Rolling Uterus exerpts.

[Guest guest]

" In spite of the absence of findings on physical exam and lab studies (even

labs that confirmed the hysterical nature of their respiratory and cardiac

complaints), the somatoform patients seemed to readily adopt a lifestyle of

invalidism. We observed that one patient had enlisted her parents to drive her

and carry even lightweight bags for her. These patients appeared truly

convinced that they were ill "

" First, these somatoform patients tended to demand an exceptional degree of

accommodation during evaluations. One patient asked to be moved to another

testing site because the perfume worn by another patient in the waiting room was

offensive. Another requested that testing be halted because the examiner’s

hair product was bothersome.

Second, given enough time, the somatoform patients eventually unmasked

themselves with claims and behaviors that violated known medical principles. The

Sisyphean task of the somatoform patient, after all, is to simulate illness

using an essentially healthy body. For example, one patient presented to the

neuropsychological evaluation claiming to be unable to tolerate the examination

room, certain that “fumes†and “mold†were present. "

Finally, the malingerers often overtly refused to cooperate with the

examination. One refused to provide a spontaneous report of symptoms and instead

insisted that the examiner ask specific questions regarding organ systems, and

refused to provide names of medical providers, ordering the examiner to look in

the records. One responded “I don’t know†to simple questions, but was

able

to provide other answers, to even more complex questions, when prodded.

Resolutely focused on their physical symptoms, individuals with the MMPI-2

conversion profile classically demonstrate impaired capacity to introspect into

their own psychological functioning. In the case of our patients, focus on

the “mold exposure†and its alleged associated physical and cognitive

effects

benefited them emotionally, diverting their attention from major

psychosocial stressors or life problems they felt unable to solve.

Some authors have posited that, rather than being dichotomous concepts,

malingering and somatoform presentations may lie on a continuum between

self-deception and other-deception, with some patients embodying elements of

both

conditions

The question often arises whether the presence of legitimate physical illness

could lead patients to produce elevations on scale 1 (hypochondriasis) and

scale 3 (hysteria) of the MMPI-2. As Graham points out, many clinicians assume

that true medical problems are necessarily emotionally distressing to

patients, and that such distress will be reflected in highly deviant scores on

the

MMPI-2 (Graham, 2000). Nonetheless, the major MMPI-2 reference sources stress

that patients with legitimate physical illness may show minor elevations on

the hypochondriasis scale, but do not obtain the significant elevations we

observed in the cases reported here:

Analysis of MMPI-2 data for each patient included examination of scores on

the Lees-Haley Fake Bad Scale (FBS; Lees-Haley, English, & Glenn, 1991).

[Told you so!!!!]

The histories shared above reflect just how deceptive and complicated

allegations of “toxic mold†exposure can be. Certainly, these six cases

represent

a small sample, and thus our findings require replication with a larger n.

However, based on the insights derived from these cases as well as the enormous

limitations of the current literature regarding “toxic mold,†we would

argue for the following cautionary principles when performing forensic

evaluations of alleged toxic mold sufferers. First, a multidisciplinary

evaluation by

neurologist, psychiatrist, and neuropsychologist is mandated.