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Symptom Exaggeration and Malingering

Patients with psychosocial issues commonly exaggerate symptoms and have medicallyunexplainable exam findings. The previously mentioned Waddell’s symptoms andWaddell’s signs are the examples. Dr. Waddell has been clear in pointing out that thesesymptoms are common while true conscious malingering is rare (Main & Waddell, 1998).Malingering is difficult to diagnose with absolute certainty (Aronoff et al., 2007).Aronoff’s review shows that literature estimates of malingering in claimants vary from1 to 67%. This is because malingering can simulate many different symptoms, illnesses,or injuries, and because of the difficulty of proving malingering is actuallypresent. Most physicians will not be comfortable in diagnosing malingering based onproposed criteria, and will insist on personal observation of intentional production ofphysical exam findings or video surveillance that unequivocally documents the patientlied. Thus, malingering will continue to be underdiagnosed. Malingering is not a biopsychosocialissue, but rather is usually a crime, in that the claim of injury or illness isto obtain financial benefits to which the individual is not entitled.

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