Transcription of WILLIAM H. REID, MD, MPH M - Forensic Psychiatry
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WILLIAM H. REID, MD, MPH M - Forensic Psychiatry
226 July 2000 Journal of Psychiatric Practicealingering is a Forensic topic that is also rel-evant to most nonforensic clinicians. Almostevery experienced psychiatrist, psycholo-gist, or therapist has wrestled with, or won-dered about, patients who appear to be faking symptomsin order to gain something of obvious value (or avoidsomething obviously painful). In this column, I will focuson malingered psychiatric or neuropsychiatric symptoms,but the definitions given below apply to malingered gen-eral medical symptoms as s Not Munchausen s or Psychosomatic Take out a copy of the Diagnostic and Statistical Manualof Mental Disorders, Fourth Edition(DSM-IV)1and look atthe small, but very important, differences among malin-gering, factitious syndromes, and somatoform syndromes(Table 1). Although these concepts are often confused, it seasy to separate them once you understand that malin-geringrefers to feigning or significantly exaggeratingsymptoms for a conscious gain or purpose,* factitiousrefers to feigning symptoms for a largely or wholly uncon-scious purpose, and somatoform( psychosomatic asused here) refers to any of several syndromes that do notinvolve feigning at all, but rather the largely or whollyunconscious creation of symptoms for an unconscious pur-pose.
226 July 2000 Journal of Psychiatric Practice alingering is a forensic topic that is also rel-evant to most nonforensic clinicians.Almost every experienced psychiatrist, psycholo-
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