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Confronted with a claim of poor vision in the absence of any apparent pathology, the ophthalmologist must consider the possibility that the patient is malingering or hysterical. The authors define four categories of such patients, and recommend diagnostic approaches for each. Specific diagnostic tests are described, as are methods of managing patients once the diagnosis of malingering or hysteria has been made.
Provocation of wounds by malingering is one of the most typical artefacts in surgery. In this paper the succesful maintaining of a wound in a girl for over 7 years is demonstrated. In this time the girl underwent 25 surgical operations and was invalidated at the age of 18 years. In patients with non-healing wounds, which cannot be explained by the rules of general pathology, doctors are well advised to think of the possibilities of malingering at an early time.
Assessment of motivation using forced-choice testing is described and illustrated with case reports. Two injured workers with protracted disability complained of numbness and loss of sensation in their fingers. Each patient received a forced-choice, multiple-choice finger graphesthesia test, with a 0.5 probability of guessing correctly on each item. Both patients performed significantly below the chance level, indicating that they had deliberately provided wrong answers. One patient did not exaggerate until the difficulty level of the task was enhanced. Forced-choice testing, particularly with enhancement of difficulty levels, is proposed as a specific measure to detect faked poor performance. Identification of malingering reduces the risk of iatrogenic damage. The subjective complaints of malingerers must be viewed with skepticism.
Severe hypertension frequently requires hospitalization. Although hospital admission is undesirable for most patients, others are motivated to achieve hospitalization status for secondary gain. The authors present a case of a prison inmate who simulated severe hypertension with a combination of Valsalva's maneuver and arm flexion, on the background of preexisting essential hypertension and mitral valve prolapse. His secondary intent--to avoid his prison duties--classifies him as a malingerer. The differences between this malingering and the psychiatric diagnosis of Munchausen syndrome are discussed. The contributions of essential hypertension and mitral valve prolapse to the self-induced blood pressure elevations also are considered.
Karl Kast, a migrant with a bad back, was examined by four Brisbane orthopaedic surgeons who all independently agreed that there was no physical basis for his complaint. After brooding over this for months, he resolved to kill these doctors and shot three (killing two) before taking his own life. This tragedy and its background are summarized, and a second instance is recorded where a surgeon could have been killed by another accident litigant. There is more to emotional disturbance after injury than a mere quest for compensation. Doctors who hold this simple belief may be at risk if they do not carefully handle the rare cases of severe and dangerous mental illness which masquerade as malingering.
Recent studies of the M have failed to confirm its effectiveness as a screening measure for malingering. The present study involved a further analysis of 99 cases reported by Gillis et al. and the construction of Rule-Out and Rule-In scales. Both scales evidence excellent internal reliability, and their combined use was effective in accurately screening greater than 80 percent of potential malingerers.
Hysteria and malingering, both commonly seen, especially in orthopaedic clinics, are reveiwed. Advances in psychology and psychiatry are often unknown or ignored by surgeons, who may thus mistreat or misdiagnose a multitude of conditions.
This project examined the use of a short inventory based on the validity subscales from the MMPI-2. In Study 1, 69 subjects responded to the extracted L, F, and K items and to those items when embedded in the complete MMPI-2. Correlations between administrations were equivalent to the original test-retest reliabilities for these scales. In Study 2, 60 subjects responded to the short-form with instructions to be honest, fake good, or fake bad. The correct classification rate was 77% using the standard MMPI-2 rules of L greater than 7OT for faking good and F greater than 7OT for faking bad. Taken together, these findings suggest that the short-form may be useful alone or when combined with other questionnaires to identify potential problems in self-report.
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Many techniques have been suggested for identifying criminal suspects who are simulating amnesia for the events surrounding a crime. The present research focuses on indirect memory tests as a potential means of discriminating between those who genuinely suffer from amnesia and those who are simulating. Subjects studied a list of words and subsequently performed either a word completion or a fragment completion task. Under normal indirect test instructions, typical priming effects were observed. When subjects were motivated to simulate amnesia for the list, target completion rates were consistently, and sometimes reliably, below baseline completion rates. This finding is contrary to the performance of genuine amnesics, whose performance on indirect tests typically mirrors that of normal subjects. Indirect tests may prove useful in discriminating genuine and simulating amnesics.
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This study investigated the relationship among psychopathology, intelligence and the simulation of psychopathological roles. The 132 Ss were 48 inpatients, 48 outpatients, and 36 nonprofessional employees. Each S simulated the MMPI profile of an anxiety neurotic, psychopathic deviate, or paranoid schizophrenic. Their simulation target was dissimilar to their diagnosis and/or Personality Screening Inventory profile. The findings were: (1) the hypothesized negative relationship between psychopathology and psychopathological role-taking was not supported broadly, but was supported more with males, blacks, neurotics, and simulators of the psychopathic deviate personality; and (2) the hypothesized positive relationship between intelligence and the simulation of psychopathological roles was supported in a small but definite relationship, with greater support among the Caucasians, males, neurotics, simulators of the 2-7 and 6-8 profile patterns, and when the simulation measure emphasized scatter and elevation similarities.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.