Malingering VS

Factitious Disorders
DSM-IV-TR
TM
American Psychiatric Association: Diagnostic and statistical Manual of Mental Disorders,
Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000
Russell L. Smith, MS,
LPA, HSP-PA, CCBT, MAC, FABFCE, NCP
INTENTIONALLY
produced physical or
psychological symptoms:
FACTITIOUS DISORDER
MOTIVATED BY A
PSYCHOLOGICAL NEED TO
ASSUME THE SICK ROLE
NOT USUALLY AWARE OF THE
MOTIVATION
MALINGERING
MOTIVATED BY EXTERNAL
INCENTIVES
GOAL IS APPARENT AND THEY
CAN STOP WHEN SYMPTOMS
ARE NO LONGER USEFUL

... To Assume the
SICK ROLE ...
SUBJECTIVE COMPLAINTS
(E.G., PAIN)
FALSIFICATION OF OBJECTIVE
SIGNS
(E.G., MANIPULATING
THERMOMETER)
SELF-INFLICTED CONDITIONS
(E.G., INJECTING SALIVA INTO
SKIN)
EXAGERATION OR
EXACERBATION OF
PEREXISTING MEDICAL
CONDITION
(E.G., FAKE SEIZURE)

Factitious Disorder
300.16 With
Predominantly
Psychological Signs and
Symptoms
~ claim depression and
suicidal ideation
~ memory loss
~ hallucinations or delusions
~ symptoms of PTSD
~ dissociative symptoms
Factitious Disorder
300.19 With Predominantly
Physical Signs and Symptoms
infection ... impaired healing
pain, bleeding, or rashes
hypoglycemia ... anemia
neurological (e.g., seizures,
dizziness, or blacking out)
vomiting or diarrhea
fevers of undetermined origin
autoimmune or connective tissue
disease
all organ systems
Factitious Disorder
~ dramatic flair
~ vague and inconsistent
~ intriguing pathological ...
pseudologia fantastica
~ knowledge of medical terminology,
routines
~ complaints of pain and requests for
analgesics
~ change/add symptoms after
negative findings
~ eagerly undergo invasive procedures
and operations
~ few visitors
~ repeated hospitalizations
Factitious Disorder
~ may give approximate answers
~ may use psychotropic drugs to
produce a wide range of
symptoms
~ may also present with abuse of
analgesics and sedatives
~ may develop conditions due to
unnecessary hospitalizations and
surgical procedures
~ role incompatible with steady
employment, relationships, etc.
Red Flags for
Factitious Disorder
an atypical or dramatic
presentation that does not
conform to known conditions
symptoms presented only when
being observed
pseudologia fantastica
disruptive behavior on ward
extensive knowledge of medical
terminology and hospital routines
evidence of multiple treatment
interventions, travel, few visitors
fluctuating clinical course with
new presentation after initial
workup proves to be negative
Malingering ...
External Incentives
Positive
Reinforcement
Financial gains
Drugs
Social
Interaction
Achieve desired
change in
placement or
services
simply to gain a
meal, a place to
sleep, etc.
simply to
manipulate
others
Negative
Reinforcement
Work Avoidance
Drugs
To establish
mitigating
circumstances
for court
To terminate
undesirable
placement or
services
Avoiding military
service