Malingering and Pain: is this a Major Problem in the Medicolegal Setting?

Abstract

The term malingering has a negative connotation, in that it is considered to intentionally project exaggerated physical and/or psychosocial symptoms for the purpose of gaining some external rewards/secondary gain. The present article will review a number of misconceptions about malingering, as well as the inherent problem in objectively measuring this construct. It will be suggested that a more comprehensive biopsychosocial approach should be used to evaluate potential barriers to recovery, as well as suboptimal performance that may delay, or prevent, recovery over an expected time period for musculoskeletal pain disorders. Such an approach will eliminate the common misuse and misdiagnosis of the construct of malingering.

Trends in Psychological/Psychiatric Injury and Law: Continuing Education, Practice Comments, Recommendations

“…Poleshuck et al (2010) found that comorbid depression and chronic pain is responsive to interpersonal psychotherapy. Schatman and Gatchel (2010) and Howard et al (2010) underscored that malingering should be addressed from a biopsychosocial perspective. That is, treatment providers should provide counseling that address factors such as symptom exaggeration, fear of re-injury, personality features, etc.…”

“…Gatchel and colleagues (e.g., Howard et al 2010;Worzer et al 2009) referred to secondary losses in these regards, as opposed to secondary gains. The concept of compensation neurosis, for example, that a settlement cures the pain, has been refuted in the research on the topic (Duckworth 2008;Margoshes and Webster 2000;Mason et al 2006;Mayou et al 2002).…”

Erratum to: Cherry-Picking Records in Independent Medical Examinations: Strategies for Intervention to Mitigate a Legal and Ethical Imbroglio

“…Personal injury insurers require a means to assess the physical and psychological status of their insured, as occurrences of unconscious symptom exaggeration (Dersh, Polatin, Leeman and Gatchel, 2004;Howard, Kishino, Johnston, Worzer and Gatchel, 2010), frank malingering (Greve, Ord, Bianchini and Curtis, 2007;Ochoa and Verdugo, 2010), and over-provision of services (Eisendrath, Rand and Feldman, 1996;Green 2011) exist in personal injury cases. Without independent medical examinations (IMEs), insurers' costs would escalate to a level that would potentially make the provision of coverage unrealistic.…”