How are factitious disorder and malingering differentiated from psychogenic nonepileptic seizures (PNES)?

Updated: Jul 26, 2018
  • Author: Selim R Benbadis, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Factitious disorder and malingering imply that the patient is purposely deceiving the physician (i.e., faking the symptoms). The difference between factitious disorder and malingering is that, in malingering, the reason for the deception is tangible and rationally understandable (albeit possibly reprehensible) such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs. In factitious disorder, the motivation is a pathologic need for the sick role.

An important corollary is that malingering is not considered a mental illness, whereas factitious disorder is. As such there are no specific diagnostic criteria for malingering.

A generally accepted view is that most patients with PNES have conversion disorder, rather than malingering or factitious disorder.

Although the DSM-5 classification is simple in theory, knowing whether a given patient is faking it is nearly impossible. In some circumstances, intentional faking can be diagnosed only by catching a person in the act of faking (e.g., self-inflicting injuries, ingesting medications or eye drops to cause signs, putting blood in the urine to simulate hematuria).

Malingering may be underdiagnosed, partly because the diagnosis is essentially an accusation.


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