Malingering

Chao Keng?

Remember that classmate whom used to fall sick so much that you have difficulty even recalling what they look like? Or that colleague who seems to be on MC every Monday and Friday? In Singapore, we have a classic phrase that we use to describe this behaviour, ie. Chaokeng.

Chaokeng – otherwise known as Malingering – is in fact related to many psychological disorders. To break it down, malingering occurs when an individual intentionally displays exaggerated physiological or psychological illness (e.g. headaches, mood swings) in order to achieve some sort of personal gain (e.g. monetary rewards, time off). A more conducive and helpful way of looking at this condition is by considering motivations behind such behaviour.

Factitious Disorder (FD) is a psychological disorder that can be used to explain malingering behaviour, with the condition that such individuals do not seek a primary reward. Unlike individuals who exploit the public health system by malingering, FD individuals do not seek any material reward. Instead, they seek intangible rewards (aka secondary gains). Secondary gains can come in the form of attention, recognition and sympathy by occupying a sick role. FD individuals may resort to hurting themselves to bring on symptoms and present in certain ways to influence diagnostic test results. Some tell-tale signs someone may suffer from FD is when they seek repeated consultation without openness to resolution and sometimes seek out several professionals for the same condition. They may also suddenly develop new or additional symptoms following negative test results.

Another disorder that may lead to malingering behaviour are individuals with personality disorders where such individuals are identified to be constantly seeking for attention and have the tendency to over-dramatise situations, which may impair relationships and lead to depression. Individuals with personality disorders may exhibit malingering behaviour in order to achieve personal gains such as time with the figure they are seeking attention from or some form of emotional validation.

Malingering may be malicious in intent but at the same time may also be the effect of an underlying disorder or disturbance. How can the intent and motivation of the behaviour be identified? The first thing to do is to try to best understand the motivations of such behaviour and see beyond the stereotypes. We are all driven to behave in ways that we see are helpful to us and preserve our self-worth. We all have blindspots to the consequences of our behaviour.

Written by Dr. Joel Yang