Malone Ricky D, Lange Christopher L
Forensic Psychiatry Service, Department of Psychiatry, Walter Reed Army Medical, Center, Washington, DC 20016-0612, USA.
J Am Acad Psychoanal Dyn Psychiatry. 2007 Spring;35(1):13-21. doi: 10.1521/jaap.2007.35.1.13.
Malingering presents special challenges to the practicing clinician, including diagnostic uncertainty, the confrontation of potentially criminal conduct, and countertransference and personal reactions. Maintaining a traditional clinical approach to the patient suspected of malingering enables the therapist to draw analogies to other disorders and utilize customary diagnostic and therapeutic skills. Malingering has long been recognized in the military, and has predictably come to the forefront of clinical practice during a time of war. The art in military medicine is to find a way to make our ethical and fiduciary responsibility to act in the best interest of the patient coincide with the needs of the system. In this context, malingering can also be viewed as an immature or primitive defense in a very stressful situation, and approached accordingly. This article discusses key elements of the history and mental status examination in the clinical assessment of malingering, and therapeutic analogies that offer the possibility of a positive outcome for an otherwise potentially negative encounter.
诈病给临床执业医生带来了特殊挑战，包括诊断的不确定性、对潜在犯罪行为的应对，以及反移情和个人反应。对疑似诈病的患者保持传统的临床方法，能使治疗师将其与其他疾病进行类比，并运用常规的诊断和治疗技能。诈病在军队中早已被认识到，在战争时期出现在临床实践的前沿也在意料之中。军事医学的技巧在于找到一种方法，使我们为患者的最大利益行事的道德和信托责任与系统的需求相一致。在这种情况下，诈病也可被视为在极具压力的情况下一种不成熟或原始的防御机制，并据此进行处理。本文讨论了在诈病临床评估中病史和精神状态检查的关键要素，以及为原本可能消极的接触带来积极结果可能性的治疗类比。
