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WADDELL AND THE DECEIVING PATIENT – IS IT ALL INTENTIONAL?
Author(s) -
Macleod A. D.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04123_5.x
Subject(s) - malingering , factitious disorder , medicine , psychiatry , clinical psychology , personality , psychology , social psychology
The intensity of pain perceived following physiological insult is unique to that individual. Pain, by IASP definition, is a subjective and psychological symptom. Circumstances, personality and psychiatric illness may amplify (and less commonly mute) volunteered pain scores. Most pain is organically initiated and then psychologically contaminated. The psychological and psychiatric factors influencing pain scores will be considered. Patients with a propensity to somatise may elaborate and/or maintain ‘organic’ pain. This occurs ‘unconsciously’ (without awareness). This process deceives the patient (and often also the doctor). Intentional amplification of pain and the construction of pain behaviours for care‐eliciting purpose (factitious disorder) or personal gain (malingering) deceives others. Though there are clinical clues to feigned pains able to be obtained from the history and signs such as those proposed by Waddell, it is notoriously difficult to differentiate partial malingering, conversion or somatoform pain and the pain signature of the particular patient. If the intent of symptom formation and its continuance is psychological, medicine has a diagnostic role. If the intent is for personal greed or is criminal, the diagnosis rests upon legal issues.