malinger v : avoid responsibilities and duties, e.g., by pretending to be ill [syn: skulk]
Malingering is a medical and psychological term that refers to an individual fabricating or exaggerating the symptoms of mental or physical disorders for a variety of motives, including getting financial compensation (often tied to fraud), avoiding work, obtaining drugs, getting lighter criminal sentences, trying to get out of going to school, or simply to attract attention or sympathy. Because malingerers are usually seeking some sort of primary or secondary gain, this disorder remains separate from somatization disorders and factitious disorders in which the gain is not obvious. Legally, malingering is often referred to as fabricated mental illness or feigned mental illness (see United States v. Binion).
HistoryMalingering has been recorded as early as Roman times by the physician Galen, who reported two cases. One patient simulated colic to avoid a public meeting, whilst the other feigned an injured knee to avoid accompanying his master on a long journey.
Because malingering was widespread throughout Soviet Russia 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 patient; 1. those who needed medical care; 2. those that thought they needed medical care (hypochondriacs); 3. malingerers; and 4. those that 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.
SymptomsThere is a rich and diverse array of methods for feigning illness. Physical methods reported include trying to deceive measuring devices such as thermometers, inducing swelling, delaying wound healing, over-exercise, drug overdose, self-harm, or directly reporting diagnostic signs of disease, learnt from a medical textbook.
Diagnosis and detection
DSM-IV-TRThe DSM-IV-TR states that malingering is suspected if any combination of the following are observed
- Medicolegal context of presentation
- Marked discrepancy between the person’s claimed stress of disability and the objective findings
- Lack of cooperation during the diagnostic evaluation and in complying with prescribed treatment regimen
- The presence of Antisocial Personality Disorder
However, these criteria have been found to be of little use in actually identifying individuals who are malingering. (Clinical assessment of malingering and deception 2nd ed. Rogers, Richard; New York, NY, US: Guilford Press, 1997.)
DetectionSome feature at presentation which are unusual in genuine cases include:
malinger in German: Simulant
malinger in French: Sinistrose
malinger in Korean: 꾀병
abandon, cut, dodge, dog it, duck, duck duty, get out of, goldbrick, goof off, jump, leave, leave loose ends, leave undone, let alone, let be, let dangle, let go, miss, not pull fair, omit, pass over, pass up, pretermit, procrastinate, shirk, skip, skulk, slack, slide out of, slip out of, sneak out of, soldier, trifle, welsh