Identifying and Managing Malingering and Factitious Disorder in the Military

Abstract

Malingering is the intentional fabrication of medical symptoms for the purpose of external gain. Along similar lines as malingering, factitious disorder is the intentional creation or exaggeration of symptoms, but without intent for a concrete benefit. The incidence of malingering and factitious disorder in the military is unclear, but likely under reported for a variety of reasons. One should be aware of potential red flags suggesting malingering or factitious disorder and consider further evaluation to look for these conditions. A deliberate and intentional management plan is ideal in these cases. Furthermore, a multi-disciplinary team approach, a non-judgmental environment, and the use of direct but dignity sparing techniques will likely be most "successful" when confronting the patient with malingering or factitious disorder.

Morgellons Disease: The Spread of a Mass Psychogenic Illness via the Internet and Its Implications in Hand Surgery

“…Insurance fraud, work release, military commitments, and other medically relevant issues may precipitate malingering. 5,6…”

“…If they do not seem open or you do not have a trusting relationship, speak with a clinician they trust, such as their primary care provider. 6 If over the course of care for the patient certain inconsistencies lead to a suspicion of deception, it is usually not helpful to confront the patient directly. Bass et al, in their comprehensive review of factitious disorders, recommend providers adopt a goal of “harm reduction,” refraining from providing risky or invasive procedures but avoiding outright challenges to the patients’ belief structure.…”

Artifizielle Störungen

“…Als Faustregel für eine psychiatrisch-diagnostische Klärung könnte gelten, dass die Wahrscheinlichkeit einer intendierten Aggravation oder Vortäuschung im Sinne einer Simulation hoch einzuschätzen ist, wo auch immer neben der klinischen Symptomatik auch ein forensisch-juristischer Kontext vorliegt [7]. Es kann so gut wie jedes psychische Syndrom vorgetäuscht werden [32] [38].…”

Non-organic Vision Loss in the Afghanistan and Iraq Conflicts

“…23 Identifying and treating suspected malingerers should involve a multidisciplinary team in a nonjudgmental setting. 24 Clinicians suspecting malingering as a source of NOVL must be careful in considering this diagnosis in military settings, as false diagnoses of malingering not only may undermine the therapeutic relationship or cause a critical diagnosis to be missed but also may expose the patient to military prosecution.…”