Content provided in partnership with

Health Care Industry

Traumatic brain injury when symptoms don't add up: conversion and malingering in the rehabilitation setting - Traumatic Brain Injury

Journal of Rehabilitation, April-June, 2002 by Patricia Rogers Babin, Patricia Gross

<< Page 1 Continued from page 9. Previous | Next

[FIGURES 3-4 OMITTED]

Analysis: The inconsistent history, over-elaborate complaints, and test findings strongly suggested malingering. The couple was told there was no cognitive reason that he could not return to work. They immediately said his balance was too poor to work on construction sites, as he would have to stick his head down in holes or go up ladders. He did not seem pleased when other alternatives to working construction were suggested, despite the claim that he only wanted to return to work.

Treatment: As noted previously, setting limits is the primary treatment for suspected malingerers.

Discussion

Most Popular Articles in Health: Fuel your workout: exercisers who eat before they work out have more energy ...; Soothe a dry, itchy scalp: 5 easy expert solutions; Cocktails and calories: Beer, wine and liquor calories can really add up. ...; The sour truth about apple cider vinegar - evaluation of therapeutic use; The, six best supplements you've never heard of: these secret weapons can ...; More »

Treatment considerations will focus on conversion disorder, as the only treatment for obvious malingering is limit setting. Conversion disorder should be conceptualized as a real and treatable problem. There is potentially much overlap between somatoform disorders such as conversion disorder and malingering. Both diagnoses may be associated with inconsistent and seemingly exaggerated performances, secondary gain, various psychopathologies, and stressful life events. The single most important difference between the two diagnoses is whether or not the patient is unintentionally or unconsciously producing the symptoms (somatoform or conversion disorder) versus intentionally or consciously producing the symptoms (malingering).

The patient with a TBI, mild or moderate, may be especially vulnerable to being diagnosed with malingering or intentional feigning of symptoms. This vulnerability may stem from the variable and the sometimes inconsistent nature of TBI sequelae, the appearance of secondary gain such as law suits or family attention, and the difficulty coping that some patients have after TBI due to the subtle, but significant changes in how they think and function. In addition, patients with TBI are frequently misjudged by the public due to the misperceptions that the public has about brain injury and recovery. These misperceptions about recovery may be strongly influenced by the media, e.g., the seemingly complete recoveries that football players make after sustaining multiple concussions. The entertainment industry also fuels the misperceptions regarding TBI recovery as can be seen by the complete recoveries that actors make after coma. As a result of these misperceptions, many people expect the patient who has sustained a concussion or TBI to make a full recovery and when the patient continues to report symptoms, they are seen as poor copers, exaggerators, or at worst malingerers.

It is clear that neuropsychological testing alone is not sufficient to differentiate between conversion disorder and malingering. Persons with TBI who are in litigation may over-endorse symptoms or under-perform on neuropsychological tests, but these facts by themselves, do not indicate malingering. Specifically, poor motivation and inconsistent performance on tests does not equal malingering. Other factors such as concomitant depression and anxiety or premorbid psychiatric problems, may account for "the inexplicable." It is essential that a person's performance on neuropsychological tests be interpreted within the context of an adequate history via record review and a thorough clinical interview (Iverson & Binder, 2000; Klonoff & Lamb, 1998). The record review and clinical interview process (the writers of this paper also recommend multiple clinical interviews and observation of rehabilitation therapies) will help determine where the conscious versus unconscious line in drawn.

Health Care Industry

Traumatic brain injury when symptoms don't add up: conversion and malingering in the rehabilitation setting - Traumatic Brain Injury

Journal of Rehabilitation, April-June, 2002 by Patricia Rogers Babin, Patricia Gross

Find Research Guides for:

Find Featured Titles for: Reference

Most Popular Articles in Health

Most Popular Publications in Health