Deception in the Emergency Setting

Abstract

Abstract Deception in medicine involves the faking, feigning, exaggeration, or actual production of signs and symptoms of a mental or physical disorder and may take the form of either malingering or factitious disorder, both of which are reviewed in this chapter. Malingering is the falsification or extreme exaggeration of illness (physical or mental) to gain external benefits. Those benefits may include avoiding work or responsibility, obtaining drugs, avoiding legal sanctions or trial, seeking attention, avoiding military service, or obtaining leave from school or paid leave from a job. Factitious disorder is also a form of deception and is characterized by falsification of physical and/or psychological signs or symptoms or induction of injury without any obvious external reward. Deception on the part of patients presenting to a psychiatric emergency service can be challenging to identify and perhaps even more unnerving to diagnose. This chapter reviews the scant research base on malingering in the psychiatric emergency setting. The focus is on assisting the clinician in detection and management of deception in this setting, including pitfalls in diagnosis, clues to the presence of deception, discharge management, and documentation.