False patients/real patients: a spectrum of disease presentation

This paper presents a synthesis of varying frameworks and value systems in which all patients are viewed by clinicians. A gradient of behaviors is arrayed which places disease simulation (Munchausen syndrome, malingering) at one end of a spectrum, with the other end anchored by 'real' disease. Between these two polarized opposites are placed the patients with 'psychological' origins to somatic presentations. These patients often called 'crocks' are somewhat different from those patients who present with disease simulation. Such patients are often referred to as 'crooks' in that they are absolutely false in their presentation and aware of such deception. The advantage of this particular schema is that it presents a gradient of behavior instead of isolated categorization. As such it is much more easily understood and used by clinicians and it presents the 'normal' and 'abnormal' within a single conceptual gradient instead of discreet categories.