Factitious disorder and malingering

Abstract

Factitious disorder and malingering are two forms of abnormal illness behaviour in which mental or somatic symptoms are deliberately fabricated or grossly exaggerated or otherwise grossly misrepresented. They are forms of other-deceit, with the person in question assumed to be fully aware of this deceit. The central distinguishing feature of both is that factitious disorder is commonly thought to be motivated by internal incentives (primary gain: medical treatment, assuming the sick role), while malingering is directed towards an external goal (secondary gain, for example monetary compensation, sick leave). The utility of distinguishing between the two forms of feigning has long been questioned. Similarly, it must be questioned why factitious disorder is apprehended as a mental disorder in its own right. Neither the Diagnostic and Statistical Manual of Mental Disorders (DSM) nor the International Classification of Diseases (ICD) contains useful diagnostic guidelines for reliably diagnosing feigned illness presentations; in particular, several decades of malingering research and conceptual developments have found no repercussion there.