We Need to Talk About Faking Psychiatric Symptoms

One Thing that makes psychiatric practice difficult is how easy it can be to fake symptoms for secondary gain. In the industry we call this malingering. Majority of patients are not faking symptoms for secondary gain, but we should be aware of situations where someone might attempt to fake symptoms and what we can do about it. The topic of today’s video is malingering in psychiatric practice, I hope you enjoy it.
Time Stamps:
Introduction 00:00 to 01:22
What is malingering: 01:23 to 03:19
4 Factors that alert you to malingering: 03:20 to 04:36
Malingered Depression: 04:37 to 08:37
Rosenhan Experiment: 08:38 to 10:46
Malingered psychosis: 10:47 to 14:27
malingered delusions: 14:27 to 16:40
For additional content see our other social media accounts: www.Shrinksinsneakers.com
Instagram: @Shrinks_In_Sneakers
Facebook: @ShrinksInSneakers
Twitter: @AndPsychiatry
Disclaimer: This is not medical advice, and the information is provided for educational purposes only. Please consult your doctor for any specific medical questions. All content is created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider. If you think you have a medical emergency, call your doctor, go to the emergency department, or call 911. We do not endorse any specific treatment, tests, or procedures. Reliance on this information is solely at your own risk.

[@xavieraleman1629]

We also need to talk about the bigger picture. Drs not believing real sick and disabled people getting lumped together..

[@butterflyfields314]

In regards to workers comp doctors, they tend to have their own biases because they are paid by the workers comp insurance company not the patient. Those doctors it’s in their best interest to minimize any type of physical or mental health problems related to a workplace injury with TBI patient 🧠🤕 As a patient with a TBI with a depressed skull fracture, DAI in the frontal lobe from left to right side, slip and fall and head hitting the edge of the brick stair. Due to their limited background with TBI and associated secondary injuries, those doctors missed my cervical spine damage, that caused problems with my right side of my body not working correctly. They also missed my eye sight issues of convergent insufficiency. It has taken years to obtain a proper diagnosis of my additional secondary injuries due to my slip and fall from cracking my skull on the edge of a brick stair. I was accused of malingering by WC doctors. I never heard that term “malingering” used to describe me as a patient or was accused of “malingering” from my past treating doctors(who was not WC doctors working for the insurance company). In the past when I would see my regular doctor for treatment for other medical conditions, which was rarely because I was healthy person with minimal negative physical or psychological health problems, before my TBI. I was not properly treated or diagnosed by workers comp doctors. The current research cohorts of TBI is mostly based on men who have a different physiology, endocrine system, pressures/responsibilities from society/gender roles than females. Also a lot of the cohorts in medical literature the males are wearing protective gear on their head, their neck/upper body overall has more density of muscular structure which does absorb some of the kinetic energy of the impact to the brain, skull, and cervical spine, than a female without a helmet protection and lesser density of bone and muscle in the upper body area🧠🤕 Overall I think it also depends where the doctor is getting their paycheck, the workers comp doctors have biases too. In regards to the medical condition of a TBI, it also depends on how much time spent in medical school/residency, experience with patients while practicing medicine or continued education credits/conferences/seminars the doctor has obtained on the topic of TBI. So the doctor has a current education and understanding of the long term health effects and problems a patient with a TBI will experience, so a proper diagnosis and treatment is provided to a TBI patient🧠🤕 Also on the neuropsychological side, there seems to be a lot of overlap of some of the mental health aspects of concussion, TBI, PCS, PPCS, PTSD and ADHD, which neuropsychological testing is male biased. The neuropsychological testing is not able to tease out the differences between the diagnoses of concussion, TBI, PCS, PPCS, PTSD, ADHD or other acquired cognitive and learning disabilities from head trauma. I have acquired learning disabilities now from my TBI, that I didn’t have before my accident. To obtain unbiased neuropsychological testing I had to go out of my insurance company network and bypass WC doctors, to obtain proper neuropsychological testing, so I could maybe finish up my environmental biology BS degree(it’s not going well, probably have to change my major, due to my acquired memory problems). When I returned to uni to finish up my degree, I noticed lots of new issues popping up that I have not experienced, pre injury of my TBI. I believe a lot of the uptick of ADHD diagnosis are really undiagnosed conditions of permanent brain damage from concussions and TBI obtained from vehicle accidents, hits to the head from fights or blunt objects or from playing sports. When a TBI is basically a person’s computer(jello like structure of the brain) has been permanently damaged from physical damage, which causes the brain to short circuit leading to over working (cognitive fatigue) to try to make connections it has lost🧠🤕 Some doctors don’t know, what they haven’t seen or treated, the long term negative health implications of a TBI, for a perimenopausal female patients, who tend to not fair as well with such a chronic medical condition of TBI compared to the cohort group of males or other females age groups from current medical research studies 🧠🤕 Sometimes the doctor does not have the best interest of the patient in mind, especially the biased workers comp doctors, who have a limited background of the long term chronic condition of TBI🧠🤕

[@anastasiaG577]

This video really got my heart racing! One of my big fears is mental health professionals thinking I am faking my symptoms of mental illness to seek attention. Another one of my fears is that I actually am faking it and don't even realize it. What about the opposite, when mental health professionals think you have a diagnosis and you don't think you do?

[@bugfact9279]

I used to fake mental illness to get extra test time in high school

[@Widda68]

So you are saying you do not have mental illness you are merely a fraud.

[@cutzycoolgirl2742]

Honestly most of the times of you think you’re faking symptoms you’re probably not… malingering in itself is pretty rare, but mental health professionals should keep an open mind.

[@NickArcade]

I work in a forensic psychiatry practice. My boss is a badass forensic psychiatrist. I fell in love with medicine and psychology working there.

[@suns1457]

great video as always Dr!

[@roryjamesobst]

WOW. its so horrible that someone would fake psychosis

[@N_K12695]

Thank you for the video!

[@trixiebelle6743]

I am not sure I 💯 agree with the doc on this one. Midwest women, especially of a certain age, are expected to be upbeat and “fake it till you make it” even if in the depths of depression hell. Or to read people’s faces and body language when “too peppy, too much, too excited, too (enter descriptor).” We learn to be secretive and evasive. Then when too much, it all might come out in verbal vomit due to years of misdiagnosis and ridicule. So not malingering but outright desperation.

[@jamiekincaid8714]

Thank you for your videos. I’m a patient not a doctor but I feel that the more I learn the better off I’ll be. I’ve been dealing with mental illness for about 30 years and my whole life has been a roller coaster ride of depression and anxiety. I was diagnosed with Schizoaffective about 15 years ago. I do have a great care team that helps me a lot. But I’m always looking to learn more so Thanks. Jamie Kincaid

[@HigoIndico]

Abnormal affect might refer to autism or adhd as well as those mood disorders that are mentioned. This should be taken into account. I've been constantly miss evaluated because of my affect. Autistic burnout looks a lot like major depression with psychotic features for someone looking it from the outside. It's been hell to try to recover and I finally had to search the whole youtube to find answers because the doctors don't seem to know anything about autism in assumed female adults.

[@AG-ey6ds]

I did clincals in a forensic state hospital. Very interesting. Most of the patients tried to hide and would lie about how they ended up there. When we read their chart, it was usually completely different than what they reported to us as students. The santa fe tx shooter has been in vernon state hospital for 3 years now and still has not been deemed comptetant to stand trial. The citizens of santa fe are wanting action and understandably so. A judge ordered and independant evaluation. Any thoughts on whether or not after 3 years he will ever be deemed competent to stand trial? There is long term unit there where patients live that it has been determined they will never be competent to stand trial.

[@v-3555]

when someone gives me a pan-positive ROS i already know its either malingering or a personality disorder 😩

[@bananabread888]

I love this topic

[@naphisa340]

❤❤❤❤can you make a video speficially focusing on malingering in ADHD.

[@alangoomez]

Second, from Sonora, Mexico :D

[@andrewphillips-hird3761]

I find your expectations of how depression should present to be very restricted, essentially to a melancholic, introjective, or endogenous depression within a primary diagnosis of major depressive disorder. However, people can have depression as part of bipolar disorder, and particularly in bipolar II is likely to be the presenting complaint, i.e. the patient will come to you saying "Doc, I feel depressed, please help" and although their eventual diagnosis would be of bipolar II, it is still fair to say that they have sought help for a genuine depression. Similarly the minor depression characteristic of persistent depressive disorder and the major depressive episodes that frequently co-occur with borderline personality disorder (whether the secondary diagnosis is major depressive disorder or bipolar disorder) can often look very different to how you describe, being more anaclitic and potentially reactive in nature, and presenting with so-called "atypical" features, mixed features, or anxious distress. Unsurprisingly (hence why I'm commenting on this point) I am a good example of someone who experiences major depressive episodes with a decent amount of contrapolar symptomatology. During an episode I experience all 9 of the diagnostic criteria, however, the exact combination I experience in a given moment does tend to slowly shift throughout the episode, partly as a function of the severity. Generally, for the majority of the episode, my mood is depressed yet still reactive, and I become generally anhedonic yet not socially anhedonic. I am also a fairly chatty person in general and this does not go away even when I am feeling like absolute trash (referring to both subjective experience and self-concept). As such, when talking to a psychiatrist during an episode, that may well be the highlight of my entire week (as I am getting to interact with someone, briefly assuaging my loneliness, and on top of that, the person is someone who is trying to get me feeling better) with the chattiness making me appear jollier still than I actually feel. This is on a background of hyperphagia, hypersomnia, fatigue, and sometimes (not always) psychomotor agitation and racing thoughts. As the episode deepens, my eating and sleeping tend to become more erratic (although I remain fatigued) my capacity to pay attention to anything is completely shot and my thoughts race faster and faster, but I become visibly much slower to an outside observer. Although sometimes I will have brief spells of being more agitated, the psychomotor retardation can get bad enough that I end up doing things like pausing for a second or so mid-stride (which starts looking like the start of catatonia at times), however, I expect that in an appointment with a psychiatrist, this would present as my thought content being more obviously depressed, whether my affective expression is congruent with my experience becomes pot luck at this stage. This is exacerbated by my tendency to intellectualise defensively - as such, telling a professional about my pain becomes an intellectual exercise as if we were discussing a third party, which can make a lot of the pain seemingly remit, but only for the duration of the conversation. So while this presentation is fairly polymorphous and involves a lot of things that are the opposite to what you describe, when my thoughts are, all day every day, something along the lines of "I feel awful, my life is awful, everything is awful because people have wronged me because they hate me because I am awful because my life is awful because I do awful things because my life is so awful" and neurovegetative symptoms are significant, I think it's fair to say that counts as a major depressive episode. It looking slightly different to what is expected is not in my case (and therefore likely also for many other cases) an indicator of malingering

[@Christ_Is_Life10-10]

What if the secondary gain is setting the therapist for a grievance .

[@mykura2018]

You are next doctorofmindmd Great

[@minepolz320]

Yaay new vid! Can you tell me please, can i use venlafaxine EX at 450mg daily if i well tolerated this dose? Or consider switch meds 😮‍💨

[@profet1385]

Yeah why not. If u tolerate it well and u respond to it. If u don't respond to it, then its not worth it. But dosage in studies goes up to 600mg and its considered as safe. Source: i used to take 600mg. I researched studies and found those that tested 600mg as the highest acceptable dosage.

[@minepolz320]

@@profet1385 Thanks, Are you still taking something?

[@profet1385]

Take into account whether you're up for weaning off venlafaxine if it doesn't work for u.

[@profet1385]

First :) for the algo

[@Dave-if5qj]

Professional inpatients Alwas know the right thing to Say to get admitted

[@benzapp1]

I never would have thought malingering represents 20% of ER admissions. I have more respect for such docs! Also interest and sort of funny about females hear "slut!" and men hearing voices that question their sexuality. I shouldn't laugh, but I sort of did.

[@clintparsons3989]

I’ve never had any psychosis but I have always wondered why they always/mostly seem negative. Why is this? If schizophrenia is from excess dopamine, and dopamine is rewarding and associated with happiness, why aren’t there more cases of positive hallucinations with voices that are positive?

[@WDBsirLocksight]

cuz we live in an evil world

[@Dave-if5qj]

I've read of some cases where The patients voices were Like friends and family to The individual and would couse Them great destress to think Of losing them from treatment

[@Widda68]

This is a subject you should discuss with your psychiatric peers. You should educate your peers as to the potential for having fraudulent patients. The vast majority of people watching your KZbins are not here because they want to learn how to fake a diagnosis. You are exacerbating the symptoms of those people who are already suffering too much.

[@thequeenofrap7326]

Depression isn't a chemical imbalance

[@Dave-if5qj]

Agree it's a whole host of factors

[@tulpamedia]

Mood disorders definitely involve serotonin and/or dopamine imbalance to a degree. It's not all of it, but it definitely is involved. Especially when it comes to depression in bipolar disorder. Bipolar disorder involves some very specific neurotransmitter imbalances. For many people with the condition, it's nearly impossible to improve without medication. Talk therapy helps a lot, but it rarely can improve or prevent the mood episodes associated with bipolar disorder without pharmaceutical intervention. Interestingly, Talk therapy seems to work a little better with depression than it does for mania. Mania and manic psychosis are essentially unstoppable without proper medication. This is a very interesting topic! I have bipolar 1 w/ psychotic features and I've wondered about this a lot. It's so complex.

[@nota7660]

Now that you told all fakers how to act lol

[@coreybeam4908]

Hey Doc, You probably have a Malingering problem yourself because you know wayyyyyy too much about it 😂

[@NatureHeadSupreme]

I think this is an American problem...American = Attention 🚮