Factitious disorder versus malingering

FACTITIOUS disorder is defined as intentional efforts to falsify an illness in oneself or another. Manufacturing an injury in oneself or another might also be performed. The individual’s identity is wrapped up in being someone who is ill, impaired, or injured. These efforts are maintained in the absence of obvious external rewards (e.g., money, off duties or duty avoidance).

Examples of factitious disorder behaviour:

◆ Reporting that one has a life-threatening illness, despite the lack of symptoms or ever receiving a diagnosis.

◆ Fabricating neurological complaints (e.g., dizziness, blacking out) in the absence of such symptoms in order to deceive others.

◆ Manipulating laboratory tests to signal abnormalities.

◆ Physically harming one self to cause injury or illness.

◆ Harming someone else (e.g., child) in order to assume a victim role

by proxy. Like the other group of somatic symptom and related disorders, factitious disorder has a somatic (bodily) component that is related to psychological functioning. However, in the case of factitious disorder, physical symptoms are not necessarily present; rather, the individual attempts to fabricate a story about them, or intentionally and deceptively induce such physical maladies. There is a clear intention to misrepresent, induce, simulate, or exaggerate such symptoms.

Malingering is pretending to be sick when you aren’t or pretending to be sicker than you are, particularly when you have something to gain. Malingering is the purposeful production of falsely or grossly exaggerated physical or psychological complaints with the goal of receiving a reward.

These may include money, insurance settlement, drugs or the avoidance of punishment, work, jury duty, release from incarceration, the military, or some other kind of service. A malingerer may attempt to raise the temperature of a thermometer through heat from a lamplight or alter a urine sample by adding sand to it; however, if the malingerer is more discrete, the clinician may have great difficulty gathering evidence for an accurate diagnosis.

Malingering is not a psychiatric disorder but rather is a fraudulent activity and can lead to abuse of the medical system, with unnecessary tests being performed and time taken away from other patients.

Malingering should not be confused with factitious disorder in which the motive is the desire to occupy a sick role, rather than some form of material gain. Patients may falsify their symptoms because they think that the symptoms will inevitably arise sometime in the future. For example, an individual may falsely claim that they have symptoms of infection while they can receive compensation, because they believe that they will likely develop the infection at some future point.

Psychiatric evaluation is mandatory and will help in both cases to separate the two when there as well as to map the way forward.

◆ Dr Sacrifice Chirisa is a passionate mental health specialist at Parirenyatwa Hospital, one of the country’s major referral centres