You are referred a patient with a 3-year history of multiple vague health and cognitive complaints including pain, nausea, memory and concentration difficulties, and fatigue. Despite an exhaustive battery of tests, no medical basis has been found for the patient's symptoms.
Additionally, the reported severity of her complaints appears grossly out of proportion given gathered information and your own clinical observations. She does appear genuinely and significantly distressed by her reported issues but otherwise denies depressive symptoms.
After meeting with the patient, reviewing medical records (which include valid performance on neuropsychological validity testing), and interviewing multiple collateral sources, you come to the opinion that the patient is not intentionally falsifying or exaggerating her symptoms.
The patient does claim that she is no longer able to work due to the severity of her difficulties and states that she intends to file for disability.
Answer C. Somatic symptom disorder
In the above case, malingering would not be a correct diagnosis. DSM-5 criteria provide 4 conditions under which malingering “should be strongly suspected.” These include:
• medicolegal context
• discrepancy between self-report and medical findings
• poor patient cooperation
• antisocial personality disorder
A number of substantive changes to the diagnostic labels and criteria for somatoform disorders appear in DSM-5. These disorders are now referred to as somatic symptom and related disorders.
This DSM diagnostic category includes factitious disorder as well as conditions such as somatic symptom disorder, illness anxiety disorder, and conversion disorder (functional neurological symptom disorder). The latter disorders can be difficult to clinically differentiate from malingering and factitious disorder because patients with these disorders also report symptoms that are in excess of, inconsistent with, or incompatible with known manifestations of true medical illness.
For related information, see “Challenges in Assessing and Managing Malingering, Factitious Disorder, and Related Somatic Disorders,” by Phillip K. Martin, PhD, Ryan W. Schroeder, PsyD, on which this quiz was based.
This article was originally published on November 11, 2015 and has since been updated.