Malingering or shamming means conscious, planned feigning or pretending a disease for the sake of gain. Diseases may be feigned for several reasons, such as by soldiers or policemen to avoid their duties, by prisoners to avoid hard work, by businessmen to avoid business contracts, by workmen to claim compensation, by beggars to attract public sympathy, by criminals to avoid legal responsibility, etc.
The diseases that may be feigned are many, e.g., dyspepsia, intestinal colic, ulcers, spitting of blood, ophthalmia, diabetes, rheumatism, lumbago, neurasthenia, aphasia, sciatica, pain in the back, blindness, deafness, vertigo, epilepsy, insanity, paralysis of the limbs, burns, artificial bruises, etc.
Patients can resort to malingering and thus distort or exaggerate their symptoms but true simulation is very rare.
(1) The patient may injure his nasopharynx with a sharp instrument, swallow the blood and regurgitate it in front of the doctor to mimic haematemesis.
(2) A skilful puncturing of the anal or vaginal mucosa, may produce bleeding.
(3) Excessive intake of digitalis may simulate a heart condition.
(4) Eating of large amount of carrot will produce carotinaemia and may simulate jaundice.
(5) Chronic ingestion of coumarin will induce a hemorrhagic diathesis. In many cases detection is easy, but in some cases it is difficult.
The history of the case should be taken from the person himself, and his relatives or friends, and any inconsistencies in his description of the symptoms noted.
Usually, the signs and symptoms do not conform to any known disease. Malingering can be diagnosed by keeping the patient under observation and watching him without his knowledge.
A complete examination is essential after removing the bandages if any, and washing the part. Rarely an anesthetic may be given to detect malingering.