Aggravation - It is an exaggeration by the subject of the described severity of symptoms that are actually present or subjectively felt. Aggravation can act consciously deterministic activity or have a subconscious nature of occurrence. The causes of aggravation of the painful symptoms can be determined, both by the true presence of the disease, and by the personality and motivational features of the person.

Aggravated behavior is considered when a person contributes to the deterioration of their own health or delays the period of illness (active form, when non-compliance with the doctor’s recommendations, self-injury is possible) or exaggerates the existing symptoms (passive form when the number of complaints increases). A pathological simulation is manifested not only by the amplification by the subject of the symptoms of the existing disease, but also by minimizing the effect of the treatment, which may not coincide with the objective indicators of improvement. This condition is attributed to mental disorder, requires appropriate clinical diagnosis and psychotherapy. Unlike conscious simulation, aggravation can be a symptom or a characteristic of the degree of progression of psychopathology.

What is aggravation?

The causes of the aggravation of the existing symptoms are mental disorders or abnormalities that accompany hypochondriac and hysteroid accentuation, as well as inherent in the elderly, with significant changes in the psyche. Also, this behavior may develop due to chronic psychological trauma (reminding others about the defect, over-care), and have a neurotic nature. The difficulty in diagnosing this disorder lies in its initial and superficial similarity with simulation, however, the simulation is always self-serving motivation, while aggravated actions are an unconscious manifestation of the hidden desires of the individual and contribute to receiving attention or care.

In the course of establishing the authenticity of mental status and forensic psychiatric examination, doctors and investigators are confronted with such phenomena as simulation and aggravation. To determine, coordinate and adjust further actions, as well as decide the fate of the subject, it is very important to distinguish one from the other. So, simulation is a deliberate, conscious, often planned act of behavior aimed at deliberately imitating nonexistent symptoms and manifestations of mental or somatic disorders, the purpose of which is often to avoid judicial punishment.

Activation of aggravated behavior can be observed, both during the investigation and at critical moments of decisions on the further fate of those already convicted. More often, the simulation uses simulation behavior with a description of anamnestic indications than directly acting out the painful symptoms. The determination of the truth of the picture of the presented complaints is reduced to a clinical investigation, observation of the subject and psychological examination.

Simulation and aggravation are different processes, although simulation against the background of the presence of pathological disorders of the psychiatric registry is aggravation.

Types of aggravation. It happens subconsciously (inherent in a sick person), deliberate (with the aim of obtaining benefits or the necessary outcome of events) and pathological (in the mentally ill). The subconscious has the desire of a person to receive sympathy and support. It is often found in patients with a hysterical, hypochondriacal and psychopathic accentuation warehouse, anxiously-suspicious individuals who overly carefully monitor the parameters of their health and any disease is immediately put on the rank of a serious, painful sensations are exaggerated.

The reasons for the aggravation for the suggested people are in reading the medical literature and attributing to themselves diseases, in the careless statement of the doctor or any representative of the medical staff.

Deliberate aggravation is motivated by profit. It is divided into active (when the patient himself delays recovery or independently worsens his condition) and passive (exaggeration of symptoms, complaints about other phenomena not characteristic of the disease) form. When deliberately exaggerating the symptoms of the disease, aggravated behavior is a criminal offense if it is used for illegal purposes (receiving insurance payments, exemption from the army, etc.).

When it becomes necessary to establish the fact of aggravation, the doctor or bailiff primarily focuses on the objective data of the patient’s examination, on obtaining the necessary tests, and not on his subjective descriptions of his well-being.

Pathological aggravation is considered in the perspective of aggravation of mental disorders.

Aggravation of mental disorders

Pathological aggravation implies an exaggeration of the symptoms of the manifestation of somatic and psycho-emotional ailments in mentally ill people. It is quite common in forensic psychiatric activities, occurring in the form of deliberate complaints of symptoms that were previously inherent and characterized the disease, but are currently cropped.

Psychiatric aggravation is divided into three main types of manifestation: meta-aggravation, super-aggravation and dissimulation. When meta-engraving, a person deliberately seeks to prolong the most acute phase of the disease (depression, arousal stimulation).

Overgrowing involves complaints of symptoms, which is excluded in case of a real diagnosable disease (intellectual and mental disorders in schizophrenia).

Dissimulation is the concealment of the disease or its manifestations, which are caused by the disease and the features of its course (with the exacerbation of schizophrenia and psychotic states, the person is not able to assess his own condition, and the motives dictated by the disease require the concealment of all symptoms).

Pathological aggravation carries symptoms that are preserved in the memory of actually existing or residual manifestations of mental disorders. Most often occurs when mental illnesses are based on organic nature (head injuries, vascular and hereditary diseases, with oligophrenia). The most common is exaggeration of intellectual inconsistency, problems in the mnestic sphere, headaches, loss of orientation in society, and depressive manifestations.

Aggravation becomes a habitual form of behavioral patterns when the first aggravated behavior led to a successful resolution of the situation or acts as a standard reaction of an altered personality in critical situations. Such a response mechanism is fixed and may reflect in the future the depth and severity of mental damage (so, with a decrease in the intellectual-mnestic sphere, the aggravated behavior begins to look more grotesque and ridiculous).

The form and degree of aggravation is a way to assess the severity of mental disorders, the degree and speed of progression of the disease. The more primitive, coarser, and more absurd the manifestations of aggravation, the greater the degree of mental disorder can be said.

Aggravation therapy includes drug therapy for the underlying disease and psychotherapy. The main goal of psychotherapy will be to search for hidden motives, human needs and bring them to the area of ​​consciousness, and at subsequent stages to search for various socially acceptable, relevant and appropriate ways to meet the detected requests.