What is Malingering? | How do those who fake psychosis get caught?

welcome to my scientifically informed insider look at mental health topics if you find this video to be interesting or helpful please like it and subscribe to my channel well this is dr. grande today I have a few different questions for this video and they're all surrounding this idea this construct of malingering so the first would be can somebody fake a mental illness next would be which ones are often faked so which mental disorders we see where people are trying to malinger and what about psychosis and malingering so answer all these questions about malingering that it's important to know here that some mental disorders can really be easily faked and I'll talk about those but it's not always so simple as to say it's malingering so the first thing I want to do is draw the distinction between malingering factitious disorder and somatic symptom disorder so about these disorders is important to know that they're all relatively rare and of course here we're talking about these disorders in relation to mental health issues so faking a mental disorder or mental health symptoms so to start with I'll cover malingering so malingering is not a mental disorder it's av code so it's really a condition and it can be the focus of clinical attention but again it's not something that somebody can be diagnosed like a mental disorder malingering is when somebody fakes mental health symptoms again it can be physical health but that's a separate area here I'm just talking about mental health so it's when somebody fakes mental health symptoms for external gain so malingering is deliberate now a factitious disorder is actually somewhat similar except it is a mental disorder but the faking of mental health symptoms is done for sympathy not for money or any other material gain factitious disorder like malingering is also deliberate so if somebody knows that they don't have the mental health symptoms and they're telling you that they do or they're acting like they do now somatic symptoms were is really quite different from those other two somatic symptom disorder isn't somebody has real symptoms that are not explained so there's no other explanation for the symptoms they're real but they seem to have something to do with the mental health side as opposed to having a physical cost so some important distinctions there between the lingering factitious disorder and somatic symptom disorder now this video of course is focusing on malingering so mental disorders can be easily faked as I mentioned before some are more easily faked than others and I think one of the reasons they can be easily faked is all the information about mental disorders is available in the literature the DSM the Diagnostic and Statistical Manual outlines all the symptoms necessary for specific diagnoses so again the information is really accessible anybody can buy DSM anybody can look up the literature and read about all these different symptoms that would be necessary for diagnosis now there are three different types of malingering we see pure malingering this is when somebody is acting like they have a disorder that they don't have so they have no mental health symptoms in reality but they're acting like they have a disorder that's characterized by mental health symptoms we also have partial lingering this is when somebody does have real symptoms and they're exaggerating those symptoms this one's particularly hard to detect when somebody has even subclinical symptoms that are real and say they're just acting like they're rising to the clinical level it's very hard to catch that the last type of malingering is called false imputation this is when somebody has real symptoms but they say the cause of the symptoms is different than it really is and again this is very hard to catch so an example of this would be somebody actually has post-traumatic stress disorder from a car accident so they have real symptoms but then they say that the post-traumatic stress disorder the symptoms are actually caused by a relationship so the partial malingering and the false imputation again very hard to detect peer malingering that first type is a little easier detect but really all different types of malingering are challenging to spot so we talked about malingering why would somebody fake the scent of a mental disorder what would be the purpose of this well there are really two different areas we could think about here one is to gain something and the others to avoid something so in the gain side we'd see motives like substances like being prescribed medications from a psychiatrist for example we see gaining money housing on the avoid side we see trying to avoid arrest although usually this doesn't work we also see avoiding prison and sometimes malingering can help something to avoid prison more often though we see it as gaining better conditions in a prison so being moved from one unit over to a mental health unit again people who malinger aren't always successful at this but this is one of the reasons another reason could be to avoid military service I don't really see this as particularly common reason but it is one of the potential reasons to fake symptoms in my experience I've seen a lot that our substance related so people trying to gain substances so for example of course I have a PhD in counseling I'm not a physician not a psychiatrist but I've worked in places before with psychiatrist and every now and then I would see presentations where people told me that they had disorders hoping that when I put that information in the progress notes that would sway the psychiatrist another popular reason is circumstances related to the criminal justice system so again trying to avoid prison or trying to get better conditions so maybe trying to get probation instead of prison or again being moved from one unit of the prison which is undesirable to a unit that is more desirable so even though malingering is uncommon and usually just for a few different reasons we still need to know how to detect it the method to detect it and the accuracy and reliability that method is really specific to this order being faked now again malingering is not common over all but it's relatively more common with certain disorders for example I really haven't seen too much malingering with substance use disorders meaning somebody doesn't have a substance use disorder and they're pretending to have one I don't see it much with anxiety disorders and actually don't see too much lingering with person is orders either well we see more often in terms of malingering would be disorders like ADHD major depressive disorder and again this has a potentially psychotic element to it major depressive disorder can have psychosis in certain situations we see malingering with post-traumatic stress disorder so someone who doesn't have it pretending that they do and I say the most popular disorder would be schizophrenia or something related to schizophrenia like schizoaffective disorder and this again of course has a psychotic element so this kind of speaks to that third question I was talking about before which is how does psychosis relate to malingering well schizophrenia would be one of the major disorders that I see associated with malingering when you hear the term malingering often times you first think of psychosis a lot of times this is because of the potential gain an individual can have in the criminal justice system as I mentioned before so that criminal justice element is a popular motive there for schizophrenia is one of the disorders that's chosen oftentimes for malingering so in terms of detecting malingering again it's specific to the disorder but how can we detect it so with many disorders detecting someone who's malingering would be pretty difficult for example if somebody's faking OCD that's fairly difficult to detect ADHD even though somewhat common that's difficult to detect conduct disorder adjustment disorder a number of other disorders would be really challenging to figure out in terms of detecting that malingering but there are a few things to look for none of these by themselves of course prove someone's malingering these are just certain things that we see in the research literature that appear to be giveaways they appear to be elements that we can detect and say well it raises the probability that we're dealing with malingering so the first would be if someone has really unlikely symptom combinations for example somebody is trying to say they have major depressive disorder but then they're repeatedly appearing happy or telling you that they're happy other would be when somebody's uncooperative now again that's just one element to look for but if somebody's uncooperative in counseling that could be a sign of malingering if somebody says I don't know a lot if they respond that way a lot even to relatively basic questions if someone tries to intimidate you as a clinician that's a sign of somebody's angry or they're upset by relatively benign questions we wouldn't expect somebody to be upset by benign questions it's a little unusual if somebody hesitates when they're answering as if they're trying to think of the correct answer based on an answer they gave before that's an indication and one of the ones I've seen a few times is if somebody asks how did I answer that question before so you might have the chart in front of you or if it's electronic on the screen in front of you and they'll say oh that's a good question or oh yeah I remember answering that before what did I say before that's a probably a little bit stronger indication of malingering another indication would be if they accuse you of inferring that they are faking that's actually a fairly good indication as well and also vague answers if somebody answers always in kind of an impressionistic way a way that lacks detail and can never give you specifics that's an indication of an increased risk of malingering now specifically looking at inconsistencies we could divide inconsistencies up as internal and external so for example an internal inconsistency would be an inconsistency in the clients history as they report so for example with post-traumatic stress disorder if they report one clear cause in one interview and then they say something else caused it another that's an internal inconsistency many of the inconsistencies related to malingering however or were called external inconsistencies I think of these external inconsistencies as really being in two categories the reported symptoms compared to the level functioning and the reported symptoms compared to the observed symptoms so an example with the level of functioning if somebody is saying that they are depressed and I mentioned this before being depressed and being happy at the same time and you can see them in the waiting room like say that there's glass there's you walk out to the waiting room and they're laughing hysterically in the waiting room that's inconsistent with depression not impossible of course but it's one of those examples of report symptoms being different than the observed level functioning in terms of observed symptoms say somebody is trying to feign delusions and they say they're being chased by the government yet they don't seem to react when you mention the CIA or the FBI and let's say those particular agencies are part of their delusion usually if somebody's having a delusion about being chased by the government or persecuted by the government they would have some reaction to that another example would be with obsessive-compulsive disorder if somebody says they have compulsions but they don't have any intrusive thoughts obsessions it's unusual to have compulsions without obsessions as a matter of fact I don't know how that would even really be possible with OCD because obsessions are really required with that disorder so again it's not impossible like somebody could just report it incorrectly but still that's an indication that something is going on potentially with malingering now when talking about malingering and psychosis I mentioned this before this is an area we see a lot specifically with auditory hallucinations there's a few things that are important to know as a clinician and really with a few other areas around psychosis I'll talk about those too so with auditory hallucinations what we see is that they're usually clear intermittent and paired with delusions those are all very common so if somebody says that they have auditory hallucinations but they can't really make out what the voices are saying that points to malingering if they say that auditory hallucinations are happening all the time and they never get a break from them that would be unusual and also if they have auditory hallucinations or they report they have them they don't have delusions that would also stand out as potential lingering now speaking of delusions there are important elements to know about delusions as well if you see that somebody reports delusions that have a sudden onset or termination that's a little unusual what we see with delusions is that they stay around a long time and they don't tend to end quickly or suddenly if somebody is talking about paranoid delusions and they're being really straight-4 with you they're eager to talk to you about their paranoid delusions and they don't seem to have any fear around them that's a bit unusual too now moving over to visual hallucinations visual Husa Nations are actually pretty interesting in relation to malingering we know what visual hallucinations are almost always in color and it's rare that they would change based on some of these eyes being open or closed another area would be that visual host nations usually involve normal-sized people so not involving people that would appear particularly small in the loose Nations I think what happens here is when individuals are trying to malinger visual loosin ations they get confused with alcohol into symptoms so there is a type of visual hallucination that involves seeing people that are small they're called lilliputian loosen ations but they're actually fairly rare with schizophrenia which is oftentimes again what somebody is trying to fame with the psychosis we do see them however as I mentioned with alcohol so really again I think this is what happens here people read about these lilliputian loosen ations and they're related to alcohol but they use them to try to feign schizophrenia and this is a fairly good indication of malingering relative to the other indications again no one sign prove somebody's malingering another thing I see with schizophrenia in general in terms of malingering is that the negative symptoms aren't usually faint and like this would be the flat effect these are fairly difficult symptoms to feign and there's actually a few other areas of sits ofrenda they're difficult to feign as well specific symptoms like words salad loose associations and derailment are also hard to fake so usually when somebody's malingering and they're trying to show you they have schizophrenia or proof do they have schizophrenia they'll skip those particular symptoms the negative symptoms the word salad loose associations and the derailment so people can malinger it is possible again it's hard to detect but it's hard to fake some of these symptoms and it's hard to fake some of them 24 hours a day so there are some indications that clinicians can use but accusing a client of malingering no matter what the circumstances is always a really sensitive situation I would say seek supervision and really have everything well documented and have safety addressed before introducing any conversation about malingering it's one of those things again lingering in general that's uncommon so we don't want to move into that area without being very careful I would say that when you do seek supervision and it makes sense to introduce malingering after all these stages have been met and all the conditions have met and you're fairly sure that's what you're dealing with be ready for a negative reaction a strong reaction including potential violence so it's important to have again safety considerations addressed before introducing this now I said this a few times but it's worth emphasizing malingering is not something I would expect a clinician to see every day so malingering and factitious disorder and somatic symptom disorder are fairly uncommon so this is something to keep in mind but not necessarily something to be focusing on a lot as a clinician our main job as counselors is to provide relief from symptoms to help clients meet their goals sometimes we'll see malingering and that's unfortunate we have to know how to deal with that but most of the time clients are telling the truth they're just trying to get better and they're coming to counseling so you could help them so some important considerations when considering malingering if you have any thoughts or experiences surrounding malingering and you want to share those please put those in the comment section I always find the comments to be interesting the oftentimes start an interesting dialogue around the topic as always I hope you found this description I'm lingering to be interesting thanks for watching

Channel: Dr. Todd Grande

Views: 253,226

Keywords: Malingering, factitious disorder, somatic symptom disorder, faking a mental disorder, faking psychosis, psychosis, schizophrenia, substance use disorder, major depressive disorder, ADHD, Lilliputian hallucinations, auditory hallucinations, visual hallucinations, forensic settings, drug seeking behavior, diagnostic and statistical manual, DSM, counseling, mental health

Id: 7egODbgN4XI

Length: 17min 43sec (1063 seconds)

Published: Wed Jan 30 2019