Post on 03-Jan-2016
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