Lecture 1 - 15 September
Learning outcomes;
1. Different forms of deception in clinical settings
2. Differences between faked and genuine syndromes
3. Methods allowing the assessment and detection of various forms of deception in clinical
settings
4. Approaches to the management and treatment of faked syndromes
5. Research approaches applied in this field
6. Ethical and legal pitfalls
First 5 lectures shows people faking bad behavior, in order to get money, medication, diagnosis etc.
Denial and substance abuse, people will show faking good behavior = contrary
Introduction
- Video recordings every week online after the lecture
- Exam
o 30 MC (1 point) and 6 open questions (5 points per question) = 60 point in total
Deception in animals;
- Fundamental to survive in animal kingdom effective
- Feigning of death to predators is common in manual animal species (opossum)
- Adult birds feign injury to draw predators away from their nest
Case report;
- Frank William Abagnale Jr. (New York, 1948) and passed bad cheques with high worth.
Committed majority of his crimes between 16-21 years.
- After releasing, he founded fraud consultancy company. To pay all his debts back. Much
money makes afterworths
- it is in animal and humans
Assumption in honesty
- Clinicians trained to believe patients
o Most information we receive to talk with people and observe them
o Research need corporate people
- Often not aware of potential for deception. DSM covers this very uniformal, but it’s much
larger why someone is not speaking the truth, finish the test etc. Data will be invalid.
- Some patient deliberately produce false or grossly exaggerate
o Malingering (gain external incentives) = underreport or overreport symptoms in
order to receive something (medication, money, special accommodations, military
service). It not a disorder.
o Assume sick role (factitious disorders/FD) = people like to be in a sick role and have
attention to get sympathy. Its internal incentive, because YOU like to be sick and
others will help you.
Common psychiatric disorders accompanied by deceptive behavior
, - Substance abuse (faking good that nothing is wrong) and dependence;
o Denial and other forms of deception in order to minimize consequence use ensure
continues supply of the substance
- Eating disorders; anorexic people are creative
o Dishonesty about body weight and food intake
o Hiding food
o Secretive use of laxatives or diuretics
o Body weight manipulation (ingesting water prior wo weighting)
- Paraphilias; sexual deviations or perversions with behaviors or sexual urges focusing on
unusual objects, activities, or situations. It’s illegal, lie about it and they fake good to not be
identified.
o Fetishism, exhibitionism, frotteurism, voyeurism, pedophilia
- Personality disorders; difficulties with control, including exaggeration or lying
o Antisocial personality disorder, borderline, historic and narcissistic personality
disorder
Factitious disorders and malingering
- FD; psychiatric condition individual presents with an illness that is deliberately produced or
falsified for the purpose of assuming the sick role. In order to get the enjoy of attention of
being sick. DISORDER NEEDS TREATMENT
o Not throw over and people are asking ‘how are you’. Its normal behavior
o Video: Child fakes being sick only when someone is watching him. If the parent is
away, there is no fake behavior anymore. Being in the centre = internal
- Malingering; also intentional/delibaretly production of false or grossly exaggerated physical
or psychological symptoms motivated by external incentives, such as financial compensation.
NOT A DISORDER
o Video: women in court falls on the floor what can be in advanced
Differences FD and malingering
Differential diagnosis
- FD or malingering
- Or real medical/ mental condition (other than FD)
o Somatic symptom and related disorders
, Prominence of somatic symptoms associated with significant distress and
impairment
Different forms (illness anxiety disorder, conversion disorder)
Illness anxiety disorder = preoccupation with fears or having a
serious illness (affections, heart attack). After a negative diagnostic
(there is no illness), they are convenient/ afraid again for another
illness. No external incentive.
Conversion disorder = Sensory or motor symptoms without any
psychological cause. Strange looking symptoms, but really think they
have them and not intentional. Pretend to have something they
don’t, but they convince they have them, but physical cause is not
findable.
o Radial nerve disrupted you won’t feel anything on that side
of that hand. Unlikely that middle three fingers no sense, but
in the pink and thumb feeling. Because of the ulnar and
radical nerve
o Sometimes arguments that speak against having symptoms,
very unconscious.
Find out if: Determining existence of an external incentive can be difficult (malingering
usually do not trumpet their external incentives) is very hard to find incentives, if the
person doesn’t say it.
Voluntariness and intentionality are more likely dimensions rather than discrete entities
What about the clinicians?
- Also lie in their academic and work career to get further
- Gert Postel lied about being a doctor, without receiving medical education
- Writing on a large scale sick notes to students
- Are prepared to lie in the interest of their patients
o Ethically difficult what you tell to family, friends and insurance companies
- Believing in placebo effects, makes the effects lager (making advantages of it)
o Placebo is deception deception is not always that you want to avoid
Why do people malinger?
1. Adaption model; Cost-benefit analysis results in deliberate decision to feign psychological
impairment. Benefits > costs
a. Substance abuse Escaping and avoiding responsibilities
2. Pathogenic model; underlying disorder discloses (onthult) in malingered symptomatology
(can’t control behavior). You need to manipulate because it is pathogenic inside you
a. Eating disorder rigidity, distorted body image, maintaining control
b. Substance abuse self-medicating
c. Paraphilias own abuse history leads to poor boundaries (poor childhood etc)
3. Criminological model; Malingering is sign of antisocial behavior committed by antisocial
persons (DSM relies on this model, questioned in research data)
a. Conduct disorder poor impulse control
b. Substance abuse secondary to antisocial personality disorder
c. Paraphilias luring victims/ maintain offending
What do laypeople think about malingering?
, - Questionnaire; It’s easier to talk about others, instead of yourselves 31,2% will
malinger/lie about symptoms if they can have an advantage of it
- Everybody knows somebody to fake an illness
Lecture 2 – 22 September Malingering
Introduction;
FD
- Psychiatric condition
- In DSM
- Presents with an illness
- Deliberately produced or falsified
- Assume to be in the sick role (hard to prove with a test)
History
- 1800’s; Soldiers and seaman pretended illness to excite compassion or interest
- 1900’s Menninger; Polysurgical or doctor addiction to ask questions and been seen
- 1951 Asher; migrate patients from hospital to hospital seeking admission through feigned
symptoms
o Munchausen syndrome; most appropriately refers to the subset of patients who
have a chronic and severe variant of FD with predominantly physical signs and
symptoms
DSM 5 criteria FD
1. Falsification of physical or psychological signs or symptoms, or induction or injury or disease,
associated with identified deception
2. The individual presents him or herself to others as ill, impaired or injured
3. The deceptive behavior is evident even in the absence of obvious external rewards
4. The behavior is not better explained by another mental disorder, such as delusional disorder
or another psychotic disorder
!!!! Assume to sick role is removed, because there is no test
Malingering is external incentive. Vs FD is intern related. Chronic form FD is Munchausen Syndrome.
By proxy is with a child related.
Pseudologica fantastica
- Synonyms;
