Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Distorted Renditions of Injury

When there is money involved, truthfulness in patient disclosure can become a concern. A study by the Research Council in 1996 demonstrated that _build up fraud_ in automobile accidents is reported as high as 33%. In another study, 17-25% of claimants admitted to lying about their level of disability in order to remain out of work.

We are concerned about malingering _ the volitional fabrication of physical and psychological symptoms to achieve an external goal. We are also concerned about distortion _ an intentional or nonintentional style of minimizing or maximizing complaints. And we are concerned about deception _ distortion of symptoms to achieve some larger goal.

Malingering is clinically defined (DSM-IVTR) as occurring in a medicolegal context (_the person is referred by an attorney to the clinician for examination_), characterized by lack of cooperation, a discrepancy between subjective complaints and objective clinical findings and associated with anti-social personality. However, with regard to anti-social personality, it should be pointed out that malingering also occurs in other personality types as well. For example the pathologically dependent, passive-aggressive or paranoid (etc) personalities.

In a 2003 article, Tearman notes: Understanding the honesty, accuracy and completeness of a patient_s self-report (of pain) is essential. It is important that the clinician reach diagnostic and treatment decision with an understanding of the truthfulness of the pain patients_ self-report.

Since deceptive patients report that treatment is inadequate, that they are suffering and that there is a high level of disability, it is important to examine the thoughts, behaviors, moods and beliefs to determine the patient_s goals and objectives have, not only for their care but for their disability role.

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