Malingering or Factitious Disorder?

Malingering is defined as the exaggeration or complete invention of symptoms in order to obtain some goal, usually having something to do with gaining social benefits.

In the context of psychological tests, malingering can be very damaging to the results of a test because it can lead the psychologist to make diagnostic decisions based on fictitious symptoms. Assigning a certain kind of medication or therapy to a patient who does not need it can cause serious damage. Furthermore, on a societal level, malingering can skew results for population surveys, and can bring about needless spending of funds for social benefits given to a group that does not require it.

However, even though malingering is not considered a mental disorder, there exists a condition called factitious disorder (of which the most severe form is Munchausen syndrome), in which a patient feigns and exaggerates symptoms. So because both malingering and factitious disorder have virtually identical definitions, how does one tell the difference? The distinction remains very blurry, because individuals who are suspected of malingering may claim to be affected by factitious disorder in order to be exempted from potential consequences, so accurate data on the distinction between the two is harder to obtain.

Theoretically, the most notable difference between the two concepts is that malingering is often done to gain social benefits of some kind, while in factitious disorder, symptoms are often exaggerated or invented to gain attention or pity. The effect on test results is essentially the same however, because while the two concepts have different motivations, the outcome still involves false symptoms.

It is still important however, to know how to tell the difference because while malingering is a conscious effort and not considered an illness, factitious disorder is a real disorder that can be treated. To my knowledge, there is no currently available test to differentiate the two. Because factitious disorder is characterized by a need for attention or pity, my theory is that a test can be devised that would assess patients to see if they require the same attention in other aspects of their lives (family troubles, money, etc…). If patients tend to exaggerate their problems in other parts of their lives in order to gain pity, perhaps this could be a good indicator as to the presence of factitious disorder. If that is not the case, one could infer that the patient only had one goal in mind (acquiring social benefits) and therefore had no need to embellish other parts of their lives, hence malingering.

This theory is quite rough and has not been tested, but perhaps developing such a test could help clinicians assess the difference between malingering and factitious disorder, and assign the right treatments to the patients who need them, while sending the ones who have no actual disorder on their way.