Malingering and factitious disorders and illnesses, active component, U.S. Armed Forces, 1998-2012

Malingering refers to the intentional fabrication or exaggeration of mental or physical symptoms by a person who is motivated by external incentives (e.g., avoiding military duty, work, or incarceration, obtaining financial compensation, or procuring drugs). Factitious disorders and illnesses are similar to malingering with respect to the fabrication of symptoms; however, these individuals seek to assume "sick roles" (e.g., hospitalization, medical evaluation, treatment). During the 15-year surveillance period, 5,311 service members had at least one health care encounter during which a provider recorded a diagnosis of malingering or factitious illness in the first diagnostic position of the administrative record of the encounter. Over 80 percent of the subject service members had only one such encounter and most (83.9%) of the diagnoses were for malingering. There were higher (unadjusted) rates of these diagnoses among recruit trainees, those under the age of 20, and junior enlisted service members. Trends in these diagnoses during the surveillance period and the small numbers of diagnoses made during deployment do not suggest a discernible correlation between malingering and factitious illness and deployment to combat theater.