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Professional News
Faking or Not?
Psychiatric News
Volume 41 Number 23 page 13-13

Psychiatrists should use caution when trying to discern whether an inmate is malingering, according to James Knoll, M.D.

"The DSM notes that under certain circumstances, malingering is adaptive," he said, such as a prisoner of war's feigning illness." I believe that being an inmate is not too much unlike being held captive in a hostile environment."

Sometimes inmates must engage in maladaptive behaviors to get the attention of the correctional facility's mental health staff. For instance, inmates may cut themselves to get the attention of mental health staff when staff resources are strained. Such behaviors do not constitute malingering in a true sense, he said.

Knoll noted that it may be difficult to distinguish a patient's motives for feigning symptoms in correctional settings. A patient who is malingering has external motives for feigning symptoms, such as avoiding work or criminal prosecution. However, some patients feign symptoms to play the "sick role." In such cases, patients have factitious disorder and are not malingering.

Psychological tests used to detect malingering usually cannot determine whether patients are malingering or have a factitious disorder. In addition," no psychological tests rule out all genuine illness," he noted.

One of the reasons psychiatrists should use caution when applying a diagnosis of malingering is that inmates will be cut off from psychiatric treatment for an indefinite period of time, Knoll said.

A sure sign that an inmate is not malingering is improvement after treatment, he noted. Another sign is a long history of special observations for suicide attempts within the correctional system.

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