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Deception in Clinical Settings - Lecture Notes
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Lecture 1 – IntroductionDeception in Animals
Feigning of death to avoid predators
Distracting predators to protect offspring
Case report
Frank William Abagnale
Born 1948 in New York, USA
Cheque con artist, forger, and imposter
Passed bad cheques worth more than $2.5 million in 26 countries
Committed the majority of his crimes between the ages of 16 and 21
After being released, he founded a financial fraud consultancy company
He earned enough money to pay back all those he scammed over his criminal career
Abagnale has made over 20 million dollars from his three books (Catch me if you can,
The art of the steal, Real U guide to identity theft)
Assumption of Honesty
Clinicians are trained to believe patients and consequently they are often unaware of the
potential for deception in the clinical setting. However, some patients deliberately produce
false or grossly exaggerate symptoms to gain incentives (malingering) or to assume the sick
role (factitious disorders).
Common psychiatric disorders accompanied by deceptive behaviour
Substance abuse and dependence
o Denial to minimise consequences of use and ensure a continued supply of the
substance
Eating disorders
o Clinicians are aware of the deceptive techniques, often lying about body
weight and food intake, hiding food, secretly using laxatives or diuretics, and
manipulating body weight (e.g. drinking a lot of water before weighing.)
Paraphilias
o Sexual deviations or perversions are often hidden, including fetishism,
exhibitionism, paedophilia etc.
Personality Disorders
o A common feature is difficulty with impulse control which includes
exaggerating and lying. Including antisocial, borderline, and histrionic or
narcissistic personality disorders.
Factitious Disorders and Malingering
Factitious disorder -> a psychiatric condition in which an individual presents with an illness
that is deliberately produced or falsified for the purpose of assuming the sick role.
Malingering -> The intentional production of false or grossly exaggerated physical or
psychological symptoms motivated by external incentives, such as financial compensation.
, Factitious Disorder Malingering
Internal incentives External incentives
Mental disorder Not a mental disorder
Often in the context of psychologically Often onset of symptoms couples with
meaningful conflicts with family members attainment of external incentives (e.g.
or occupational roles financial compensation.
Often chronic with a history of prior feigned Often time-limited and environmentally
illness and insistence on aggressive pursuit opportunistic
of treatment
More females More males
-> determining existence of an external incentive can be difficult (malingerers usually do not
trumpet their external incentives)
-> Voluntariness and intentionality are more likely dimensions rather than discrete entities.
The crying baby had an internal incentive of attention whereas the woman in court wants to
influence the court by exaggerating her symptoms (of getting hit) meaning it is an external
incentive.
Differential Diagnosis
Somatic symptoms and related disorders
Prominence of somatic symptoms associated with a significant distress and
impairment
Different forms (e.g. conversion disorder and illness anxiety disorder)
Illness anxiety disorder -> preoccupation with fears of having a serious illness
Conversion disorder -> sensory or motor symptoms without any physiological cause
, What about the clinicians?
Gert Postel (1958)
German imposter
Successfully applied as a medical doctor several times without ever having received
medical education
It is estimated that around 30% of all sick notes are bogus
Physicians and clinicians are prepared to lie in the interest of their patients (e.g. to secure
insurance payment)
Lecture 2
Factitious Disorder
Refers to the psychiatric condition
In which an individual presents with an illness
That is deliberately produced or falsified
Usually for the purpose of assuming the sick role
History
First report 1200 B.C. in early Egyptian poetry
FD is presumably present throughout human history
1800’s seamen pretended illness for compassion or interest
1900s – Menninger: “polysurgical” or “doctor addiction”
Asher (1951) case report of patients who
o who habitually migrate from hospital to hospital
o seeking admission through feigned symptoms
o while embellishing their personal history
o Munchausen syndrome (after Baron Munchausen)
Munchausen describes a small portion of FD patients
DSM-V Classification --->
Three types of FD:
(1) FD with predominantly
psychological signs and
symptoms
a. Factitious psychosis
b. Factitious PTSD
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