Factitious Disorder Vs Malingering: Understanding The Difference

You may have encountered Munchausen syndrome (now known as Factitious Disorder) before in Netflix series or movies, often portrayed as patients faking illness for attention, undergoing unnecessary surgeries, or manipulating loved ones with fabricated symptoms. These depictions highlight a real clinical disorder.

Factitious disorder, however, drives individuals to become the “sick role” through deception motivated by psychological needs, such as emotional care, qualifying it as a diagnosable psychiatric condition in the DSM-5 [1]. 

Malingering, on the other hand, involves the deliberate production or exaggeration of symptoms for tangible external gains, like financial compensation or evading responsibilities, and is not classified as a mental disorder. Read on to understand their differences, diagnostic challenges, and implications for treatment.

What is Factitious Disorder? 

Factitious disorder is an official mental illness classified as a somatic symptom disorder (also called somatoform disorder, and formerly known as Munchausen). People with this disorder often exaggerate or lie about having, or the severity of, their medical or psychiatric symptoms.  Factitious disorder is rare, with estimates ranging from 0.2-1% in hospital settings and around 1.3% in primary care settings [1]. 

There are two primary kinds of factitious disorders: 

• Factitious disorder imposed on self (FDIS): The individual lies about their own health and the severity of symptoms. 

• Factitious disorder imposed on another (FDIA): The person lies about someone else’s health, and the victim is usually a child, elderly, or disabled person who can’t take care of themselves. This is also referred to as Munchausen Syndrome by Proxy (MSBP).

People with factitious disorders also try to fake diagnostic test results. For example, they might falsify urine tests by swapping out urine samples or taking medications they know will change the results of a blood test.  

What is Malingering?

Malingering is the intentional fabrication or exaggeration of symptoms specifically for external incentives such as avoiding work or legal responsibilities, financial gain, or obtaining drugs. 

It is not an official mental health disorder, but rather a behavioral issue sometimes found in individuals with mental health disorders such as borderline personality disorder, antisocial personality disorder, and dissociative disorders. 

Common examples of malingering include: 

• Claiming severe back or neck pain to receive paid leave or disability benefits 
• Exaggerating psychiatric symptoms during legal trials to avoid persecution
• Faking or exaggerating accidents or injuries for insurance payouts
• Fabricating or exaggerating pain to obtain prescription drugs such as opioids or benzodiazepines  

Diagnosing Malingering vs Factitious Disorder

It’s difficult to recognize someone who is malingering versus someone with a factitious disorder, as they may present similarly, but the motivations and intentions of their behaviors are different. 

Malingering isn’t an official diagnosis and is often directly related to incentives or rewards such as money, drugs, or leave from work. Signs of malingering can include:

• A previous diagnosis of antisocial personality disorder
• Significant difference between a person’s stated injury or illness and the findings of the professional
• Refusal of appropriate treatment for the illness they claim to have
• Involving a lawyer early in the diagnostic process may indicate a financial motive 

People with factitious disorders intentionally produce or exaggerate symptoms, but can’t control their behavior and are not doing it for an external incentive. Their motive is due to underlying psychological needs rather than personal gain. It is an official diagnosis in the DSM-5, and the criteria include [2]:

1. DSM-5 Criteria for Factitious Disorder Imposed on Self

• Falsification of physical or psychological signs/symptoms, or induction of injury/disease, with identified deception
• Presents self to others as ill, impaired, or injured
• Deceptive behavior persists without obvious external rewards
• Not better explained by another mental disorder (e.g., delusional disorder)

2. DSM-5 Criteria for Factitious Disorder Imposed on Another

• Falsification of symptoms in another person, with identified deception
• Presents the other (victim) as ill/impaired

 Malingering vs Factitious Disorder: A Quick Glance 

How Are Malingering and Factitious Disorder Treated? 

Malingering and factitious disorder require different approaches due to their varying motivations and classifications. Malingering, being intentional for external gain, focuses on detection and incentive management rather than therapy. Factitious disorder, a psychiatric condition, is treated with psychotherapy to address underlying psychological needs. 

Malingering “Treatment”

• Indirect confrontation: Discuss findings without accusing; offer alternative explanations to de-escalate, and encourage honesty.​

• Remove incentives: Limit access to rewards like drugs or time off; monitor compliance.​

• Supportive counseling: Encourage behavioral changes without formal therapy.​

Factitious Disorder Treatment

• Psychotherapy (CBT primary): Challenge deceptive patterns and build coping skills.
  • Example: Helping a patient recognize attention-seeking behavior through cognitive reframing sessions.​

• Hospitalization if needed: Manage self-harm from induced symptoms.
  • Example: Inpatient care for someone injecting contaminants, with supervised removal.​

• Family therapy: Involve support networks to address enabling.
  • Example: Educating relatives on boundaries and recognizing FDIS or FDIA to provide support and reduce stigma.​

Mental Health and Addiction Treatment for Men at AnchorPoint 

At AnchorPoint, men receive tailored mental health and addiction support through Christ-centered programs addressing these challenges head-on. Specialized therapies like CBT, group sessions, and equine-assisted therapy address personality disorders, maladaptive behaviors, and co-occurring issues, fostering genuine vulnerability and lasting recovery. 

Take the first step toward authentic strength. Contact our admissions team to verify your insurance benefits today.

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