Was it a malingering of a mental disorder? Clinical case of self-disclosure of the patient and its interpretation

A clinical case of Stanislav G., 18 years old, an IT-specialist, who underwent therapy in a psychiatric hospital in connection with a schizotypal disorder diagnosed in him, is described. After a month, the patient admitted that he was feigning a mental disorder, because he could not receive effective treatment for the vegetative symptoms of hypothyroidism diagnosed in him, and began an intensive search for the psychopathological causes of his own illness. He believed that he had some signs of schizotypal disorder, but they were not enough to make an official diagnosis and receive the desired psychopharmacotherapy. For persuasiveness, he studied on the Internet the anamnesis of patients and decided to simulate “elements of reasoning, emasculation of associations and a distorted perception of the interlocutor’s words, flattening of affect”. On re-examination after claiming the sham, it was concluded that he did not have the listed symptoms and that there was no scientific evidence to support any psychiatric diagnosis. Doubts in the analysis were only caused by the patient’s motivation to simulate psychopathology in the absence of traditional grounds for malingering (criminal prosecution, military service), and excessive intellectualization of health problems and a specific style of thinking that did not go beyond the norm. The article discusses the question of whether the patient had symptoms of schizotypal disorder and, if so, whether they could completely stop in a short period of time. The article provides substantiations for the conclusion about the detection of feigning behavior in the patient, and provides data on the differential diagnosis between the malingering of a healthy person and pseudo-simulation in schizotypal disorder, as well as observations on the specifics of the mental activity of persons with schizoid personality disorder and Asperger’s syndrome — diagnoses assumed in the examined.