FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[PSYCHOSOMATIC ILLNESS NOT MALINGERING]

Question: A person I work with is always complaining of one illness or another. This gets her special consideration from our supervisor. I admit that she has some health problems, and she is also under a lot of emotional stress, but I think she is just imagining most of her conditions. How can you tell if a person is malingering?

Answer: Some of the symptoms of any illness are due to the emotional state of the person. In most cases the emotional component is small. As an example, a broken big toe is painful and interferes with normal walking. This is frustrating, but the minor frustration - the emotional component - is small. In some individuals, however, the emotional component plays a major role. As an example, the broken big toe causes much attention from a previously non-attentive spouse and special consideration at work. These emotional benefits can cause an exaggeration of the infirmity caused by the injury and also prolong the recovery.

There are two terms that describe physical conditions that occur as the consequence of the person's emotional state, malingering and psychosomatic illness. Malingering, the condition you think your coworker has, describes the display of symptoms to achieve some external gain. This would accurately describe a worker who complains of back pain in the hope of receiving disability payments or relocation to a more favorable job. Unfortunately, malingering is not a rare occurrence. We physicians employ numerous special physical examination techniques to identify such individuals. Despite this, it can be difficult at times to distinguish a skillful malingerer from someone with a true physical problem.

A psychosomatic illness is similar to malingering, but there is an important distinction: the symptoms of an individual with a psychosomatic illness occur because of the emotional disorder but without the individual's awareness that the emotions are producing the physical symptoms. Therefore, there is no intent to deceive or to achieve personal gain. As an example, consider the person complaining, ìmy heart is pounding out of my chest. I must be having a heart attack.î In this situation, the person's high level of anxiety produces these heart symptoms. There is actually nothing wrong with the heart.

Psychosomatic conditions are quite common. Most of us experience them, in a mild form, at one time or another. Haven't you or your children worried themselves into a stomachache over an impending test at school or a similarly stressful event at work? Most psychosomatic illnesses resolve as the causative stressful situation improves. In those with a severe case, which fortunately are uncommon, many medical tests and procedures may be needlessly done before a correct diagnosis is established. After the diagnosis of a psychosomatic illness is established though, counseling and medicine is usually quite effective.

Therefore, I can't answer your question without knowing much more about your coworker and her situation. Even then, it would be quite difficult to determine if your coworker suffers from a psychosomatic illness, or a significant medical condition with an emotional component, or if she is simply malingering.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.