A Factitious Disorder must be distinguished from a true general medical condition and from a true mental disorder. Suspicion that an apparent mental disorder or general medical condition in fact represents Factitious Disorder should be aroused if any combination of the following is noted in a hospitalized individual: an atypical or dramatic presentation that does not conform to an identifiable general medical condition or mental disorder; symptoms or behaviors that are present only when the individual is being observed; pseudologia fantastica; disruptive behavior on the ward (e.g., noncompliance with hospital regulations, arguing excessively with nurses and physicians); extensive knowledge of medical terminology and hospital routines; covert use of substances; evidence of multiple treatment interventions (e.g., repeated surgery, repeated courses of electroconvulsive therapy); extensive history of traveling; few, if any, visitors while hospitalized; and a fluctuating clinical course, with rapid development of “complications” or new “pathology” once the initial workup proves to be negative. However, it should be noted that the absence of objective signs (e.g., a demonstrable lesion) is not necessarily an indication that the symptoms (e.g., pain) are intentionally produced.
In Somatoform Disorders, physical complaints that are not fully attributable to a true general medical condition are also present, but the symptoms are not intentionally produced. Malingering differs from Factitious Disorder in that in Malingering, the individual is consciously motivated by an external incentive. Individuals with Malingering may seek hospitalization by producing symptoms in attempts to obtain compensation, avoid prosecution, or simply “get a bed for the night.” However, the goal is usually apparent, and they can “stop” the symptoms when the symptoms are no longer useful to them. In Factitious Disorder, the individual is usually not aware of the motivation behind the factitious behavior and external incentives are absent.