Factitious Disorder vs Malingering: Understanding the Differences

Factitious disorder and malingering are two conditions that can be easily confused, but they have some key differences. In this blog post, we will explore these differences and provide some insight into these two conditions.

What is Factitious Disorder?

Factitious disorder is a condition in which a person intentionally produces or exaggerates physical or psychological symptoms, without any external rewards. In other words, the person is not motivated by any tangible external incentives such as avoiding work or military service, or evading criminal prosecution.

Patients with factitious disorders may alter their own physiology in order to simulate real illnesses. For example, they may take drugs to produce symptoms. This can put them at risk for serious injury or death, and they may even need to be committed to an institution for their own protection.

The prevalence of factitious disorder is not well established, but it is estimated to be around 0.5 to 0.8 percent of patients in general hospital settings. The disorder is also thought to be more common in women than in men. However, systematic research on this disorder is lacking and there is currently no theoretical model of why it develops (Hooley et al, 2019).

What is Malingering?

Malingering, on the other hand, is a condition in which a person intentionally produces or grossly exaggerates physical symptoms for external incentives. These incentives can include avoiding work or military service, evading criminal prosecution, or obtaining financial compensation.

Key Differences

The key difference between factitious disorder and malingering is the motivation behind the behavior. In factitious disorder, the person receives no tangible external rewards for their behavior. In contrast, the person who is malingering is motivated by external incentives.

Another important difference is the potential harm caused by the behavior. In factitious disorder, the person may be at risk for serious injury or death due to their actions. In malingering, the harm caused by the behavior is typically limited to financial or legal consequences.

A Dangerous Variant: Factitious Disorder Imposed on Another

A dangerous variant of factitious disorder is factitious disorder imposed on another (sometimes referred to as Munchausen’s syndrome by proxy). In this condition, the person seeking medical help has intentionally produced a medical or psychiatric illness (or the appearance of an illness) in another person. This person is usually someone (such as a child) who is under his or her care.

In a typical instance, a mother presents her own child for treatment of a medical condition she has deliberately caused. To produce symptoms, the mother might withhold food from the child, add blood to the child’s urine, give the child drugs to make him or her throw up, or heat up thermometers to make it seem as if the child has a fever. If the child is hospitalized, the mother might deliberately infect an intravenous (IV) line to make the child more ill.

This form of child abuse can seriously endanger the health of the victim and may require intervention from social service agencies or law enforcement. In as many as 10 percent of cases, the actions of the mother may lead to a child’s death.

This disorder may be suspected when the victim’s clinical presentation is atypical, when lab results are inconsistent with each other or with recognized diseases, or when there are many frequent returns or increasingly urgent visits to the same hospital or clinic. The perpetrators (who often have extensive medical knowledge) tend to be highly resistant to admitting the truth about what they are doing. They also appear to be devoted to their child, making it hard for healthcare providers to suspect that they are the cause of the child’s problems.

It has been estimated that it takes an average of 14 months to confirm a diagnosis of factitious disorder imposed on another. If the perpetrator senses that medical staff are suspicious, he or she may abruptly terminate contact with that facility and show up at another one to begin the process anew. Compounding the problem of detection is that healthcare professionals who realize they have been duped may be reluctant to acknowledge their fallibility for fear of legal action.

One technique that has been used with considerable success in diagnosing this disorder is covert video surveillance of the mother and child during hospitalizations. In one study, 23 of 41 suspected cases were finally determined to have factitious disorder by proxy, and in 56 percent of those cases,

Video
surveillance was essential to diagnosis.

Conclusion

In conclusion, factitious disorder and malingering are two conditions that can be easily confused but have some key differences. The main difference between these two conditions lies in their motivation: while people with factitious disorder receive no tangible external rewards for their behavior, those who are malingering are motivated by external incentives such as avoiding work or military service or evading criminal prosecution.

References

Hooley, J. M., Nock, M. K., & Butcher, J. N. (2019). Abnormal Psychology (18th ed.). Pearson Education (US). https://bookshelf.vitalsource.com/books/9780135191033