“The self-perception of illness and disability is more correlated with unhealthy coping strategies and depression than it is with the actual physical damage. This is why we see such a range in pain behaviors among our patients. When we can rule-out malingering, we are left with an awareness that we cannot understand the patient’s response to injury or perception of disability without examining how each patient copes and to what degree they are depressed.
Let me illustrate with a case example. The patient was a 42 year old woman with a neck injury incurred when working with manufacturing equipment. She was minimally educated and did not fully understand what she was told about her MRI except that she “needed neck surgery” of which she was quite frightened. She believed that following neck surgery, she might not be able to walk. Again, she understood very little.
She would arrive at the office, limping and dragging her left leg while massaging her neck. She would engage in vocal utterances of pain. Often she would use a cane incorrectly for this neck problem.
Concurrently, her husband was a brittle diabetic and ultimately passed away. Her son was carjacked and shot in the back. Another son was complaining of a hearing loss which was traced to an expanding lesion in his brain to he succumbed.
Therefore, she lived alone. The grandchild of the son who had died was being reared by his widow’s promiscuous and drug abusing daughter.
None of these factors were known when the patient was referred. The presenting question was whether she was malingering.
Her portrayal of helplessness resulted from a combination of exceedingly poor coping strategies, a catastrophic response to her multiple family losses and a plea for help from her care givers. “Caregivers have a role in identifying and improving maladaptive coping strategies…pain behavior is defined as actions and expressions by which pain or illness is communicated to others.(1)”
- (1) Jansen, S. J., her Muelen, D. P. et al (2015) Does verbal and nonverbal communication of pain correlate with disability? Psychosomatics, 56:4, 338-344.