Malingering

Malingering
Classification and external resources
Specialty
ICD-10	Z76.5
ICD-9-CM	V65.2
Patient UK	Malingering
MeSH	D008306

Malingering is fabricating or exaggerating the symptoms of mental or physical disorders for a variety of "secondary gain" motives, which may include financial compensation (often tied to fraud); avoiding school, work or military service; obtaining drugs; getting lighter criminal sentences; or simply to attract attention or sympathy. Malingering is different from somatization disorder and factitious disorder. Failure to detect actual cases of malingering imposes a substantial economic burden on the health care system, and false attribution of malingering imposes a substantial burden of suffering on a significant proportion of the patient population.

Signs and symptoms

Some conditions are thought to be easier to feign than others. For example, virtually everyone has experienced pain and knows how a person in pain should appear to others.

History

In the Hebrew Bible, King David feigns insanity to Achish, king of the Philistines (I Sam. 21:10-15). This is by many supposed not to have been feigned, but a real epilepsy or falling sickness, and the Septuagint uses words which strongly indicate this sense. Odysseus was stated to have also feigned insanity in order to avoid participating in the Trojan War. Malingering has been recorded historically as early as Roman times by the physician Galen (Quomodo morbum simulantes sint deprehendendi), who reported two cases. One patient simulated colic to avoid a public meeting, while the other feigned an injured knee to avoid accompanying his master on a long journey. In his social-climbing manual, Elizabethan George Puttenham recommends that would-be courtiers have "sickness in his sleeve, thereby to shake off other importunities of greater consequence" and suggests feigning a "dry dropsy [...] of some such other secret disease, as the common conversant can hardly discover, and the physician either not speedily heal, or not honestly bewray."

Because malingering was widespread throughout the Soviet Union to escape sanctions or coercion, physicians were limited by the state in the number of medical dispensations they could issue.

With thousands forced into manual labour, doctors were presented with four types of patients:

1. those who needed medical care;
2. those who thought they needed medical care (hypochondriacs);
3. malingerers; and
4. those who made direct pleas to the physician for a medical dispensation from work.

This dependence upon doctors by poor labourers altered the doctor-patient relationship to one of mutual mistrust and deception.

United States Armed Forces

Malingering is a court-martial offense in the United States Armed Forces under Article 115 of the Uniform Code of Military Justice, which provides that:

Any person subject to this chapter who for the purpose of avoiding work, duty, or service–
(1) feigns illness, physical disablement, mental lapse or derangement; or
(2) intentionally inflicts self-injury;
shall be punished as a court-martial may direct.

Related conditions

• Factitious disorder
• Ganser syndrome
• Insanity defense
• Münchausen syndrome

References

Ninivaggi, Frank J., Malingering. In: Sadock BJ, Sadock VA, Ruiz P, eds. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 9th ed. Vol. II. Philadelphia: Wolters Kluver/Lippincott Williams and Wilkins; 2009: 2479-2490. ISBN 978-07817-6899-3.