Now let’s talk about Malingering and we’ll start with a case example of this “50-year-old man
who comes to the hospital complaining of hearing command auditory hallucinations and they
told him to hurt himself.” So, you do your evaluation and you find that this man though is
unwilling to cooperate in any action plan other than being admitted to the hospital for observation.
So you try to brainstorm with him about other alternatives, safety net outside of the hospital,
you asked about connecting to outpatient providers and he’s really uncooperative with you in the
emergency room but he tells you that he wants to be admitted, he also tells you that he’d like
medication and the only medication that has ever helped him with these hallucinations are
benzodiazepines. He absolutely refuses to consider any anti-psychotic medication. So, on your
review of his previous hospital records, you see that this man has a pending application for
disability and in fact he’s come to the hospital multiple times seeking admission, looking to hope
his disability application. So, he further is refusing to participate with you and when you asked
to speak to collateral sources of information he says “No.” His answers to you are vague and
inconsistent, although he does intersperse a lot of technical medical jargon into his conversation.
So he uses phrases like "command hallucinations" and also "needing PRNs," terminology that's usually
used by nurses and doctors, not usually by lay people or patients. So, what is malingering?
You’re probably suspecting this from the case example and malingering is actually the faking or
exaggerating of symptoms for obvious external benefit. Some common reasons are disability,
evading prosecution or criminal charges, looking for money, housing, or to get medication
especially controlled substances. So, malingering involves the feigning of physical or psychological
symptoms. You’re really looking for personal gain and it’s very common when people have external
motives to malinger symptoms to try to get what they want and it’s pretty common in hospitalized
patients, more often occurring in men than women and some of the criteria that you’re going to
look for to diagnose it are as follows. The presentation is usually with multiple vague complaints
that do not conform to a known medical condition. The patient often has a long history of many
hospital stays. Generally, they’re uncooperative and they refused to accept a good prognosis
or even refused to talk with you about a management plan that could help them. The symptoms
also tend to improve once the desired objective is obtained. So, with this gentleman, you might
be suspecting malingering. That summarizes some of the somatoform disorders and other disorders
that fall under that category. You know a little bit now about the diagnosis and how to go
about management and treatment of these patients.