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Deception in Clinical Settings - Lecture Notes

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summary of the lectures, they could be confusing at times but this summary I made has helped some of my friends pass :))

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  • 21 januari 2023
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  • 2022/2023
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  • Anselm fuermaier
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Lecture 1 – Introduction
Deception in Animals
 Feigning of death to avoid predators
 Distracting predators to protect offspring

Case report
Frank William Abagnale
 Born 1948 in New York, USA
 Cheque con artist, forger, and imposter
 Passed bad cheques worth more than $2.5 million in 26 countries
 Committed the majority of his crimes between the ages of 16 and 21
 After being released, he founded a financial fraud consultancy company
 He earned enough money to pay back all those he scammed over his criminal career
 Abagnale has made over 20 million dollars from his three books (Catch me if you can,
The art of the steal, Real U guide to identity theft)

Assumption of Honesty
Clinicians are trained to believe patients and consequently they are often unaware of the
potential for deception in the clinical setting. However, some patients deliberately produce
false or grossly exaggerate symptoms to gain incentives (malingering) or to assume the sick
role (factitious disorders).

Common psychiatric disorders accompanied by deceptive behaviour
 Substance abuse and dependence
o Denial to minimise consequences of use and ensure a continued supply of the
substance
 Eating disorders
o Clinicians are aware of the deceptive techniques, often lying about body
weight and food intake, hiding food, secretly using laxatives or diuretics, and
manipulating body weight (e.g. drinking a lot of water before weighing.)
 Paraphilias
o Sexual deviations or perversions are often hidden, including fetishism,
exhibitionism, paedophilia etc.
 Personality Disorders
o A common feature is difficulty with impulse control which includes
exaggerating and lying. Including antisocial, borderline, and histrionic or
narcissistic personality disorders.

Factitious Disorders and Malingering
Factitious disorder -> a psychiatric condition in which an individual presents with an illness
that is deliberately produced or falsified for the purpose of assuming the sick role.

Malingering -> The intentional production of false or grossly exaggerated physical or
psychological symptoms motivated by external incentives, such as financial compensation.

, Factitious Disorder Malingering
Internal incentives External incentives
Mental disorder Not a mental disorder
Often in the context of psychologically Often onset of symptoms couples with
meaningful conflicts with family members attainment of external incentives (e.g.
or occupational roles financial compensation.
Often chronic with a history of prior feigned Often time-limited and environmentally
illness and insistence on aggressive pursuit opportunistic
of treatment
More females More males
-> determining existence of an external incentive can be difficult (malingerers usually do not
trumpet their external incentives)
-> Voluntariness and intentionality are more likely dimensions rather than discrete entities.

The crying baby had an internal incentive of attention whereas the woman in court wants to
influence the court by exaggerating her symptoms (of getting hit) meaning it is an external
incentive.

Differential Diagnosis




Somatic symptoms and related disorders
 Prominence of somatic symptoms associated with a significant distress and
impairment
 Different forms (e.g. conversion disorder and illness anxiety disorder)
 Illness anxiety disorder -> preoccupation with fears of having a serious illness
 Conversion disorder -> sensory or motor symptoms without any physiological cause

, What about the clinicians?
Gert Postel (1958)
 German imposter
 Successfully applied as a medical doctor several times without ever having received
medical education




It is estimated that around 30% of all sick notes are bogus
Physicians and clinicians are prepared to lie in the interest of their patients (e.g. to secure
insurance payment)

Lecture 2
Factitious Disorder
 Refers to the psychiatric condition
 In which an individual presents with an illness
 That is deliberately produced or falsified
 Usually for the purpose of assuming the sick role

History
 First report 1200 B.C. in early Egyptian poetry
 FD is presumably present throughout human history
 1800’s seamen pretended illness for compassion or interest
 1900s – Menninger: “polysurgical” or “doctor addiction”
 Asher (1951) case report of patients who
o who habitually migrate from hospital to hospital
o seeking admission through feigned symptoms
o while embellishing their personal history
o Munchausen syndrome (after Baron Munchausen)
 Munchausen describes a small portion of FD patients

DSM-V Classification --->

Three types of FD:
(1) FD with predominantly
psychological signs and
symptoms
a. Factitious psychosis
b. Factitious PTSD

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