Malingering

 - False and Self-Inflicted Injuries -

This page was last updated on Sunday, February 17, 2013


A Word About Shoes and Painful Bunions

Women who wear high heeled shoes with narrow toes often have bunions. A bunion is an inflamed swelling of the small fluid-filled sac on the first joint of the big toe accompanied by enlargement and protrusion of the joint. The prevention is very simple. Avoid wearing narrow pointed shoes, especially those with high heels.  Women who wear them are more likely to fall.

Syndromes and Simulations

A syndrome is a group of signs and symptoms that occur together and characterize a particular abnormality or a condition or an identifiable pattern of behavior. Munchausen syndrome is a condition where a person malingers. Sometimes, these individuals will self-inflict injuries on their body or use makeup or prosthetics to fabricate an illness or an injury.  So false and self-inflicted injuries are perhaps the most misunderstood behavior involving false allegations.  For an example, some parents will abuse their child to prevent the other parent from receiving custody or visitation rights. So the problem lays with the notion that women have the unfettered right to accuse anyone that it is willing to set aside the truth. So instead of trying to solve this problem, many ignore it in hope that it would magically go away but it does not.

Those who fake injuries usually simulate them by using makeup, prosthetics, and torn clothing and drug and medical supply stores are common sources of material. Most colleges and universities have an Arts or Drama department that can produce sophisticated materials that are often used in legitimate productions. The most important point to remember is that most faked injuries that incorporate these materials cannot be subjected to actual testing because they would reveal the fraud. For an example, glue and coloring can simulate scabs.

Color Changes in Injuries

This is why photographs are often used to portray injuries that never did exist. One way of proving that a bruise is real and that bruises change color as they heal - they go from red to blue to cyan and to yellow. Another way of checking the authenticity of a bruise is that they contain clotting material and we can extract this material for testing.

Blood plasma contains proteins that cause blood to clot but they normally circulate in an inactive form. However, when something damages a blood vessel, the platelets help in clotting the blood by adhering to other platelets and to the epithelium (a cellular membrane). Then the fibrous tissue changes into strands that crisscross and create a mesh that squeezes out the fluid and forms a solid clot (hardened blood and serum). These clots, called scabs, can be collected and then tested in a laboratory.

Today, most physicians prescribe low dose aspirin to prevent blood clots while physicians prescribe warfarin for the treatment of atrial fibrillation, pulmonary embolism, venous thrombosis and other medical conditions. Too much warfarin or aspirin or can result in excessive bruising or bleeding. Blood testing can reveal that a person is using them to induce bruising or bleeding in themselves or that they are trying to poison another person. Women are far more likely to use poisons than men.

A perpetrator uses trickery and simulations to direct attention away from them and to the targeted person. These often include feigned assaults and false allegations. Although self-inflicted injuries can be symptomatic of Borderline Personality Disorder, they are usually a result of the actor trying to draw attention to themselves. However, self-mutilation is often used to garner attention or to avoid conflict especially after the perpetrator has manipulated or harmed others. I call this the ‘poor me’ excuse because the offender blames the victim by saying that ‘you made me do it’.

Handedness

The hands of a person are mirror images of each other and they have a specific arrangement: thumb, index, middle finger, ring, and pinkie (little). So when the hands are placed are placed palm to palm, each finger has a corresponding opposite finger. This is also true of human feet and toes. Most people who are right-handed are also right-footed and those who are left-handed are more likely to be left-footed but not always?

Handedness refers a tendency to use one hand rather than the other. While most people are right-handed, others are left-handed, and a few can use both hands with equal ease. The reason that handedness is important is that it determines whether a right-handed person, a left-handed person inflicted an injury, or was self-inflicted.

For an example if two people faced each other, then a right-handed person would usually strike their victim's left side while a left-handed person would strike their victim's right side. Otherwise, the strike would be on the opposite side if they did not face each other. In other words, face-to-face strikes are mirror images while strikes from behind are not. However, the most important evidence is that they exchange the DNA of the victim and the DNA of the assailant between the two. However, if they exchanged no DNA, then the accused did not touch or strike the purported victim.

Note: The null hypothesis is a statistical hypothesis being tested and accepted or rejected in favor of an alternative. For an example, the difference between two samples is due to chance alone and not anything else. The point is we can never prove the null hypothesis and the data set can only reject the null hypothesis or fail to reject the null hypothesis. This is the evidence of inclusion or noninclusion that was on my mind.

Faked and Self-Inflicted Injuries in False Allegations of Abuse or Rape

Most self-inflicted injuries are either faked with cosmetics or made by sharp or pointed objects. Most faked injuries are usually shallow or surface abrasions. Also, the lack of severity often belies the victim’s account of the injuries and not consistent with a typical attack or the dynamics of an actual encounter. Moreover, as with false allegations of rape, the reporting officer will extensively quote the accuser giving a false appearance of genuineness.

This is why women so easily make false allegations and hard to refute, that those who support this doctrine do so through subterfuge, and extortion. They do not care about the truth, because they want a predetermined result of their own making. Women are responsible for nearly all the false allegations of rape and abuse because these particular offenses do not require corroborating evidence for arrest and conviction.

The Constitutional right to confrontation is especially significant when dealing with allegations of abuse and rape in most jurisdictions. The reason for this is that these are the only crimes that do not require corroborating evidence for conviction. Without witnesses and no physical evidence, the court must decide the matter as to the credibility of the accuser. This is the person who had waited until the evidence would have dissipated and that is the essence of premeditation.

Features of Faked and Self-Inflicted Injuries

Many faked and self-inflicted injuries are a result of an attempt to obtain compensation from an insurance company. Since insurance companies are aware of this behavior, they will refer such claims to their own experts for evaluation. When the instance is a result of rape, they will insist that the insured will undergo a rape kit examination. This is to prove that the crime occurred and that the evidence has been collected to prove the claim.

The problem is that no one requires women who do claim rape to participate in the rape examination. This may mean that the crucial evidence would not be collected and this allows her to make a false claim at some point in the future. This is also true of other forms of abuse, including spousal battery. The features of faked and self-inflicted injuries appear below.

  •         The use of fingernails and sharp or pointed tools.
  •         The presence of shallow abrasions and cuts.
  •         Isolated lesions.
  •         Lesions with uniform curved or linear features.
  •         Parallel or crisscross lesions.
  •         Lesions that appear on the opposite (non dominant) side of the body
  •         The location of injury is easily reachable by the ‘victim’.
  •         Sensitive body regions are neither harmed nor damaged.
  •         Clothing is undamaged or the damage is inconsistent.
  •         There are no defense injuries on the hands, arms, and legs.
  •         Old scars that are consistent with present injuries.
  •         Multiple ‘trial’ cuttings and stabs.

The most important feature about real injuries and bruises is that they may spread but they don’t move. One of the best ways to detect a faked injury is to take photographs and then wait a few hours or to the next day and see if they have changed position, extent, or coloration.

 

Munchausen Syndrome by Proxy

Munchausen syndrome by proxy is a psychological disorder where the parent (typically the mother) lies about the child's family and medical history. The mother may falsely accuse the father of child abuse or spousal abuse. She may tamper with the child’s medication and medical specimens to create an impression of child abuse, child neglect, or child sexual abuse. This syndrome is not limited to child abuse. It also occurs as elder abuse where the caretaker deliberately over medicates their charge or causes injury to the person in their care. This is often done to alienate the patient from their relatives and friends for monetary reasons, attention, or for other purpose.

Sometimes the term, ‘Munchausen syndrome’ is interchangeably used with factitious disorder. It is an illness or injury that someone has intentionally produced. The difference is that sometimes the ‘sick’ person is not aware of its cause and so the illness might be psychosomatic or simulated in nature resulting from neurosis. So Munchausen syndrome may apply to a person who has a chronic variant of a factitious disorder with mostly physical signs and symptoms. That is why the term, "psychosomatic" relates to symptoms caused by a mental or emotional disturbance. Moreover, unconfirmed reports about psychosomatic Munchausen syndrome do exist.

Munchausen syndrome is a condition where a person will intentionally cause the signs and symptoms of an illness or an injury. Sometimes the illness or injury is so serious that doctors have to hospitalize the patient. These persons are sometimes so eager to undergo invasive medical interventions that they will do almost anything to receive attention. According to the literature, these persons with Munchausen Syndrome have commonly feigned about thirty-three illnesses and conditions. These include Sexual Abuse, Spousal Abuse, and Ideation. (Note: Ideation is the capacity for, or the act of forming self entertaining ideas such as suicide.)

Some persons are sometimes eager to undergo invasive medical interventions and so they go to doctor to doctor to satisfy their craving for attention. According to the literature, Munchausen patients have feigned more than thirty-three illnesses and conditions. These include Sexual Abuse, Spousal Abuse, and Ideation. (Note: Ideation is the capacity for, or the act of forming self entertaining ideas such as suicide. Please see the literature on this and other personality and mental disorders).

 

Additional Resources

Medline Plus Munchausen Syndrome By Proxy

Personality Disorders - A Brief Summary

Wikipedia (Self-harm) - Wikipedia.org  Self Harm

Wikipedia (Munchausen Syndrome) - Wikipedia.org  Munchausen Syndrome

 

Edward Steven Nunes


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