MALINGERING

MALINGERING
Dr. Zakarias Poerba, MSi
STIK-PTIK
Malingering


An individual fakes an incapacity in order
to avoid a responsibility.
Malingering is diagnosed when
the conversion like symptoms
are under voluntary control
(Davison, et al., 2004)
Kepalsuan atau rekayasa yang dibuat individu yang
bertujuan untuk menghindari tanggung jawab.
Malingerer di diagnosa sebagai hasil gejala yang
sengaja di kontrol/dikuasai oleh si pelaku
Malingering

Is the intentional production of false or grossly
exaggerated physical or psychological
symptoms, motivated by external incentives
such as avoiding military duty, avoiding work,
obtaining financial compensation, evading
criminal prosecution, or obtaining drugs.
Adanya rekaan dan rekayasa palsu dan berlebihan terhadap gejala fisik
maupun psikis, di dorong oleh insentif ekternal (seperti dapatkan uang),
menghindari pekerjaan, memperoleh kompensasi keuangan (keringanan
akan beban pengeluaran), mengurangi masa tahanan atau untuk
mendapatkan OBAT (bagi drug abuser)
3 Types
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The Pathogenic
The Criminological
The Adaptational
The Pathogenic
• People who motivated by
underlying pathology
• Genuinely disturbed
• The voluntary production of bogus
symptoms will eventually erode and
be replaced by a genuine disorder
Memang sudah menjadi patologis atau
GANGGUAN
Seseorang yang dimotivasi karena (juga)
sudah ada patologi
The Criminological
• People with an antisocial /
oppositional motivation
• Feign mental disorders to
obtain outcomes they do
not deserve
Dilakukan oleh pelaku kriminal , berperilaku seakan2 mengalami
GANGGUAN MENTAL
Biasa individu memiliki kecenderungan perilaku ANTI-SOSIAL
(MELANGGAR HUKUM)  PSIKOPAT untuk menghindari hukumanhukuman
The Adaptational
• The person who makes “a
constructive attempt, at least from the
feigner’s perspective, to succeed in
highly adversarial circumstances”
Disesuaikan dengan situasi dan merancang
 belum tentu masuk jadi gangguan (seperti
Pathogenic), jadi bersifat SITUASIONAL
Variety of Claims
• Claims of Amnesia
• Claims of Injuries &
disabilities
• Psychosis & Deception
Malingering & Criminal Justice
System

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Competency to stand trial (CST)
assessments: 60,000 referrals in US / year
Base rates of malingering estimated from
8% to 17.4%
Surveys of psychiatrists / psychologists
working in forensic settings: report
malingering in 16-18% patient population
Cornell DG, Hawk GL: Law & Human Behavior (1989)
Rogers R, et al: Law & Human Behavior (1998)
Rogers R: Clinical Assessment of Malingering & Deception (2nd Ed. 1997)
Psychosis & Deception
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Targets of Faked Psychosis
Targets
1. Behavior
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2. Somatic
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3. Sensation
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4. Imagery
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5. Affect
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6. Cognition
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7. Interpersonal
Examples
Bizarre motor behavior
Audible self-talk
Internal body changes
Physical disease processes
Vivid hallucinations
Strange illusions
Terrifying nightmares
Uncontrollable flashbacks
Immobilizing fear
Suicidal depression
Delusions of persecution,
grandiosity; looseness of thought
Inability to respond: mutism
Sexually inappropriate questions

1)
2)
3)
4)
Malingering should be strongly suspected if any
combination of the following is noted:
Medicolegal context of presentation (e.g the person is
referred by an attorney to the clinician for examination)
Marked discrepancy between the person’s claimed stress
or disability and the objective findings
Lack of cooperation during the diagnostic evaluation and
in complying with the prescribed treatment regimen
The presence of Anti social Personality Disorder
Individu yang dapat dideteksi jika:
1) Adanya catatan medis yang dirujuk oleh pengacaranya sendiri
2) Periksa kesenjangan/diskrepansi antara stres yang diKELUHkan dengan
temuan di lapangan (dapat bertanya pada saksi/org2 sekitar)
3) Kurang nya koordinasi selama evaluasi diagnosa, apakah ada beda antara
keluhan, diagnosa dan treatment yang disarankan
4) Munculnya kepribadian Anti sosial (orang2 yang cenderung melawan,
melangggar)  cek lagi pada Type Criminological
malingering
In contrast, malingering are likely to be more guarded
and cautious, perhaps because they consider
interviews a challenge or threat to the success of lie.
 Malingering is the intentional production of false or
grossly exaggerated
physical or psychological
symptoms.

-Malingerer cenderung lebih berhati-hati karena mereka
mengetahui bahwa mereka dinilai saat di wawancara atau
bahkan di tes
-Sering memunculkan rekayasa gangguan fisik dan psikis
secara berlebihan
Malingering & Jail Inmates

1.
2.
3.
4.
Potential motives for malingering in jail
population may include:
Avoid or delay legal proceedings with a
“mental defense” (insanity, incompetent
to stand trial)
Obtain(memperoleh) a preferred housing
change (i.e. psych ward, hospital unit)
Evidence to obtain SSI benefits after
release
Obtain psychotropic medications
(sedation=pemberian obat/drugs)
Malingering
• Individuals may be stimulated to
fake mental illness at several
points in the criminal justice
process, including determining
competency to stand trial,
pleading not guilty by reason of
insanity, and attempting to
influence the sentence
(Wrightsman & Fulero, 2005)
Strategi Malingerer supaya dapat simpati publik.
Mengkreasi sejumlah statement sehingga
memengaruhi emosi publik.
Detecting Malingering
• Healthcare providing
• the medical records contain evidence of
over-treatment for minor problems.
• Malingerers are usually not willing to
undergo extensive painful diagnostic testing,
treatment or surgery.
Deteksi :
1)Fasilitas kesehatan yang dirujuk langsung
2)Simak atau baca baik2 rekam medis nya, gangguannya
sedikit tapi minta treatment/pelayanan yang berlebihan
3)Biasanya Malingerer tidak mau untuk tes, operasi
Malingering: Assessment
Resnick PJ. Psychiatr Clin North Am (1999)
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1.
2.
3.
4.
5.
Collateral behavioral observations (nursing, custody)
Clinical interview, malingered “voices”:
Continuous rather than intermittent
Vague, inaudible
Not associated with delusions or thought disorder
No strategies to cope with “voices”
Claim that all instructions are obeyed
Intermittent  sebentar-sebentar Vague - samar-samar, tidak jelas
Inaudible  tidak terdengar jelas
No 4  tidak bisa didiagnosa kl ternyata calon tersangka memiliki gangguan
wicara/pendengaran
No 5  protes kl harus turuti perintah terus2an
Kl bicara sering terus menerus, kurang jelas makna nya
Malingering Assessment:
Miller Forensic Assessment
of Symptoms (M-FAST)
• “The times when you can’t go to
sleep, do you often smell strange
odors that are not really there?”
• “When I hear voices, my hands
begin to sweat”
• “Often, I get the strange feeling
that I am from another planet”
• “On many days I feel so bad that
I can’t even remember my full
name”
Malingering Summary
• There should be strong suspicion for
malingering in forensic settings
• Malingering for psychotropic medications
is a growing problem for jails
• Assessment of malingering should involve
collateral(tambahan) observations and
records
• Consider the adjunct use of validated
screens (M-FAST) and tests (SIRS)
• Need better exchange of clinical
information between forensic settings (i.e.,
jails and state hospitals)
“Trans-Institutionalization”
(Criminalization of the Mentally
Ill)
400,000
350,000
300,000
State hospital
pts
Mentally ill
prisoners
19
69
19
79
19
90
19
94
20
01
250,000
200,000
150,000
100,000
50,000
0
Source: US Dept. of Health Human Services & Dept of Justice statistics
Malingering Assessment:
Structured Interview of Reported
Symptoms (SIRS):
Sample questions:
• “Do you become fearful of
soft household objects for no
real reasons?”
Most NGRI Patients are Schizophrenic
(Rogers & Shuman, 2000)
Disorder
Percentage
Schizophrenic
62.2
Personality disorder
12.0
Organic disorder or mental
retardation
Mood disorder
5.8
Other
11.6
5.0