Academic journal article Iranian Journal of Psychiatry

Feigned Symptoms among Defendants Claiming Psychiatric Problems: Survey of 45 Malingerers

Academic journal article Iranian Journal of Psychiatry

Feigned Symptoms among Defendants Claiming Psychiatric Problems: Survey of 45 Malingerers

Article excerpt

Objective: In many jurisdictions, psychiatric problems are intended for commutation. Therefore, a forensic psychiatrist has an important role in detection of malingering. While several studies evaluate diagnostic tests, it is less known what symptoms are more likely to be imitated by malingerers.

Method: In a prospective study 45 malingerers, who were diagnosed according to interviews by two forensic psychiatrists, from defendants with a judicial order for evaluation of mental status and criminal responsibility during a period of eighteen months were examined in legal medicine center of Tehran. Participants were assessed in another interview to determine symptoms. Dichotomous symptoms in felony and misdemeanor groups were analyzed using fisher's exact test. The level of statistical significance was set at P<0.05.

Results: Thirty-eight malingerers were charged with misdemeanors and seven with felonies. Behavioral symptoms were most frequently faked by 35 participants (77.8%). Participants charged with criminal accusation had a significantly lower mean age (P=0.032) and a higher level of education (P=0.008) than other non-criminal defendants. A statistically significant increase in memory function problems was demonstrated in the misdemeanor group (P=0.040). With regard to dual symptom imitation, statistically significant correlations were observed between thought content and perceptual symptoms (P=0.048) for felonies and mood & affect and thought process symptoms (P=0.034), mood & affect and behavioral symptoms (P=0.000) and cognitive function and behavioral symptoms (P=0.039) for misdemeanors. In general, many simulators attempted to mimic simple symptoms of behavioral disorders. Probably felony offenses need less accurate programming; therefore, their rates are higher in older, less educated participants.

Conclusion: This study demonstrated that differences between presenting symptoms among different offenses may not be useful in detection of malingering,; however, unusual dual symptom imitations may be useful, particularly when standard tests are not performed.

Key words '.Forensic Psychiatry, Malingering, Deception, Interview

Iran J Psychiatry 2013; 8:1:14-19

C-laim of psychiatric disorder has become an important basis for civil and criminal lawsuits as its diagnosis is based on interviews and many people are familiar with some psychiatric symptoms (1). Some malingerers have been able to deceive the psychiatrists adeptly. The famous example was in Rudolf Hess case (Hitler's deputy fuehrer of the Nazi party) who claimed total amnesia in court, and the examiners concluded that Iiis amnesia was genuine (2). True psychiatric patients and psychiatrists forfeit when others successfully fake psychiatric symptoms for evasion of responsibility (3). Therefore, it is important for forensic psychiatrists to narrow diagnostic criteria and to try to determine genuine and simulated symptoms.

Malingering is known as deceitful and dishonest simulation of an illness symptom for personal gain (4).

For diagnosis of malingering using Diagnostic and Statistical Manual of mental disorders, 4th ed, (DSM- IV), symptoms should be grossly exaggerated (5).

What surely specifies malingering from other psychiatric conditions is intentional deception for an external motivation (4, 6). These participants are often involved in malingering in attempts to achieve financial gain or legal responsibility and are usually awkward with interviews and reluctant to receive medical care (7, 8).In a study of 2155 mental illness claims, eleven percent of subjects received formal malingering diagnosis. The majority of malingerers were those charged with kidnapping and robbery (28.4% and 21% respectively) and surprisingly the minority being malingerers charged with murder (4.9%)(9). Psychiatric symptoms seem to be easy to malinger because there are no objective manifestations and the discovery of the false subjective psychological claims such as suicidal attempts, anxiety, emotional numbing, and depression are difficult to certify. …

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