Factitious disorders and malingering in relation to functional neurologic disorders

Area of Science:

• Neurology
• Psychiatry
• Forensic Psychology

Background:

• Malingering interest has surged, with a notable rise in publications since 1990.
• While common in medicolegal contexts, malingering exists on a spectrum and isn't always obvious.
• Detecting intentional symptom presentation poses challenges in clinical settings.

Purpose of the Study:

• To explore the complexities of malingering and factitious disorders in clinical and neurological practice.
• To highlight the limitations of clinical skills alone in identifying malingering.
• To challenge existing definitions and diagnostic approaches to factitious disorders.

Main Methods:

• Review of academic literature on malingering and deception.
• Description of psychometric tools like symptom validity tests.
• Discussion of non-medical investigations for detecting malingering.
• Analysis of specific neurological conditions where symptom exaggeration is prevalent.

Main Results:

• Malingering detection often necessitates specialized psychometric tests and investigations beyond standard clinical assessment.
• Areas like postconcussional syndrome, psychogenic nonepileptic seizures, and chronic pain are prone to symptom exaggeration.
• The study questions the current DSM-5 definition of factitious disorder, suggesting a need to consider intentionality and psychopathology.
• Evidence indicates a potential bias in diagnosing factitious disorders in healthcare workers as "hysterical."

Conclusions:

• Effective malingering detection requires a multi-faceted approach combining clinical suspicion, psychometric testing, and thorough information gathering.
• Current diagnostic frameworks may not fully capture the nuances of intentional symptom presentation.
• Further research is needed to refine diagnostic criteria and understanding of factitious disorders, particularly in specific patient populations.