We have a friend named Alberto who has been discharged from lumbago. Keep charging while you are at home recovering. The day of the medical check-up arrives and the doctor asks you to make certain movements. It also asks about the degree of pain. Alberto can not perform all movements correctly and ensures that it hurts a lot. The doctor issues another medical part so that Alberto continues to leave. Our friend, through simulation, has managed to be more down time.
Alberto's first casualty was real, but he realized that he was comfortable at home without working and, once recovered and knowing the symptoms of lumbago, he decided to simulate them in the second medical inspection. He took advantage of a real situation and dramatized it to obtain an external benefit: not work and collect at the same time. The simulation, as we will see throughout the article, still involves a long debate about whether or not it may be a symptom of a disorder. Let's go deeper!
- 1 Simulation, what is it? Is it a disorder?
- 2 Differences and categories
- 3 Evaluation in the simulation
- 4 Conclusion
Simulation, what does it consist of? Is it a disorder?
According to the DSM-V, the simulation consists of the "Intentional production of disproportionate or false physical or psychological symptoms, motivated by external incentives like: avoiding a job, getting financial compensation, escaping a criminal conviction, getting drugs, not performing military service, etc. ". In the simulation, there is supposedly knowledge that you are lying about the symptoms, so the disorder or pathology would be ruled out. However, there are authors who argue that it could be an indicator of some type of mental disorder.
The team of Mercedes Inda (2000), from the University of Oviedo, puts on the table the question of whether the simulation could be the reflection of some mental disorder. The authors state that "This can be quite clear in the so-called 'factitious' or fictitious disorder, where the person intentionally pretends physical or psychological symptoms, in order to assume the role of the patient".
The authors point out that it could be a sign of a Histrionic personality disorder for the lack of control over manipulative behavior. They also point out that conscious exaggeration could be part of a neurotic behavior since, as Mercedes Inda's team states, "No person in his right mind usually reaches these extremes, nor would he choose such tortuous and painful routes, to obtain possible gains".
Inda team lists the most simulated disorders:
- Post-traumatic stress disorder.
- Post-traumatic brain damage syndrome.
Differences and categories
Resnick (1997), establishes differences between simulations:
- Pure simulation or pretending a non-existent disorder.
- Partial simulation or conscious exaggeration of present symptoms or a disorder that has already been overcome.
- False amputation. It consists in the erroneous attribution of real symptoms to a certain cause. All this, due to an incorrect interpretation of the situation or a conscious deception.
Yudofsky (1985) divided the simulation into four categories:
- Events staged. It consists in preparing an episode in detail, for example, preparing an outrage or a fall in the workplace.
- Data manipulation. Modification, alteration or contamination of medical tests in order to simulate abnormal findings.
- Opportunistic simulation Through an injury or accident the person exaggerates the symptoms to maximize financial compensation.
- Invention of symptoms. It consists of the invention of symptoms without previous evidence of injuries or illness. It can range from neurological aspects such as seizures or headaches, to psychological aspects such as psychosis or post-traumatic stress disorder. For example, children often simulate tummy ache so as not to have to go to school.
Stoudemire (1989), added a fifth form of simulation, the self-destructive behavior. It is a behavior of self-harm, self-destruction and / or mutilation. The objective is to avoid some obligation. For example, cases of soldiers who shoot themselves can be found to avoid entering into combat or self-injury of prisoners to leave their cells.
Lezak (1995), advises the following neuropsychological tests to detect possible simulations:
- Bender test.
- Benton Visual Retention Test.
- HAlstead-Reitan battery.
- PICA (Porch Index of Communicative Ability).
On the other hand, it is important to perform a complete medical and psychological exam. It is convenient to rule out any real pathology both medical and psychological. Some authors such as DuAlba and Scott (1993), point out the importance of cultural differences when assessing simulation.
Yudofsky listed a series of clinical indicators through which one can suspect that simulation is taking place. However, the author assures that These indicators lack a diagnostic nature because they can occur in more situations. The following points would make it easier to detect if someone is simulating:
- The history, examination and diagnosis data are inconsistent with symptomatic complaints.
- The symptoms are poorly defined and vague.
- There is excessive dramatization of complaints.
- The patient is uncooperative in the diagnosis.
- Favorable diagnoses are received with some resistance from the patient.
- The wounds seem self-induced.
- In case of analysis, drugs or unsuspected toxins usually appear.
- The medical records have been altered.
- Existence of a history of accidents or recurrent injuries.
- Antisocial personality traits can be seen.
- Through the symptoms or the disorder one can avoid some legal procedure or a possible entry into prison, as well as avoid unpleasant activities, situations or living conditions.
- The patient has requested addictive drugs.
Factors in the simulation of psychosis and other disorders
Resnick offers some key points to detect the simulation of psychosis and other disorders:
- Avoid being guided by subjective trust in the diagnostic acuity itself.
- Consider the importance of the subject's motive for deceiving.
- To exclude the simulation, avoid relying solely on the results of the interview and in physical examination.
- Contemplate the use of tests designed to detect simulation.
- Collect collateral and confirmatory information.
Simulation is a subject that is still being investigated in psychology. The difficulty in detecting cases of deception is still high, even so, little by little methods are being obtained for it. On the other side, Some authors emphasize the adaptive aspect of simulation.
Although throughout the article it has been drawn as a phenomenon stained with picaresque whose intention seems to be malicious, there are also cases where it could be justified. If we know that they will send us to a war where maybe we can die, Wouldn't we self-injure ourselves to get rid of almost certain death? Thus, simulation is an interesting and controversial issue.
- Inda, M., Lemos, S., López, A. and Alonso, J. (2005). The simulation of physical illness or mental disorder.Roles of the psychologist, 26, 99-108.
- Dualba, L., and Scott, R. (1993). Somatization and malingering for workers' compensation applicants: A cross-cultural MMPI study. Journal of Clinical Psychology, 49 (6), 913-917.
- Lezak, M. (1995). Neuropsychological assessment (Third Edition). New York: Oxford University Press.
- Resnick, P. (1997). Malingering of posttraumatic disorders. In R. Rogers (Editor), Clinical assessment of malingering and deception (pp. 130-152). New York: Guilford Press
- Yudofsky S. (1985). Conditions not attributable to a mental disorder. In "Comprehensive Textbook of Psychiatry (fourth edition)". Edited by James, B., Alcott, V. and Ruíz, P. Evansville: Wolters Kluver.
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