What Is the Difference Between Malingering and Factitious Disorder?
Factitious disorder is the term used to describe a pattern of behavior centered on the exaggeration or outright falsifications of one’s own health problems or the health problems of others. Some people with this disorder fake or exaggerate physical problems; others fake or exaggerate psychological problems or a combination of physical and psychological problems. Factitious disorder differs from a pattern of falsified or exaggerated behavior called malingering. While malingerers make their claims out of a motivation for personal gain, people with factitious disorder have no such motivation.
Factitious Disorder Basics
People with factitious disorder do several things that are unexpected for patients who present themselves for medical treatment, or for individuals seeking treatment for others in their care. First, they commonly exaggerate or lie about problems in their medical histories or the histories of others. They also present their doctors with symptoms that don’t legitimately come from illnesses or injuries, and fail to use their doctors’ care as a means to get better and recover from their physical or psychological complaints. In addition, people with factitious disorder often intentionally injure themselves or others, undergo unnecessary surgical procedures, or purposefully fake or alter the results of the tests doctors use to diagnose illness.
Critically, individuals affected by factitious disorder don’t engage in these behaviors out of the desire to do such things as miss work, gain financial rewards or insurance benefits, or otherwise commit fraud. Instead, they have an ingrained, unreasonable attachment to the notion of being ill or acting as the caretaker of another ill person. The two most well-known forms of factitious disorder are probably Munchausen syndrome and Munchausen syndrome by proxy. People with Munchausen syndrome do things to fake or exaggerate their own physical problems, while people with Munchausen syndrome by proxy do things to fake or exaggerate the physical problems of others (typically children or elderly people incapable of caring for themselves). The American Psychiatric Association officially recognizes factitious disorder as a mental illness and classifies it with a group of conditions called somatic symptom and related disorders.
Malingerers may engage in many of the same activities as people affected by factitious disorder. However, unlike individuals affected by that disorder, malingerers have clear external motivations that drive their faking and exaggerating behaviors. Common motivations for malingering include insurance fraud or other forms of financial gain, the improper acquisition of controlled medications, shirking of obligations for military service, shirking of work obligations, or an attempt to avoid incarceration for criminal acts.
Malingering is not a form of mental illness. However, people who adopt malingering behaviors often have a diagnosable mental illness called antisocial personality disorder. Individuals with this disorder have a long-standing pattern of involvement in activities that purposefully exploit or manipulate others, or blatantly disregard the legal rights of others. Malingerers also frequently exhibit signs of another personality-related condition, called histrionic personality disorder. Individuals with this condition habitually and reflexively use excessive displays of drama and emotion to gain attention from others.
Doctors often have considerable difficulty telling the difference between cases of factitious disorder and accurately reported, legitimate physical or mental health complaints. This situation can be complicated substantially by the need to identify the behaviors of malingerers who have neither factitious disorder nor legitimate health complaints. Potential telltale signs of a malingering individual include a previous diagnosis for antisocial personality disorder, the early involvement of lawyers in a medical issue, and poor compliance with the treatment prescribed by a doctor. Doctors can also detect malingerers by looking for inconsistencies in the symptoms presented by their patients and extensively interviewing patients suspected of malingering.
Factitious disorder and malingering can both potentially bear a strong resemblance to a mental disorder called conversion disorder, which also belongs to the somatic symptom and related disorders category. In a manner similar to malingerers and individuals with factitious disorder, individuals with conversion disorder come to their doctors with medical problems that don’t stand up to extensive scrutiny. However, unlike factitious disorder patients or malingerers, people with conversion disorder truly believe that they have the ailments they report to their doctors. Common problems reported in cases of conversion disorder include things such as limb paralysis, blindness or other visual disturbances, hearing loss, hallucinations, unusual numbness, loss of proper muscle coordination, an inability to walk normally, and swallowing or speaking difficulties.