Malingering VS Factitious Disorders

1. 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

2. 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

3. ... 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)

4. 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

5. 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

6. 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

7. 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.

8. “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

9. 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 Malingering ... External Incentives