ABSTRACT
Posttraumatic illnesses, the diagnoses of which sometimes rely upon the patient's self-reports, are often linked to financial incentives. One type of self-reported posttraumatic illness known as chemosensory dysfunction occurs in as many as 24.5% of head trauma victims. Ferreting out individuals pretending to have chemosensory dysfunction as part of litigation for economic gain is a clinical dilemma requiring a multimodal approach. This includes evaluation of historical context, complaints, physical examination findings, chemosensory testing, psychiatric evaluation, and ancillary testing. Long-standing chemosensory complaints seemingly produce or exacerbate psychiatric problems in various ways. As chemosensory problems persist over time, patients may become pessimistic about an eventual recovery and this may lead to depression. Historical clues indicating malingering also include complaints of trauma-induced absolute loss of chemosensory ability. Consistent with his physical findings, both first taste and temporal summation indicate problems within the chemosensory system.
