Differentiating factitious psychological presentations from malingering: Implications for forensic practice

Abstract

Practitioners and researchers have long been challenged with identifying deceptive response styles in forensic contexts, particularly when differentiating malingering from factitious presentations. The origins and the development of factitious disorders as a diagnostic classification are discussed, as well as the many challenges and limitations present with the current diagnostic conceptualization. As an alternative to a formal diagnosis, forensic practitioners may choose to consider most factitious psychological presentations (FPPs) as a dimensional construct that are classified like malingering as a V code. Building on Rogers' central motivations for malingering, the current article provides four explanatory models for FPPs; three of these parallel malingering (pathogenic, criminological, and adaptational) but differ in their central features. In addition, the nurturance model stresses how patients with FPPs attempt to use their relationship with treating professionals to fulfill their unmet psychological needs. Relying on these models, practical guidelines are recommended for evaluating FPPs in a forensic context.

An overview of malingering and deception in neuropsychiatric cases

“…However, blithefully ignoring motivation does not diminish its importance. In closely examining the literature, Velsor and Rogers (2019) identified factitious psychological presentations (FPP) as a dimensional response style. This response style addresses several motivations such as genuinely felt, but markedly distorted, needs regarding the sick role and needs for nurturance.…”

A case report and literature review of cognitive malingering and psychopathology

“…For this reason the American Academy of Clinical Neuropsychology (6) deemed Sherman, Slick and Iverson criteria (13)-which represent the updated version of Slick et al criteria (4)to be the most widely used model for detecting cognitive malingering within the empirical research on the subject (Table 1). Finally, in order to overcome the limitations of DSM-5 model of malingering, it seems to be crucial to evaluate motivational patterns of patients who feign symptoms (14). At this respect, the literature on malingering suggests different explanatory models such as the pathogenic model-whereby malingering manifestation relies on the struggle between the unconscious illness and conscious production of symptoms-, the criminological modelwhereby malingering is motivated by a desire to control and manipulate others-, and the adaptational model which explains motivations for malingering in terms of a riskbenefit analysis (15,16).…”

Munchausen Syndrome in the Context of Liaison Psychiatry: A Case Report and a Narrative Review

“…During the reconsideration of hysteria and simulation in 1908 by Joseph Babinski (1857-1932), French physician Georges Dieulafoy (1839-1911) introduced the term “pathomimie”. He enlisted his friend, French writer Paul Bourget (1852-1935), to coin a new term for describing self-induced skin lesions observed in patients [ 4 ].…”

“…The term “Munchausen Syndrome” was coined in 1951 by Richard Asher, inspired by the infamous Baron von Münchhausen, a German nobleman known for his extravagant and false narratives [ 4 , 5 ]. Twelve years before the Baron's death in 1785, Rudolph Erich Raspe (1737-1794) anonymously published the first edition of Baron von Münchhausen's tales.…”