Malingering Versus Factitious Disorder
To malinger is to exaggerate or feign an illness in order to escape duty or work. There are many malingerers in the world of mental health. Some attempt to avoid long prison sentences by feigning a mental illness: they may try to act psychotic or depressed and suicidal. Some are successful and are sent to a psychiatric state hospital; others return back to prison to serve the remainder of their sentence.
Another example of malingering is a homeless person wanting shelter as winter is approaching. They will enter a hospital emergency department and make up various symptoms such as, “I had a seizure“, “I had a stroke”, “I’m really sick, my stomach has been killing me.” If the neurologist or ED physician is experienced, they will easily catch on to the malingering.
Factitious disorder is when a person presents with real symptoms in order to assume the sick role; they have an unconscious desire to be treated like a patient. They may self-inject fecal material in order to acquire a bacterial infection or self-administer insulin in order to become hypoglycemic.
Patients with factitious disorder are usually female nurses or hospital employees who have general knowledge of the healthcare system and desire upfront medical attention. There is even factitious disorder by proxy, where a person will make their child or elder sick in order to assume the caretaker role!
The clear difference between malingering and factitious disorder is that the former is a conscious act; the latter is a conscious act motivated by an unconscious desire. Malingerers find an excuse to obtain a get out of jail free card, while patients with factitious disorder have unconscious conflicts that become the drivers behind their behavior.
If you find a patient who is unwilling to cooperate with medical procedures and evaluations and paints a sketchy picture, then you have just met a malingerer. If you find a patient who is a middle-aged female and has a medical track record of entering many different hospitals in a short period of time for suspicious and questionable activity, then you have just met a person with factitious disorder.
Welcome to the world of mental health!
Are you Ready? (This is Defeating Stigma Mindfully)