Talk:Malingering/Archive 1

Malingering is not considered a mental illness
"Malingering is not considered a mental illness. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV- TR), malingering receives a V code as one of the other conditions that may be a focus of clinical attention."

"It is interesting to note that malingering is not considered a form of mental illness or psychopathology; rather it is considered a deliberate behavior. Malingering is classified in the DSM-IV-TR as a "V" code (ie, other conditions that may be a focus of clinical attention)." Ward20 (talk) 04:47, 23 July 2009 (UTC)

most commonly feigned
This material is very deceptive and POV, "The disorders most commonly feigned include mild head injury and medically unexplained symptoms like those associated with fibromyalgia and chronic fatigue syndrome. The source actually states, "...the most likely ailment to be malingered was mild head injury, followed by fibromyalgia or chronic fatigue syndrome, pain, neurotoxic disorders, electrical injury, seizure disorders, and moderate or severe head injury.  In another report, malingerers more commonly presented with cervical pain and repetitive strain injuries...". The text cherry picks data while ignoring other data. In addition, the primary source, Mittenberg reports about "diagnostic impressions of probable malingering", it is not clear how that corresponds to proven malingering.

The source also contradicts wording in the article, "a study...asked 172 Veterans Administration patients and 160 medical students...to complete a questionnaire..." The questionnaire contained a pattern of medically unexplained symptoms, "problems for which a physician could find no organic basis, and a malingering index score was calculated....The study revealed... medical and surgical patients...received a malingering index score even slightly lower than that of the medical students."

Another review does not conclude malingering in fibromyalgia is high,. "In Israel, there is an increase in the number of suits filed against private insurance companies and the National Insurance system for post-traumatic fibromyalgia. According to the literature, it is probable that the number of cases that involve malingering or secondary gain is low." Ward20 (talk) 03:17, 20 July 2009 (UTC)


 * OK so add more sources or change wording or discuss, do not delete MEDRS. Pls also be civil, it is not deceptive the article gives list, "mild head injury followed by fibromyalgia or chronic fatigue syndrome" i did not go down to least likely, it is not deceptive i am giving a few exampels also the large study found 37-39% from the claim cases were probably malingering, you delete that also wo discussing. The other review, you just read abstract or do you read Hebrew? BC article is in Hebrew and it says in Israel "it is probable" the number is "low" it does not say the percentage is low and it does not say what low is. Obvious, you can not prove a FM case is malingering bc there is no total objective test for FM or malingering. I am reverting, pls discuss changes you want. RetroS1mone   talk  02:25, 21 July 2009 (UTC)


 * Reasons why the material is deceptive and POV are discussed on the talk page above. The material was removed as stated in the edit summary. It's not uncivil to call material deceptive. WP:MEDRS is not a reason to keep material that contradicts its source.


 * To reiterate, The cited (McDermott) source references two malingering studies among others. The Mittenberg reference found 39% percent of mild head injury, 35% of fibromyalgia/chronic fatigue, 31% of chronic pain, 27% of neurotoxic, and 22% of electrical injury claims had "probable malingering and symptom exaggeration". The Hurst reference found different results that, "malingerers more commonly presented with cervical pain and repetitive strain injuries." The chronic pain, and neurotoxic percentages are also close to the FM and CFS percentages. The McDermott source states there are huge large variations in these types of studies, and that another study found fibromyalgia cases (25-30%) had similar malingering results as chronic pain.


 * McDermott only once mentioned medically unexplained symptoms to discuss a study that found medical patients having medically unexplained symptoms had a malingering index score lower than medical students.


 * The Israeli FM study abstact is quoted directly. I don't know what low is in their study, but 35% is not low by any reasonable definition.


 * It is not correct to say mild head injury and medically unexplained symptoms like those associated with fibromyalgia and chronic fatigue syndrome are the most commonly feigned, as the source does not state that and the Israeli study contradicts it. The material cherry picks data to state something different than what  McDermott states. There is uncertainty and differences in opinion about the amount of illness feigned. McDermott implies medically unexplained symptoms are not most commonly feigned.


 * The whole sentence, "The disorders most commonly feigned include mild head injury and medically unexplained symptoms like those associated with fibromyalgia and chronic fatigue syndrome", is misleading and inaccurate to the source. The whole sentence is so obviously biased (head injury is not linked while the other conditions are for example) there is no reason to keep any of the sentence. No condition illness should be stigmatized in this manner. There is no constructive reason for it. Period, full stop. Ward20 (talk) 22:25, 22 July 2009 (UTC)


 * MEDRS say some conditions are feign more then other conditions. MEDRS say, some people including the person that wrote the ACR classification for fibromyalgia do not believe, FM is a disease. These view points are notable and important in literature, it is constructive when all major view points are in Wiki not only the view points Ward20 and RetroS1mone likes.
 * Stigmatize, McDermott says people more likely fake FM etc bc pain is more easy to fake, why that does "stigmatize" real FM or CFS or IBS? People fake chest pain to get drugs, it does "stigmatize" heart disease? People fake head injuries, it does "stigmatize" head injuries?
 * "The Hurst reference found different results" bc the Hurst reference is only about chest pain and it is smaller, the Mittenberg study was 33,000 patients refered and any condition. The Mittenberg study says 35% of FM/CFS claims may be malingered and it says, percentage is 2-4% under the real bc from reporting bias, that is why other sources say from 35-39%. You can read more in the text on Malingering, R. Rogers Clinical Assessment of Malingering and Deception 3rd Edition, Guilford, 2008. ISBN 1593856997
 * A review in Hebrew about Israel is it MEDRS for English encyclopedia, when it is it is MEDRS for situation in Israel, it does not contradicts a NA study and other reviews and textbooks. When it contradicts, i do not think it does, it does not say it is false.
 * We can also talk on the effort reporting literature, i did not cite that yet. RetroS1mone   talk  02:44, 23 July 2009 (UTC)


 * Here is a partial answer. Are you kidding me? Of course faking any illness to get benefits stigmatizes those illnesses. See and


 * "A diagnosis of malingering delivers a powerful stigma, so psychiatrists must carefully weigh all the evidence before drawing that conclusion."
 * Ward20 (talk) 05:38, 23 July 2009 (UTC)


 * No i am not kidding and your references say, diagnosis of malingering stigmatizes the malingerer ya know the person!! Like conviction of felony stigmatizes the felon and conviction of pedophilia stigmatizes the pedophile. Conviction of pedophilia does not stigmatize every person that works with children and likes children. Diagnosis of malingered chest pain does not stigmatize heart disease. RetroS1mone   talk  03:26, 25 July 2009 (UTC)


 * Read Day care sex abuse hysteria Ward20 (talk) 20:13, 31 July 2009 (UTC)


 * We should not arrest pedophiles bc it might make some day care workers suspected?? OK one from my examples is bad in your opinion, your own sources say, stigma is on the diagnosed malingerer. They do not say, it is on every one with the feign condition. Stigma is irrelavent any way bc Wikipedia is not to right great wrongs it is for reporting from MEDRS. RetroS1mone   talk  22:26, 31 July 2009 (UTC)


 * No RetroS1mone one of my MEDRS sources stated the stigma is not only on the diagnosed malingerer, "When this constellation of factors is combined with unresolved litigation-compensation issues, it is not surprising that chronic pain disorders are often misdiagnosed as hysteria or malingering. Unfortunately, these diagnoses may have significant negative consequences that are not often appreciated and may compromise treatment."


 * But let's move on from that. You have not substantiated, "The Hurst reference found different results bc the Hurst reference is only about chest pain and it is smaller". I don't believe the Mittenberg study was 33,000 patients, they sampled patients and extrapolated up to 33,000 persons. You have not addressed that the McDermott article does not support adding medically unexplained symptoms to the text because patients with medically unexplained symptoms received a malingering index score even slightly lower than that of the medical students. Ward20 (talk) 00:23, 1 August 2009 (UTC)


 * Your source says, misdiagnosis of malingering can stigmatize the suspect malingerer. It does not say, diagnosis of any person or misdiagnosis of any person stigmatize every person with the condition they might have. The Hurst reference is only about chest pain it is substantiated by Hurst reference, pls read. Mittenberg study was more then 33,000 patients, they estimate population from 33,000 cases. Malingering in MUS vs medical students, so we can not say malingering in article, is synthesis. RetroS1mone   talk  02:40, 1 August 2009 (UTC)

(outdent) I agree with RetroS1mone that the stigma is probably meant to apply only to the patient, but not the disease at large. At the same time, though, I think Ward's quite right in pointing out that what something is intended to stigmatize and what it stigmatizes in fact are not always the same.

What concerns me more is the restatement of Mittenberg's "diagnostic impressions of probable malingering" into what reads like an undisputed fact that these are the most common feigned illnesses. The fact that Mittenberg was so careful in his wording as to use "impressions" and "probable" in the same sentence says to me that a similar caution should be used in the article. Over and above that, the entire Misdiagnosis of Chronic Pain as Hysteria and Malingering document should suggest that any diagnosis of hysteria or malingering, and any statistics on them, should be viewed with at least some skepticism or perhaps "caution" would be a better word. Again, I don't see this presented in the lead.

I don't dispute that there are a percentage of cases that are malingering, but in the same way the various doctors have been quite careful about their wording, so should we be. --RobinHood70 (talk) 19:19, 2 August 2009 (UTC)

Intro
I tightened up the intro a bit and tried to make it flow better. Since changes like this can be hard to detect in the diffs, here's a list of what they are: I'd like to do something with that last sentence because it sticks out like a sore thumb in terms of flow, but I can't figure out anywhere to fit it in better. Also, while I don't doubt the truth of it, I'm not entirely sure it's supported by the cited source, since the source talks about "fraud that broadly includes malingering", which means that it's talking about the burden of fraud, not specifically malingering. It could probably stand to have a more specific source cited. I also haven't changed the wording about the most common conditions that are feigned, since that's being discussed elsewhere on the talk page. --RobinHood70 (talk) 19:58, 2 August 2009 (UTC)
 * I consider "psychology" to be part of "medicine", so removed it in the first sentence.
 * Malingering refers to the concept in general, so I removed "an individual".
 * Merged "secondary gain" into another sentence to make it shorter/flow better; linked it (technically the same as the "primary gain" link, but figured the two might be separated at some point, so left both links in place).
 * Merged wordy "trying to get out of going to school" into "avoidance of..." wording (necessitating change to semicolons in list).
 * Put ref all on one line instead of split.

The intro says "or simply to attract attention or sympathy" but I thought that was the definition of "factitious disorder" ... isn't that precisely the distinction: that malingering is for something concrete and factitious is for sympathy and attention? —Preceding unsigned comment added by 24.61.41.1 (talk) 22:10, 21 October 2010 (UTC)

Clean-up
I've removed copy-and-paste from the Diagnostic and statistical manual of mental disorders per WP:COPYOTHERS, as well as dubious unsourced assertions, assertions citing primary sources, and assertions not supported by their cited sources per WP:MEDRS. I'll see if I can get to the medical library later in the week and start rebuilding the article. --Anthonyhcole (talk) 00:34, 12 March 2012 (UTC)

NPOV
Really, it's quite ridiculous to portrait malingering as, essentially, a crime - historically, it's often been a good thing. Avoiding conscription into tyrannical armies (often for reasons of conscience rather than, or in addition to, more selfish motives), a chance to escape the gulag, family emergencies, political protest. By humane standards, most work and school relationships of the past were at least mildly exploitative and/or abusive, and to categorically claim malingering is always a bad thing seems quite insulting. I would go so far as to say that these days, a sick day is often a social fiction rather than anything that could be described as fraud.

Is there any evidence it's "damaging [to society]"? Presenteeism is also often so described, and it seems unclear that anything can be done about that without also encouraging some malingering.

The puritan expectation of perfect self-motivation in all circumstances isn't just unrealistic: it's also wasteful. Sometimes there are better things to do than waste time at work. Sometimes it's the only way to get to a job or college interview and out of a horrible situation. And, yes, sometimes it's a selfish and antisocial thing to do.

Let's keep in mind that the secondary gain might be "not having to shoot someone", or "not getting abused by a horrible teacher".

46.115.119.40 (talk) 09:42, 19 May 2010 (UTC)
 * So fix the article. You'll need to provide secondary sources, but if you can, I think the article would benefit from a section representing your point of view. An intelligent search of Google Books should drum up something. Anthony (talk) 09:53, 19 May 2010 (UTC)
 * Sorry, I'm too sick to do it... 46.115.119.40 (talk) 19:54, 25 April 2014 (UTC)

Performance?
If an actor fabricates the symptoms of a disorder to portray a character, that's not malingering, right? Where is the line between performance and malingering drawn? --Damian Yerrick (talk | stalk) 23:43, 29 March 2007 (UTC)

Where there is a secondary gain for the patient. --PaulWicks 21:53, 30 March 2007 (UTC)

But what is classified as secondary gain? Have there been any notable court cases against performance artists accusing them of seeking a secondary gain? --Damian Yerrick (talk | stalk) 04:30, 31 March 2007 (UTC)

Sorry, I thought this was a joke at first hence the brevity of my response. OK, well if an actor is acting sick, that's acting. However if an actor can't be bothered to show up for rehearsals and so feigns an illness, that's malingering. Malingering is not a crime, nor really a diagnosis, it's more of a verb really. --PaulWicks 09:26, 31 March 2007 (UTC)

It can be symptomatic of other illnesses or abuse. I know many like to classify it purely as criminal behavior, but it usually is indicative of some other more severe problem that goes untreated. 24.47.159.180 sorry, that would be a factitious disorder. malingering is a medico-legal term. malingering implies that the patient is seeking gain. a factitious disorder is when the patient does it to appear sick as a psychological coping mechanism only. — Preceding unsigned comment added by 114.72.120.122 (talk) 17:52, 28 December 2016 (UTC)

Gale Encyclopedia as reference
this really needs to be revised. the correct way to cite is to cite the original works. I've read some of the source work for the malingering section of gales encyclopedia and Neuropsychology of Malingering Casebook is actually quite adversarial towards the diagnosis of malingering. citing it as being largely misunderstood and misapplied with physicians presuming that a referral from an attorney indicates the defence team is attempting to construct a fake disorder while the majority of referrals in the USA to neuropsychologists are from lawyers. Such that there is a bias constructed by the DSM in recommending that malingering be considered a priori whenever forensically assessing a patient. it's actually really critical of any assessment of malingering and points out repeatedly that there's really no authoritative way to assess malingering. the Gale encyclopedia article is pretty much a meaningless work with such minimal citation and thought put into it that it shouldn't be quoted.

this is the list of citations from the malingering section of the 5th edition: Dell, Paul F., and John A. O’Neil, editors. Dissociation and the Dissociative Disorders: DSM-V and Beyond. New York: Routledge, 2009. Morgan,Joel E.,andJerryJ.Sweet,editors.Neuropsychology of Malingering Casebook. New York: American Academy of Clinical Neuropsychology, 2009. Rogers, Richard, editor. Clinical Assessment of Malingering and Deception. New York: Guilford Press, 2008. WEBSITES Malingering. PsychNet-UK. www.psychnet-uk.com/ dsm_iv/malingering.htm. (accessed August 9, 2010). Malingering in the Clinical Setting.Psychiatric Times. www.psychiatrictimes.com/display/article/10168/ 55286. (accessed August 9, 2010). — Preceding unsigned comment added by 114.72.120.122 (talk) 18:30, 28 December 2016 (UTC)

Soviet Union
The part about doctors in the Soviet Union in the History section is silly and does not belong here. While the information is sourced, it really doesn't offer any insight into malingering. Since the source material isn't online, I can't even check to see what it DOES say. At the very least, this section should be changed to say something like "malingering was prevalent in the Soviet Union" rather than this POV critique of doctor-patient relationships in the Soviet Union.--50.53.142.250 (talk) 22:01, 27 April 2012 (UTC)


 * Good points. The section was also confusing. I deleted it, primarily because--as 50.53.142.250 said five years ago--it does not offer any insight into malingering.  - Mark D Worthen PsyD   (talk)  06:02, 20 September 2017 (UTC)