“unconscious magnification of symptoms”
“In all probability there was a link between his ongoing pain tolerance, level of behavioural activity and mood variability. This may well contribute to unconscious magnification of symptoms. However, this pain is not due to the index accident.”
“Reliability and Validity of Findings” she wrote that the claimant had endorsed symptoms in a manner that was “highly consistent” with honest reporting, that she had “no reason to doubt his veracity”, and that there was “no evidence of conscious exaggeration.”
“In all probability, there is an interaction between his ongoing pain tolerance, level of behavioural activity and mood variability.”
“41. In my judgment whilst some of the symptoms the claimant reports are supported by what the claimant told the various medical practitioners several I find are exaggerated (the effect on his speech, the characterisation of the pain as chronic when it was characterised as 2 on a scale of 1 to 5, the potential for pain as being assessed as minor or trivial and that the way the claimant described the pain was like pins and needles when present but that it came and went). That is supported by Dr Misra [183 9.3] who identified a probable link between the claimant’s pain tolerance, level of behavioural activity and mood variability and they may contribute to ‘unconscious magnification of symptoms’. 42. I return to Dr Misra’s assessment below.”
“55. Thus, again doubt is cast as to the claimant’s account generally on matters. It was in the claimant’s interest to relay the existence of adverse effects to the providers of the medical reports in the context of his personal injury claim. 56. Dr Misra stated that she had no reason to doubt the claimant’s veracity and his account was consistent verbally and the symptoms and psychological problems were highly consistent and thus an honest report of his difficulties and there was no evidence of conscious exaggeration or other consistency factors [186 paragraph 13]. However, no GP or hospital records were provided to Dr Misra and the only other medical report she had was that of Dr Whittington [185 Section E]. I should also record that Dr Misra’s assessment was undertaken by videoconference. She thus did not have the other reports and claimant’s impact statements, nor has she heard the claimant’s account before me. 57. For the reasons I give above there are inconsistencies in those accounts and I also note Dr Misra acknowledged (see (41)) an ‘unconscious magnification of symptoms’ by the claimant. 58. That consistency and credibility point is reinforced by another issue the respondent refers me to, namely that one of Case Number: 1306691/2019 - 15 - the principal adverse effects the claimant gives concerning his mental health impairments was the effect that has had on him socialising. In contrast Dr Misra indicated there was no significant disruption to the claimant’s life and socialisation was not affected [181 - 5.4.3]. 59. Those matters collectively call into question the account the claimant has given to different practitioners and the Tribunal over time, concerning matters that go to the core of his complaints here, whether there was a substantial adverse effect on his ability to undertake day to day activities. 60. They spread across the depth and breadth of his account and combined with the credibility points I refer to above lead me to conclude notwithstanding the assessment Dr Misra made as to the veracity of the claimant’s account (see (56)) that I should place no weight on the claimant’s account (unless supported elsewhere) and that includes that given to the various practitioners and thus the conclusions they reach as a result.”
“As to Keratoconus I find there is no medical evidence to suggest that the adverse effects the claimant describes are firstly matters that cannot be corrected by wearing contact lenses (paragraph 5(3)(a)), secondly (albeit unconsciously) his account of the effects is to be given little weight by virtue of the other inconsistency and credibility points I make above (including but not limited to (60)) and are for the reasons I give (30) (as supported by Dr Misra, see (41)) unconsciously exaggerated.”
“63. As to the jaw/TMJ for the reasons I give above the way the claimant categorised his pain (and speech) was at odds with the characterisation by the medical practitioners and the same credibility and exaggeration issues arise as I identify above. Whilst medication was prescribed within the material time, doubt is cast on the basis for that in my judgment for the reasons I give above concerning exaggeration and the medical opinions being based on the claimant’s account, to which little weight should be given. Further Dr Speculand indicated that any ongoing issue appeared to be as a result of poor dental hygiene. That in my judgement would appear to be a reasonable coping strategy in that the claimant was to be expected to do something he should have been undertaking in any event.”
“As to the Mental Health impairment in February 2020 Dr Whittington concluded that the mental symptoms the claimant exhibited were symptomatic of a psychiatric disorder known as Mixed Anxiety and Depressive Disorder whereas in April 2020 Dr Misra diagnosed that the claimant was clinically depressed.”
“Some of the medical practitioners identified that some of the alleged impairments have impacted on others. As a result I have considered if viewed collectively the impairments mean the s.6 threshold is met. For the same reasons I give above (see for instance (67)) it is not.”
“With regards to unconscious magnification of symptoms – this refers to the potential impact of psychological distress on physical symptoms. Specifically, it describes the maintaining and magnifying effect of increased psychological stress on pre-existing pain.”
“I accept the clarification Dr Misra provides is that her earlier comments do not support the finding I came to that Mr Rehman had exaggerated and was inconsistent. I have thus reflected on my findings and leaving out of account the ‘unconscious magnification of symptoms’ issue, the other credibility points I identified still remain (including the difference between the account the claimant gave concerning socialisation and Dr Misra’s view (see (58))). As I indicated they stretched across the breadth and depth of Mr Rehman’s account and lead me to the same view I came to in (59) & (60).”
“if viewed collectively”
“That is supported …” by Dr Misra’s reference to “unconscious magnification”
“My conclusions were essentially that the claimant’s account was not to be believed on the basis he had given different accounts over time, including those to the various medical experts he was seen by and that despite it being in his interests to give a full account of the effects of any impairment to those medical experts, he had not done so (see (30)).”