Functional visual loss and malingering

Abstract

Malingering is an intentionally deceptive mimicry of a nonexistent disorder, and augmentation is an intentionally exaggerated account of an existing disorder. Functional visual loss is a subjectively described visual disorder without an objectively observed abnormality. It is an unconscious, often subconscious, simulation of a nonexistent disease. (Synonyms include psychogenic visual loss, conversion, and hysterical visual loss). The related group of psychogenic ocular disorders includes functional disease, psychosomatic disease, and artificial eye diseases. Psychosomatic eye disease is initiated by a psychically triggered (or heavily influenced) organic disease with demonstrable pathological findings, as for example, in some reported cases of glaucoma, uveitis, or central serous retinopathy. Artificial eye diseases arise by self-inflicted trauma (autoaggression) and have demonstrable pathological findings during the eye examination. This type is usually associated with psychoses or so-called specific personality disorders. Simulation and functional visual disturbances are characterized by a tendency to mask themselves. The specific diagnosis is important, however, so that the patient will not be unjustly classified as a simulator on the one hand, and on the other hand, to spare the patient with functional disease any unnecessary and expensive tests, to avoid the development of additional symptoms, and to provide the patient with appropriate help. This chapter covers the clinical presentation, the differential diagnosis, and the specific ophthalmic diagnosis of these disorders. The most important principles are addressed here, although a more complete description and extensive bibliography are provided in Trauzettel-Klosinski (see Trauzettel-Klosinski [1997a, b] under "Further Reading").