Antisocial and Borderline Personality Disorders in the Emergency Department: Conceptualizing and Managing “Malingered” or “Exaggerated” Symptoms
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Purpose of Review
Patients with antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are often suspected of malingering or exaggerating symptoms, though there is no clear evidence that they do so more than other patients. We review the manifestations, etiology, and management of seemingly feigned symptoms in these disorders, particularly related to their presentation in the emergency department (ED).
It is dangerous to assume that all patients with ASPD and BPD are intentionally feigning symptoms in the ED. However, when ASPD patients are known to be malingering, the focus should be shifted to addressing the motivation behind malingering and the patient’s true goals, ideally done with a curious rather than confrontational approach. BPD patients also may appear to be malingering or exaggerating symptoms, but their presentation often is more accurately attributed to the lack of ability to mentalize and effectively communicate their needs, as well as emotional hypochondriasis.
Education of ED staff, demonstrating genuine concern, and attempting to find a common goal with patients will aid in keeping an objective view of the patient’s distress, minimizing escalation, and optimizing patient outcomes.
KeywordsAntisocial personality disorder Borderline personality disorder Malingering Emergency department Factitious disorder
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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