Feigning illness, also known as malingering, involves the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding work, obtaining financial compensation, evading criminal prosecution, or accessing drugs. Identifying feigning illness is crucial in various settings, including healthcare, legal, and social services. The indicators of feigning illness also happens to be next up in our tour of the ASWB exam content outline. So here are the indicators and methods used to assess feigning illness:

Indicators of Feigning Illness

  • Inconsistent Medical History

    • Discrepancies: A medical history that is inconsistent with observed symptoms or known patterns of disease.
    • Changing Stories: The patient’s account of symptoms or medical history changes frequently.

  • Overly Dramatic or Atypical Presentation

    • Exaggeration: Symptoms are reported with unusual severity or drama that is inconsistent with clinical findings.
    • Atypical Symptoms: Symptoms do not match any known medical condition or are bizarre and atypical.

  • Symptoms Aligned with External Incentives

    • Secondary Gain: The presence of obvious external incentives, such as avoiding work, obtaining medications, or evading legal responsibilities.
    • Legal and Financial Context: Claims arise in contexts where there is potential financial or legal benefit.

  • Noncompliance with Treatment

    • Avoiding Follow-Up: The patient avoids follow-up appointments or medical evaluations.
    • Ignoring Advice: The patient does not comply with prescribed treatments or therapies.

  • Inconsistencies During Examination

    • Physiological Inconsistencies: Physical symptoms that vary significantly between observed behavior and reported symptoms.
    • Psychological Inconsistencies: Cognitive or psychological test results that are inconsistent with reported symptoms.

  • Reluctance to Provide Information

    • Evasive Responses: The patient is vague or evasive when asked for details about their condition or history.
    • Resistance to Testing: The patient shows resistance to undergoing diagnostic tests or procedures that could confirm or refute their claims.

  • Evidence of Prior Malingering

    • Previous Records: Medical or legal records indicating previous instances of feigning illness.

  • Discrepancy Between Reported and Observed Functioning

    • Observed Functioning: There is a significant discrepancy between how the patient describes their capabilities and what is observed during unstructured moments.

Methods to Assess Feigning Illness

  • Clinical Interviews

    • Structured Interviews: Using structured interviews, such as the Structured Interview of Reported Symptoms (SIRS), to assess inconsistencies and atypical symptoms.
    • Open-Ended Questions: Asking open-ended questions to allow the patient to elaborate on their symptoms and history, providing opportunities to identify inconsistencies.

  • Psychological Testing

    • Symptom Validity Tests (SVTs): Tests specifically designed to assess the validity of reported symptoms, such as the Test of Memory Malingering (TOMM).
    • Personality Assessments: Using standardized personality assessments like the Minnesota Multiphasic Personality Inventory (MMPI-2) that include validity scales to detect exaggerated or inconsistent responses.

  • Behavioral Observations

    • Functional Assessment: Observing the patient’s behavior in different settings to identify discrepancies between reported limitations and actual functioning.
    • Unobtrusive Observation: Observing the patient without their knowledge to gather objective data on their behavior and symptoms.

  • Collateral Information

    • Third-Party Reports: Gathering information from family members, coworkers, or others who can provide additional insights into the patient’s functioning and history.
    • Medical Records: Reviewing past medical records to identify inconsistencies or patterns of behavior indicative of malingering.

  • Medical and Neurological Testing

    • Objective Tests: Utilizing objective medical tests that can confirm or refute the presence of claimed physical symptoms (e.g., imaging studies, lab tests).
    • Incongruent Results: Identifying incongruent results that do not match the patient’s reported symptoms.

  • Legal and Contextual Analysis

    • Contextual Factors: Analyzing the context in which the symptoms arise, such as pending litigation or potential financial gain, to determine the likelihood of malingering.
    • Behavioral Incentives: Evaluating the potential external incentives that may motivate the patient to feign illness.

Ethical Considerations

  • Avoiding Bias: It is important to approach assessments without bias and to consider all possible explanations for a patient’s symptoms, including genuine medical conditions and psychological distress.
  • Confidentiality and Respect: Maintaining confidentiality and treating the patient with respect throughout the assessment process, even if malingering is suspected.
  • Clear Communication: Communicating findings clearly and objectively, avoiding accusations or confrontations.

These indicators and methods provide a comprehensive approach to identifying and assessing feigned illness, ensuring that social workers can accurately differentiate between genuine and fabricated symptoms while maintaining ethical standards in their practice. 

On the Exam

Social work licensing exam questions on the topic should look something like this:

  • An employee reports debilitating anxiety and panic attacks that prevent them from working, but they are observed engaging in strenuous physical activities and socializing without any signs of distress outside of work hours. What method would best help confirm or refute the possibility of feigning illness?

  • A patient in a legal case involving a work injury reports severe cognitive impairments that limit their daily functioning. Neuropsychological testing reveals patterns inconsistent with known cognitive impairments, and the patient has a clear financial incentive. What should the social worker consider to evaluate the possibility of malingering?

  • A veteran seeking increased disability compensation reports experiencing PTSD symptoms. The social worker notices that the veteran’s symptoms are highly inconsistent with the typical presentation of PTSD and that the veteran is very familiar with the diagnostic criteria. Which assessment method would be most appropriate in this situation?

Get questions like these (with answers, rationales, and suggested study links!) when you study with SWTP's full-length practice tests.

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August 2, 2024
Categories :
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