Functional neurologic symptom disorder, somatic symptom disorder, and illness anxiety disorder vs Factitious disorder and malingering
How to tell Functional neurologic symptom disorder, somatic symptom disorder, and illness anxiety disorder and Factitious disorder and malingering apart when a board question makes them look alike.
Not intentional: conversion/somatic/illness anxiety; intentional without external reward: factitious; intentional with external reward: malingering.
Side by side
Conversion disorder (functional neurological symptom disorder) has neurologic symptoms incompatible with disease; somatic symptom disorder has distressing symptoms plus excessive thoughts/behaviors; illness anxiety has health anxiety with minimal symptoms.
Factitious disorder intentionally falsifies symptoms without obvious external reward; malingering intentionally falsifies symptoms for external gain.
Conversion, somatic symptom, and illness anxiety presentations are not intentionally produced; the problem is symptom expression or anxiety/preoccupation.
Factitious disorder and malingering involve intentional deception, separated by internal sick-role motivation versus external incentives.
Nonanatomic neurologic deficits support conversion; high anxiety about real symptoms supports somatic symptom; fear of serious illness with few symptoms supports illness anxiety.
Induced illness, tampered tests, inconsistent history, eagerness for procedures, or clear secondary gain helps separate factitious disorder from malingering.
The trap
Medically unexplained symptoms are not automatically faked; intentional production requires evidence or a clear incentive pattern.
The repair move
For symptom-related disorders, decide whether symptoms are neurologic, somatic anxiety, illness fear, or intentional deception.
Try a free question
CoreA patient develops leg paralysis after a stressor. Exam findings are inconsistent with neuroanatomy, imaging is normal, and the patient is not consciously feigning symptoms. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Conversion disorder. Neurologic symptoms incompatible with disease and not intentionally produced support conversion disorder.
Why the other choices are tempting
- B. Somatic symptom disorder centers on distressing somatic symptoms plus excessive thoughts or behaviors.
- C. Illness anxiety disorder has illness fear with minimal somatic symptoms.
- D. Factitious disorder involves intentional falsification without obvious external reward.
- E. Malingering involves intentional falsification for external gain.
Flashcards
Tap a card to flip it.
What supports conversion disorder?
Neurologic symptoms incompatible with recognized disease and not intentionally produced support conversion disorder.
What supports somatic symptom disorder?
Distressing somatic symptoms plus excessive thoughts, feelings, or behaviors about them support somatic symptom disorder.
Quick answers
What is the fastest way to tell Functional neurologic symptom disorder, somatic symptom disorder, and illness anxiety disorder from Factitious disorder and malingering?
Not intentional: conversion/somatic/illness anxiety; intentional without external reward: factitious; intentional with external reward: malingering.
What is the key clue for Functional neurologic symptom disorder, somatic symptom disorder, and illness anxiety disorder?
Conversion disorder (functional neurological symptom disorder) has neurologic symptoms incompatible with disease; somatic symptom disorder has distressing symptoms plus excessive thoughts/behaviors; illness anxiety has health anxiety with minimal symptoms.
What is the key clue for Factitious disorder and malingering?
Factitious disorder intentionally falsifies symptoms without obvious external reward; malingering intentionally falsifies symptoms for external gain.
What is the common trap with Functional neurologic symptom disorder, somatic symptom disorder, and illness anxiety disorder vs Factitious disorder and malingering?
Medically unexplained symptoms are not automatically faked; intentional production requires evidence or a clear incentive pattern.