DSM-III

In DSM-III, this category is called Conditions Not Attributable To a Mental Disorder That Are A Focus of Attention Or Treatment

Malingering

The essential feature is the voluntary production and presentation of false or grossly exaggerated physical or psychological symptoms. The symptoms are produced in pursuit of a goal that is obviously recognizable with an understanding of the individual's circumstances rather than of his or her individual psychology. Examples of such obviously understandable goals include: to avoid military conscription or duty, to avoid work, to obtain financial compensation, to evade criminal prosecution, or to obtain drugs.

Under some circumstances Malingering may represent adaptive behavior, for example, feigning illness while a captive of the enemy during wartime.

A high index of suspicion of Malingering should be aroused if any combination of the following is noted:

  1. medicolegal context of presentation, e.g., the person's being referred by his attorney to the physician for examination;
  2. marked discrepancy between the person's claimed distress or disability and the objective findings;
  3. lack of cooperation with the diagnostic evaluation and prescribed treatment regiment;
  4. the present of Antisocial Personality Disorder.

The differentiation of Malingering from Factitious Disorder depends on the clinician's judgment as to whether the symptom production is in pursuit of a goal that is obviously recognizable and understandable in the circumstances. Individuals with Factitious Disorders have goals that are not recognizable in light of their specific circumstances but are understandable only in light of their psychology as determined by careful examination. Evidence of an intrapsychic need to maintain the sick role suggests Factitious Disorder. Thus, the diagnosis of Factitious Disorder excludes the diagnosis of the act of Malingering.

Malingering is differentiated from Conversion and the other Somatoform Disorders by the voluntary production of symptoms and by the obvious, recognizable goal. The malingering individual is much less likely to present his or her symptoms in the context of emotional conflict, and the symptoms presented are less likely to be "symbolic" of an underlying emotional conflict. Symptom relief in Malingering is not often obtained by suggestion, hypnosis, or intravenous barbiturates, as if frequently is in Conversion Disorder.

Borderline Intellectual Functioning

The category can be used when a focus of attention or treatment is associated with Borderline Intellectual Functioning, i.e., an IQ in the 71-84 range. The differential diagnosis between Borderline Intellectual Functioning and Mental Retardation (an IQ of 70 or below) is especially difficult and important when certain mental disorders coexist. For example, when the diagnosis is of Schizophrenic Disorder, Undifferentiated or Residual Type, and impairment in adaptive functioning is prominent, the existence of Borderline Intellectual Functioning is easily overlooked, and hence the level and quality of potential adaptive functioning may be incorrectly assessed.

Adult Antisocial Behavior

This category can be used when a focus of attention or treatment is adult antisocial behavior that is apparently not due to a mental disorder, such as a Conduct Disorder, Antisocial Personality Disorder, or a Disorder of Impulse Control. Examples include the behavior of some professional thieves, racketeers, or dealers in illegal substances.

Childhood or Adolescent Antisocial Behavior

Same as above. Examples include isolated antisocial acts of children or adolescents (not a pattern of antisocial behavior).

Academic Problem

This category can be used when a focus of attention or treatment is an academic problem that is apparently not due to a mental disorder. An examples is a pattern of failing grades or of significant underachievement in an individual with adequate intellectual capacity, in the absence of a Specific Developmental Disorder or any other mental disorder to account for the problem.

Occupational Problem

This category can be used when a focus of attention or treatment is an occupational problem that is apparently not due to a mental disorder. Examples include job dissatisfaction and uncertainty about career choices.

Uncomplicated Bereavement

This category can be used when a focus of attention or treatment is a normal reaction to the death of a loved one (bereavement).

A full depressive syndrome frequently is a normal reaction to such a loss, with feelings of depression and such associated symptoms as poor appetite, weight loss, and insomnia. However, morbid preoccupation with worthlessness, prolonged and marked functional impairment, and marked psychomotor retardation are uncommon and suggest that the bereavement is complicated by the development of a Major Depression.

In Uncomplicated Bereavement, guilt, if present, is chiefly about things done or not done at the time of the death by the survivor; thoughts of death are usually limited to the individual's thinking that he or she would be better off dead or that he or she should have died with the person who died. The individual with Uncomplicated Bereavement generally regards the feeling of depressed mood as "normal," although he or she may seek professional help for relief of such associated symptoms as insomnia and anorexia.

The reaction to the loss may not be immediate, but rarely occurs after the first two or three months. The duration of "normal" bereavement varies considerably among different subcultural groups.

Noncompliance with Medical Treatment

This category can be used when a focus of attention or treatment is noncompliance with medical treatment that is apparently not due to a mental disorder. Examples include failure to follow a prescribed diet because of religious beliefs or to take required medication because of a considered decision that the treatment is worse than the illness. The major differential is with Personality Disorders with prominent paranoid, passive-aggressive, or masochistic features.

Phase of Life Problem or Other Life Circumstances Problem

This category can be used when a focus of attention or treatment is a problem associated with a particular developmental phase or some other life circumstance that is apparently not due to a mental disorder. Examples include problems associated with going to school, separating from parental control, starting a new career, marriage, divorce, and retirement.

Marital Problem

This category can be used when a focus of attention or treatment is a marital problem that is apparently not due to a mental disorder. An example is marital conflict related to estrangement or divorce.

Parent-Child Problem

This category can be used when a focus of attention or treatment is a parent-child problem that is apparently not due to a mental disorder of the individual (parent or child) who is being evaluated. An example is child abuse not attributable to a mental disorder of the parent.

Other Specified Family Circumstances

This category can be used when a focus of attention or treatment is a family circumstance that is apparently not due to a mental disorder and is not a Parent-Child or a Marital Problem. Examples are interpersonal difficulties with an aged in-law, or sibling rivalry.

Other Interpersonal Problem

This category can be used when a focus of attention or treatment is an interpersonal problem (other than marital or parent-child) that is apparently not due to a mental disorder of the individual who is being evaluated. Examples are difficulties with co-workers, or with romantic partners.

DSM-IV

Conditions

  1. Psychological Factors Affecting Medical Condition
  2. Medication-Induced Movement Disorders
    1. Neuroleptic-Induced Parkinsonism
    2. Neuroleptic Malignant Syndrome
    3. Neuroleptic-Induced Acute Dystonia
    4. Neuroleptic-Induced Acute Akathisia
    5. Neuroleptic-Induced Tardive Dyskinesia
    6. Medication-Induced Postural Tremor
    7. Medication-Induced Movement Disorder Not Otherwise Specified
  3. Adverse Effects of Medication Not Otherwise Specified
  4. Relational Problems
  5. Problems Related to Abuse or Neglect
  6. Additional Conditions That May Be a Focus of Clinical Attention

DSM-5

Conditions

Relational Problems

  1. Problems Related to Family Upbringing
  2. Other Problems Related to Primary Support Group

Abuse and Neglect

  1. Child Maltreatment and Neglect Problems
  2. Adult Maltreatment and Neglect Problems

Educational and Occupational Problems

  1. Educational Problems
  2. Occupational Problems

Housing and Economic Problems

  1. Housing Problems
  2. Economic Problems

Other Problems Related to the Social Environment

Problems Related to Crime or Interaction With the Legal System

Other Health Service Encounters for Counseling and Medical Advice

Problems Related to Other Psychosocial, Personal, and Environmental Circumstances

Other Circumstances of Personal History

  1. Problems Related to Access to Medical and Other Health Care
  2. Nonadherence to Medical Treatment
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