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Illness deception and work: incidence, manifestations and detection
1Department of Occupational Health, Dudley and Walsall NHS Trust, Health Centre, Cross Street, Dudley DY1 1RN, UK. jon.poole@dudley.nhs.uk
Occupational Medicine (Oxford, England)
|December 24, 2009
Summary
Illness deception is common in occupational medicine, with 8% of patients exhibiting such behavior. Simulated weakness of grip can be detected by inconsistent maximal grip strength measurements.
Area of Science:
- Occupational Medicine
- Psychiatry
- Forensic Medicine
Background:
- Illness deception (ID) presents diagnostic challenges in clinical practice.
- Objective detection methods for ID can yield significant health economic benefits.
- Understanding the prevalence and presentation of ID is crucial for accurate diagnosis.
Observation:
- The study investigated the incidence of ID in a general occupational medicine clinic.
- Case vignettes illustrate diverse manifestations of illness deception.
- Maximal grip strength variability was compared between patients with suspected simulated weakness and control groups.
Findings:
- Eight percent (32 of 400) of patients displayed illness deception, primarily malingering (29) and three factitious disorder (3).
- Manifestations included simulated hand-arm vibration syndrome, occupational asthma, deafness, and limb weakness.
- Patients simulating grip weakness showed a high coefficient of variation (17.3%–37.8%) compared to controls (≤14.5%).
Implications:
- Illness deception is a frequent occurrence in occupational medical settings.
- Variability in maximal grip strength can serve as an objective indicator of simulated weakness.
- Improved diagnostic strategies for ID are needed to ensure appropriate patient management and resource allocation.
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