How can you tell if someone is faking schizophrenia?

Jack Nicholson Loughner

In medicine, it’s called “malingering” if a patient is trying to deceive someone by faking, feigning or exaggerating symptoms.

Doctors try to discover fakers the same way that people good at detecting lies discover liars. They look for inconsistencies, or things that don’t quite match.

For instance, if a supposed schizophrenic can tell you clearly and without confusion that they’re extremely confused, their actions don’t correspond with what they are saying. A very confused person can’t clearly say how confused they are.

Or, if they act mentally disorganized while talking with a psychiatrist, yet later they can play chess with another patient, something doesn’t match.

It’s considered an advanced skill to detect a malingering schizophrenic, because a psychiatrist must know in detail the difference between real and fake psychotic symptoms.

So how do doctors catch the fakers?

A malingerer is like an beginning actor who’s overacting. A beginning actor may try to play a drunk person by slurring every word and swaying and falling down, but an experienced actor knows what a drunk is like, and plays the drunk as someone who is drunk, but is trying to act normal.

Many people who try to fake a mental illness try to “play crazy.”

A faker will try to make their illness front and center, and make their psychosis the first thing they want to discuss, while a real patient will be reluctant to explain their symptoms.

A faker will be hostile and act as if nobody believes him or her, which is rare in genuine psychotics.

A faker will act stupider than they should be, not realizing that intelligence will not diminish just because he or she is psychotic.

Fakers will be vague about details. Instead of saying that a voice was male or female, the faker might say “I don’t know.” Real psychotics would know the answer.

It’s also difficult to fake certain schizophrenic symptoms, such as getting off track while speaking, coining new words, finding associations between unrelated things, or speech which is so disorganized that at first it sounds correct but which actually makes no sense.

In acting, a beginning actor will keep trying to add things to a performance. To play the emotion “sad,” a bad actor will add heavy sighs and crying, while a good actor will subtract emotion, such as letting the character smile just a little, but making it a tight smile with no happiness showing around the eyes.

An inexperienced faker will do the same, by adding symptoms of “craziness,” forgetting that there are also many things that get subtracted from an individual with schizophrenia.

Faking it: How to detect malingered psychosis - Feigned schizophrenia symptoms usually won’t deceive the clinician who watches for clues and is skilled in recognizing the real thing, The Journal of Family Practice>>

40 comments:

  1. This comment has been removed by a blog administrator.

    ReplyDelete
  2. Ignore the previous, typos due to iPhone. I know somebody who I think is faking schizophrenia, whenever he does something wrong, rude or regrettable he insists it is his alter ego, he takes medication which is apparently for it, yet when forgetting his medication in the morning I have discovered that if reminded he will have an episode, yet when forgotten he is fine... He orders me to follow his girlfriend around Kingston as he gets paranoid when she talks to another boy... He will act hostile when not believed, he now works as a freelancer and lives alone, he turned 18 two weeks ago, he was my best friend, now he is attempting to ruin my relationship because I questioned him

    ReplyDelete
    Replies
    1. If he says he has "schizophrenia" then he's probably lying. The actual term is "multiple personality disorder" and no doctor would tell him he had "schizophrenia" as that is an entirely different mental illness.

      Multiple personality disorder is multiple personalities "inhabiting" one body. Schizophrenia is a splintering of the one personality into a fragmented mess.

      Delete
    2. This is not true at all btw!

      Delete
    3. Sound to me like he a good manipulator. He may be trying to use his "Condition " to get his way or what he wants. And him ORDERING you to stalk his girlfriend is Wrong on SO many levels I dont know were to start. He may not be Schizo but psycho!!! Do your self a favor and disconnect your self from his life if at all possible!!!

      Delete
  3. How do I prove he is lying?

    ReplyDelete
    Replies
    1. I am not in the medical profession - I am just a person with an opinion - My opinion is why prove anything? To me at least, a person who fakes being mentally ill actually probably is to a degree otherwise they would be doing other things more positive...Maybe I'm wrong - however, it is up to you to decide.

      Delete
    2. There is no way to "prove" that he or she is lying, because as a medical professional your job is to take in symptoms as explained by the patient along with symptoms you observe by yourself. Rather than compiling evidence, which is either true or false, the objective is to see what aligns with what because, to an extent, everything is "true" - the issue lies in the question: how true is it? (side note: the DSM-V, or later when applicable, would be used by a doctor if unsure whether or not there are "enough" symptoms to definitively diagnose a mental illness as such.) The comment above me is accurate in that respect, because generally someone faking an illness has a reason for doing so; i.e. maybe someone with depression will fake symptoms of anxiety or ADHD with the intent to obtain a prescription for substances like alprazolam (xanax; a commonly abused anxiolytic of the benzodiazepine drug-class) or mixed amphetamine salts (adderall; a commonly abused stimulant used off-label for depression and appetite suppression). People with depression often times will try to self medicate through other sources, which unfortunately can lead to substance abuse and drug-seeking tendencies; which is even more unfortunate, as it can become a deadly combination.

      The point is that as a good doctor, you must refrain from anything other than evaluation of your patient. When it comes to a point where you know the patient is lying to you, it is easy to become accusatory - however, you have to remember that you are the doctor and at the end of the day: you get to choose to write the Rx, not them. Evaluate their actions, behaviors, tendencies, tone of voice; everything. Furthermore, on this topic specifically, I don't know why anyone would try to fake schizophrenia other than for sympathy or an excuse in court... Mood stabilization through lithium, bupropion, or other substances can be absolute hell on one's body and they have nearly zero recreational value to a drug-seeking patient (unless they enjoy looking and acting like a zombie, of course).

      Hope this helps! Sources include that I am a prospective medical student, pursuing psychiatric pharmacology, studying neuroscience for what will be my fourth year this fall. I also am, interestingly enough, a patient who has suffered from major depressive disorder: suicidal-type, ADHD: combined type, and generalized anxiety disorder. I've currently had my symptoms in remission for almost 8 months now (new record!) and I've experienced almost every medicine in the book over the last few years.

      Feel free to message me on facebook if you have any more questions (but please do not spam me, because that means I'll have to beat you up... just kidding, but seriously don't spam me, haha), and I'll surely do my best to answer them!

      Keep in mind that I am not, by any means, a licensed medical doctor, nor do I have any responsibility for anything that you do based on the things I have said or will say. As a student, I can only give educated advice. Please make sure to always discuss any and all health concerns with your primary physician.

      Delete
  4. A court system (if we assume the system is not corrupt) spends huge amounts of time and energy trying to discover what's true or not true and who's lying or not lying, and they can still get it wrong.

    You may never know 100% if he's lying. If your friend is ill, whether it's schizophrenia or another mental disorder, he might not actually know exactly what the truth is, so how can you discover if he's lying?

    One thing that people with mental illness do is to isolate themselves. What might be more important for you is to figure out how you can remain his friend, even if he is lying, while minimizing any harm to yourself.

    ReplyDelete
  5. Well he turned most of my friends against me by lying about me behind my back, he isn't particularly isolated as he is extremely social and spends the weekend with a load of my now ex-friends doing ketamine in his flat, he's a compulsive liar and has told many an anecdote multiple times, the exact same story but according to him he did it THAT day (on which he will tell me the story) and it is exactly the same, I don't want him as a best friend, he receives a lot of money from canary wharf for his condition and I think he loves it
    I have split personality disorder so it is difficult to comprehend the benefits when I am still in full time education with a Saturday job and happily don't receive any
    He never has compulsive ticks, he is organised, he holds a high earning job and is very social, it seems he is only schizophrenic when it suits him, he is also very open about his condition when I am not

    ReplyDelete
    Replies
    1. Honestly why do you care if he is faking this? It sounds like you are a crappy friend to me. As someone who has mental illness I take offense to this because it took me to go through HELL AND BACK to get recognized. And I think you deserve EVERYTHING he is doing to you. As he sounds like he has something wrong even if he is misdiagnosed...

      Maybe you should have been a real friend and not questioned HIS LIFE and HIS BUSINESS!!!

      Delete
    2. He has his reasons for caring because this person has hurt him. As for your anger about the issue - that is your anger, and that is all about you, not him. I am sure at one time they were friends. Your anger is something you need to deal with big time.

      Delete
    3. Mental illness is complex, but taking offense is something you may want to hold back on. Comparing yourself to others will not only make you angry but it's going to hinder your own ability to overcome your issues and regain your health. I also suffer from quite a few mental illnesses, so I know exactly what you mean by hell and back... If it bothers you that much, I really suggest that you take a step back and evaluate yourself rather than your friend. You can't be responsible for their decisions, so don't try to be! I know it hurts to "give up" on someone else, but at the very end of the day you have to look out for yourself and if they refuse to take your advice then it is out of your control. Best wishes.

      Delete
  6. my ex is this way, i knew she was depressed but shshe refused to get help, i listened to her stories but i never got the other side and her mother acted like things were never that way. Now shes suposably schizo but they keep putting her on and off drugs cause they make her sick. Every time we got into a spat though she would blame her loss of memory or how she was having siezures (which never came up till during fighting). I dont know if i should relax and believe her or not. I feel like shes just using it as a sob story. I know with my mental problems i was quick to try to get them fixed but she was always hesitant

    ReplyDelete
    Replies
    1. Who knows? Maybe move on huh?

      Delete
    2. Sometimes, w/schizophrenia, you convince yourself (or voices, if you have auditory hallucinations, convince you) not to seek help.

      Delete
    3. Separate yourself from the situation if it is hurting you, especially if you don't see it getting any easier to deal with. Have her see a psychiatrist - many times people think that they are doing enough just by simply seeing any doctor they can see, but most physicians are not well versed in mental healthcare. A psychiatrist will take the time to fully evaluate everything, and more often than not they will produce much more accurate diagnoses. If she refuses to see a psychiatrist then she doesn't value the relationship nor does she value your health, and that's not fair to you at all.

      Delete
  7. I was crazy untiL i ate the soup

    ReplyDelete
  8. Umm... These 'true' signs sound just like me... Especially connecting things that don't connect. Like... It's 11:43 right now, right? Well, 1x(-1+4)=3... 11:43. I'm guessing I'm just weird...

    ReplyDelete
    Replies
    1. Haha you remind me of myself, I do this too but with words. Its complicated to explain I spell out a certain word in my head, like I draw it out but only two letters at a time going down like in column, and if its a positive word there wuldnt be a letter missing, if there is a space missing its a negative word lmao im weird too...

      Delete
  9. This is a bunch of b.s. I have schizophrenia but I know when I am confused because of the schizophrenia, and can describe my confused state to my psychiatrist. Schizophrenia is, after all, an inability to tell reality from unreality. Not an inability to play chess, which one might be able to do even better than usual if a voice caused by psychosis were telling him or her which move to make. Right?

    ReplyDelete
    Replies
    1. It's all very subjective, as you know. The idea of chess was, I assume, brought into question simply due to its widespread recognition as a "complex-cognitive task" to mental health researchers. I've actually done research on ADHD therapy through complex-cognitive tasks as opposed to pharmaceuticals.

      This may be inaccurate, but it almost sounds as though you have what's known as schizotypal personality disorder, or sometimes referred to as schizoid type in more advanced cases. I have a minor type of schizotypal affective disorder, which means that I generally need a "trigger" (such as heavy depression or anger) to cause an episode; this type is most times not medicated, but it is all variable due to severity. I actually have a close friend of mine who is diagnosed as schizoid, to the degree of severity that warrants being medicated, however she has no problem whatsoever when it comes to talking, thinking, functioning, or anything else - as long as she is not having a schizoid episode. There is so much ambiguity when it comes to diagnoses of mental disorders that it is hard to say anything definitively, but for this article I think it just tried to cover the top-layer of information. Obviously you and I know a little bit more info about this subject, so I wouldn't worry too much about the claims made by the author. :)

      Delete
    2. what's a bunch of bs is, i got pregnant, tried to tell my parents, they didn't believe me, so i ran away to find help, but it was too late, i lost the baby. the EMS took me to Memorial Hospital, and i ended up in the part of that hospital called the Clark Center. and i told them i was pregnant, and they didn't believe me. the baby was premature, so i didn't show at all. and this idiot doctor thinks i'm schizophrenic, but i know i'm not. he even put me on an antipsychotic, but i know i don't need it.

      Delete
  10. I am a concerned mother of a 20 year old who says he has what he calls " psychotic breaks." He has had issues with ODD and ADD as a young child. He claims to see people that aren't there. My concern is that he has experimented with lsd and research chemicals since he was about 15. Can he have drug induced schizophrenia? Also, I have taken him to many a therapist and it wasn't until the last two years he started with these claims. I don't want to sound cold or that i dont believe him but I know he still messes with drugs and he seems to only want to get help if a doctor is going to help him "medically" He says when these episodes happen he doesnt recognize familiar people. I have never witnessed him not recognizing me but I am not sure what to think. This is my son with quite a history of not being truthful. I want to help if truly there is a problem but some things just dont make sense to me.

    ReplyDelete
  11. Your son has multiple, overlapping problems:

    - ODD and ADD in his youth
    - Experimenting with psychoactive drugs
    - Possible "malingering" or pretending to have more severe symptoms
    - A history of lying
    - Saying he has "psychotic breaks" and is seeing people who don't exist.

    It's not up to me to diagnose your son, but I would be less concerned about whether he in fact has drug induced schizophrenia and focus on the fact that something's not quite right.

    This is a problem where a psychiatrist is the proper person to diagnose and treat your son.

    Ask a trusted doctor or therapist for a referral, and good luck.

    ReplyDelete
  12. Very little of this is accurate. I know a person that has been a diagnosed schizophrenic since 10yrs old. He almost always knows when he is experiencing confusion, looks and behaves drunk when extremely psychotic, and has a huge decrease in intelligence only when psychotic. From the onset of his illness he has often heard voices that can not be distinguished as either male or female.Through hospital stays he has met many others that are this way, we've been told by Dr.s this is actually common in higher intelligence schizophrenics. If a person is faking it they have to have something seriously wrong with them, it's hard work to maintain for any amount of time, more so than having a job.

    ReplyDelete
    Replies
    1. But it pays better then most jobs and all you have to do is act out there from time to time. The DOc's make it easy to scam others because they make money by giving out DX's Doc's loose money when they tell the client that there isn't anything wrong with them. You do the math.... I should know I see this every day at work.

      Delete
  13. Here's a thought:
    If you think someone is faking you could tell them that "at least you don't ______ like the really severe schizophrenics" then wait until they do it.

    Make it something like writing upside down, howling at bright lights, being deathly afraid of carpet, or licking wood - things that are not actually harmful...

    ReplyDelete
  14. my husband had a nervous breakdown and sometimes he is able to pull himself together 'normal' then he goes crazy again. it is driving me nuts, he has lost his job and is headed for permanent disability.

    ReplyDelete
  15. this is retarded. ive been diagnosed with paranoid schizophrenia, and schizophrenia undifferentiated type. i am a college student, and although psychology is not my major (im majoring in computer science) ive taken quite a bit of psychology courses, including "abnormal behavior" all as part of my general ed. I am very aware of my delusional beliefs, and my episodes of psychosis... but just being aware of them doesnt make it go away. i understand schizophrenia more than a psychiatrist or therapist ever could, because not only do i have the theoretical knowledge they have but also *phenomenal* knowledge which you only ever acquire from experiencing the mental illness first hand, not through case studies or lecture halls...

    this whole article is a joke, it's reasons like this that psychiatry is still consider an art and not a science.... cause of BS like this.

    ReplyDelete
  16. it is necessary to understand exactly what the disorder is. As seen above, it is a type of schizophrenic disorder, which can be distinguished from the others. paranoid schizophrenia symptom

    ReplyDelete
  17. Whoever was talking about that person not taking their medication and then you reminding him. He might have relapsed the second you told him he forgot to take his medication, which is why it added stress to the person with the diagnosis if they know it is important to take their medication. I'm pretty sure medication has a half-life or something of so many hours, but as hours go pass by so does the effect of the medication. Less stabilizing effect and more stress added = acting out because of psychotic illness.

    ReplyDelete
  18. Well I don't know what to do, I have out of body experiences daily, I am not in control of what I say or do I'm just along for the ride I scream at myself constantly to stop but it never does and often it is destructive. I've been told for years from people I know that they believe I'm schizophrenic, but I wen to see a psychologist and have been going back to see him for 3 years he keeps telling me this is all a part of an elaborate plan of mine, but it's not I can not hold a job for more than 3 days, ssri's he prescribed sent me into a 18 month acid trip, in which I got arrested 3 times and ended in a psych ward. I can't agree with myself on facts and get accused of lying constantly even though I tell everyone this ahead of time, so i have 2 choices suicide or prison the street's not a big deal I have a place to stay just i often wake up in a pool of my own blood outside somewhere.I'm in multiple places and timelines all at the same time it won't end. Since typing in my symptoms led me to this page maybe i shouldn't have told my psychiatrist my symptoms in the first place he tells me i'm lying everytime i see him and won't let me see anyone else.

    ReplyDelete
  19. It would be hard to fake scizophrenia. The one way to catch someone out is if they mention schizophrenia, that way you know theyve been reading up on it or are trying to lie to get attention, otherwise, if they experience symptoms but dont specifically mention an illness, there is a low chance they are lying

    ReplyDelete
  20. From personal experience, how can you not be sure that perhaps the mentally unstable (faker) maybe has a condition that is unknown or that you and other simply do not understand. Doctors get it wrong everyday

    ReplyDelete
  21. was wondering if this could apply to a child who claims to hear voices. My daughters dad got custody of her a few years back and moved several states away. My visitation with her is once a month. Her dad in these last 3 years has been deployed over seas for the majority of the time. Her dad got angry w me stopped visitation for 5 months then my daughter started having fainting spells and they had test ran and nothing to prove any medical problems with her. Her fainting spells only came when she was arguing with her stepmother. I became fed up w everything after she had another fainting spell and cracked her head on the kitchen counter after a dispute w her step mom and i drove two states away uninvited demanding answers. My daughter was on a military base in there hospital. Once i was there she was fine wanting all my attention. Once released it was like nothing happened we went to her dads untill she had to go to bed and i had to leave. The next week my daughter found out her father was being deployed again and she had a fainting spell and said she was hearing voices and it landed her 9 year old but in a psychiatric ward for a week where she never fainted or was sick. They released her said that she had to see some counselors be put on this psychotropic drug. Then bam two weeks after that her father was deployed and she said to her counselor that she was seeing things now and hearing voices and they put her butt back in the psych ward again this time for a month. She seemed to be doing ok and picking up on the actions of the children around her then would display these actions while she was supposedly sleeping like clawing her arms and twitching and that only happened in the first five minutes of her eyes closing then supposedly slept soundless the rest of the night. She was in there for almost a month and all they got from her was she missed me she was scared her dad might die over seas and that she was being bullied at school. Yet they still laced her up with psychotropic drugs sent her back w her step mom with a new round of counselors. Once in a blue moon she still said she heard and saw things everyone seemed to think my child is going insane or already was. They felled to ask her when does she see and here things well when she is upstairs at her step moms home in the dark all alone being made to go to sleep while her step mother is downstairs with her three younger siblings all nice and cozy in the same room sleeping. Does nobody else see it but she is acting out because she is scared and lonely and as a child and your by yourself in the dark and scared the shadows come alive and every insignificant noise you hear is terrifying. But all the drs see is mental instability. Now its 3 more months later my visitation w her they retarted w me after i showed up on there doorstep and she has had no problems since then and after i explained to her that it was ok to be scared of the dark and that being alone in the dark and being scared sometimes jumpstarts ones imagination. I explained to her what i did as a child when i was scared of the dark and taught her to count sheep and she has been fine up intill now because they made our september visit on the weekend of the first then our october visit on the weekend of the 25 which makes time between visits almost two months. So she starts getting upset more through the week then her grandmother from her fathers side visits and she is made to go to school where she procedes to tell her teacher about a demonic being that she can see. So she then gets what she wants and gets sent home. She is so smart and gorgeous and a lil drama queen and she is hurting feels abandoned when she hasnt been and isnt shown the same kind of love from her step mother that her siblings receive so she has put on an elaborate show for attention because bad attention is better than no attention and now she is being medicated for what i see as melingering and nobody sees it but me. What do i do

    ReplyDelete
  22. What do you do with your nine-year-old daughter who is a "lil drama queen" and might be faking that she's hearing voices and seeing things?

    You obviously love your daughter and are concerned about her.

    I'm not a doctor and I can't diagnose her. She might be faking schizophrenia or she might be exhibiting signs of schizophrenia or another mental illness.

    What is true is that she is under stress.

    And you are under stress because she is under stress.

    I suggest you make an appointment with a local therapist or psychiatrist so that you can talk with someone who knows more about these things and can help you to help her.

    Knowledge about her problems and how you can help her - whether she has schizophrenia or not - will help both of you.

    ReplyDelete
  23. How about my boyfriend's Mom? Always making doctor appointments with new and different doctors for new problems, and always asking for "lorazapam 2mg" to be called in BEFORE her appointment, because she is "scared". She passes out mid sentence because she takes too much of her trail mix of pill Rx, even keeps them all mixed up together in a ziplock baggie so no body can keep track of her self over dosage. How about us taking her to the emergency room back to back weeks from over dosing, her teeth are rotting out of her 50 year old young mouth from all the junk food she eats every minute of every day. She is morbidly obese, we helped her lose 30lbs by grocery shopping for her, and then she gained 60lbs celebrating with cake, ice cream, candy, chips, fast food. She does not even take anything for bipolar or schizophrenia, because they dont make her high, she prefers Neurontin and Lorazapam, and now we stuck her fat ass in rehab, and she is like, " When I get out I dont want to work, I just want to keep working out, and keep trying to lose weight, and get healthy, and I told my doctor I only want to take 1mg of lorazapam, not 2mg" ...then, Why did she not break her 2mg lorazopam in half? and why, then, did she take more like 10mg along with 1600mgs of Neurontin, when she is only suppose to take (1) 400mg in the AM and (2) 400mgs in the PM?
    She sits at home all day while her husband works a job he hates just for the insurance, so she can continue this merry go round of in and out of the institutions, ER's, and now rehab?
    She also collects a government disability check, and she is afraid if she goes back to work she will lose her benefits.
    My BF's dad keeps having talks with him about how she always messed around with other men, always ran away, still likes to dissappear from time to time, and I have witnessed her pull a vanishing act, and I also have busted her on the phone with her dentist, trying to get an extra 2mg of lorazapam from them, and they refused since she still owed them 125.oo for the extra laughing gas in her last appt;)
    I am sorry, but I believe she is taking her family for a ride, and she is just another drug addict, period.
    I think my bf's dad is going to leave her, and she will NOT be staying with us, period.

    ReplyDelete
  24. Sounds like your boyfriend's mom has a host of problems. That's what's so difficult about brain disorders and mental illnesses - it's tough to figure out what's real and what's not real. And then if it is "real", what "real" is it? Is it a bipolar disorder, schizophrenia, an anxiety problem or drug addiction? Is she self-medicating with her drugs or using them to get high?

    Whatever it is, it's sure frustrating to deal with from the outside.

    I can only imagine what it must like to deal with the problem from inside her own brain.

    ReplyDelete

Note: Only a member of this blog may post a comment.

Related Posts with Thumbnails