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The Psychological letter
August,
1998
Sick
or "Just Plain Sick"
A
recent question posed at our internet website was the following:
"Aren’t people who fake their symptoms just plain sick?"
The question is provocative and complex:
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If
we define sick as disgusting, revolting, repugnant or
objectionable, then faking symptoms is arguably "sick"
in the colloquial use of the term. But if we define
"sick" as indicating the presence of a disabling
disorder, then the answer becomes the all too frequent:
"Well, yes...no...or maybe."
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Let
us dispense with the situations in which falsifying symptoms
indicates an illness unto itself. A person who consciously
exaggerates their symptoms and/or limitations, for purposes of
securing unneeded medical care, may be suffering from what has
been described in past issues of The Psychological Letter® as a
Factitious Disorder. Such individuals will inflict harm upon
themselves and undergo painful diagnostic, therapeutic and even
surgical experiences in order to maintain their dependent patient
role. They will engage in painful and health damaging behaviors to
enable them access to ongoing and unneeded health care. They will
not, however, seek psychological care for the underlying problem
that drives these maladaptive behaviors.
When
a patient manufactures or consciously amplifies their complaints, not
in order to secure medical care, but to receive tangible gains such as
monetary awards, the patient is not typically considered
psychologically ill. However, there is an exception to this as well.
Patients
who falsify their symptoms because they are afraid that someday they
will develop these symptoms may, indeed, have an underlying
psychological disorder. This form of malingering is often referred to
as pathogenic malingering.
Pathogenic
Malingering occurs when an individual feels that they must falsify
their symptoms during a time period while they still have access to
disability benefits. This fear of future disease or disorder drives
this maladaptive behavior, and the underlying fear must be addressed.
Adaptive
Malingering, however, is not driven by underlying psychological
disorder. It arises because the patient perceives and/or is repeatedly
told by others (including the media) that he/she is in an antagonistic
and risky position. The patient believes that they need to either
create symptoms or risk that someone (doctor, insurer, employer, etc)
will take advantage of them.
Antisocial
Malingering, arguably the most common, is a more direct attempt to
maximally take advantage of a situation, to tangibly gain by access to
a disability benefits package and a disability role.
There
are those who engage in pure malingering in which all symptoms are
fabricated, partial malingering in which the symptoms are present but
exaggerated, simulation malingering of a specific condition,
dissimulation malingering by denial of the true (and noncompensible)
factors that may be causing the symptoms, and/or false imputation in
which the individual has a demonstrable problem but that problem is
due to a source which the patient is not disclosing such as drug abuse
or an unreported injury.
The
exaggeration or falsification of symptoms is a complex mixture and may
involve individuals who are unhealthy, self-destructive, dependent,
fearful or simply dishonest and manipulative. The concern as to which
is really occurring is not merely "academic" since conscious
embellishment ties up needed health resources, and reinforcement of
falsification does nothing to rehabilitate the person engaging in the
maladaptive behavior.
D.B.A.
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