoms of PTSD ~ dissociative symptoms

Factitious Disorder

300.19 With Predominantly Physical Signs and Symptoms infection ... impaired healing pain, bleeding, or rashes hypoglycemia ... anemia neurological (e.g., seizures,

dizziness, or blacking out) vomiting or diarrhea fevers of undetermined origin autoimmune or connective

tissue disease all organ systems

Factitious Disorder

~ dramatic flair ~ vague and inconsistent ~ intriguing pathological ...

pseudologia fantastica ~ knowledge of medical

terminology, routines ~ complaints of pain and requests

for analgesics ~ change/add symptoms after

negative findings ~ eagerly undergo invasive

procedures and operations ~ few visitors ~ repeated hospitalizations

Factitious Disorder

~ may give approximate answers

~ may use psychotropic drugs to produce a wide range of symptoms

~ may also present with abuse of analgesics and sedatives

~ may develop conditions due to unnecessary hospitalizations and surgical procedures

~ role incompatible with steady employment, relationships, etc.

“Red Flags” for Factitious Disorder

an atypical or dramatic presentation that does not conform to known conditions

symptoms presented only when being observed

pseudologia fantastica disruptive behavior on ward extensive knowledge of

medical terminology and hospital routines

evidence of multiple treatment interventions, travel, few visitors

fluctuating clinical course with new presentation after initial workup proves to be negative

Malingering ... External Incentives

Positive Reinforcement

Financial gains Drugs Social

Interaction Achieve

desired change in placement or services

simply to gain a meal, a place to sleep, etc.

simply to manipulate others

Negative Reinforcement

Work Avoidance

Drugs To establish

mitigating circumstances for court

To terminate undesirable placement or services

Avoiding military service