Malingering Definition/description • • • The intentional fabrication of symptoms for a secondary gain - Motivated by an external stimulus - E.g. time off work, avoiding police, obtaining narcotics, insurance money etc. Complain usually stops after the intended external reward has been obtained as opposed to factitious disorder Differs from conventional disorder and somatic symptom related mental health disorders by intentional production of symptoms Epidemiology • • More common in males Often occurs after an incidence - Especially if legal proceedings commence Diagnosis DSM V • Strongly suspected if any of the combination is present: 1. Medicolegal context of presentation 2. Marked disappearance between the individual’s claimed stress or disability and objective findings and observations. 3. Lack of cooperation during the diagnostic evaluation and in complying with the pre-scribed treatment regimen 4. The presence of antisocial personality disorder Management • • • Explained the objective clinical and diagnostic study findings t the patient and make a detailed record on their file Avoid unnecessary referral as this perpetuates malingering The diagnosis should only be directly discussed with the patient as part of a supportive confrontation - Supportive confrontation: ➔ At least two staff members present ➔ Should be non-judgemental, non-punitive and the results of the meeting should be fully documented in the shotes and shared with the relevant healthcare professionals. ➔ Patients may react defensively to confrontation, leading to a lawsuit or violent behaviour. Key info • • Avoid using the term malingering in the patient’s medical record Malingering Is not classified as a somatic symptom and related disorder or a mental illness in the DSM-V