Impairment Update: Illness Behavior

Abstract

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) notes that many methods used to report medical impairments rely on the completeness, accuracy, and honesty of the patient's self-presentations. Symptom exaggeration is best understood in the context of clinical phenomena that lie along a continuum from unconscious and unintentional to conscious and intentional. Illness behavior refers to the ways in which given symptoms may be perceived, evaluated, and acted upon by different persons, and such behavior can be appropriate or inappropriate, depending on context, and can be learned and reinforced. Further, certain illness behaviors potentially confound the association between illness or injury, on the one hand, and impairment or disability, on the other hand. For example, any deficit can be exaggerated, including neuropsychological deficits, pain, and loss of sensation. Specialized assessments include symptom validity testing to assess memory or sensory deficits, and maximum voluntary effort testing assesses strength deficits. In their assessment of illness behavior, physicians should employ the same degree of thoroughness as they would with any condition. Written reports should include not only the conclusion that symptom exaggeration is present but also the basis for this determination. A table shows the characteristics of symptom magnification syndromes and other related conditions vs the presence of symptoms such as seeking gain or deception.