Do we know the mind of others? Suspicion of malingering in emergency psychiatry

Abstract

Introduction Malingering can be divided into simulation and exaggeration of symptoms. Malingering has traditionally been considered rare in general psychiatry. In contrast to earlier estimates, more recent studies report that doctors suspect malingering frequently in psychiatric emergency departments. The aim of this study is to survey how often doctors in psychiatric emergency units in a public, free-of-charge, mental health service suspect that patients are malingering, and which diagnoses, symptom complaints and suspected reasons for malingering doctors ascribe to their patients. Methods Questionnaires were distributed in three psychiatric emergency departments in Denmark. Suspected simulation and exaggeration were rated with a 5-point scale. Doctors were encouraged to write down the symptoms and perceived causes for suspected malingering. Results 362 questionnaires were filled in. 25% of all patients were suspected of simulating to some degree. 8% of patients were highly suspected or definitely believed to be simulating. Patients complaining of suicidal ideation were most frequently suspected of malingering. ‘Attention seeking’ was the most common suspected reason for malingering. Patients with diagnoses of substance use and personality disorder were the most suspected of malingering. Conclusion This is the first study to investigate doctors’ suspicions of psychiatric malingering in a European setting. Patients with established personality and substance use disorder are at higher risk of being suspected of malingering, which potentially affects the course of treatment significantly. The rise in suspected malingering is conspicuous and requires further investigation. Doctors are encouraged to act conservatively upon suspicion of malingering in emergency psychiatry.