Malingering, factitious disorders and somatoform disorders: Pathology review

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Malingering, factitious disorders and somatoform disorders: Pathology review

Psychological disorders

Bipolar and related disorders

Bipolar disorder

Feeding and eating disorders

Anorexia nervosa

Bulimia nervosa

Medication-induced movement disorders and other adverse effects of medication

Neuroleptic malignant syndrome

Serotonin syndrome

Somatic symptom and related disorders

Factitious disorder

Somatic symptom disorder

Trauma and stressor-related disorders; Abuse

Physical and sexual abuse

Post-traumatic stress disorder


Malingering, factitious disorders and somatoform disorders: Pathology review

USMLE® Step 1 questions

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USMLE® Step 1 style questions USMLE

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A 17-year-old girl presents to her primary care physician to evaluate right leg weakness for two weeks. The patient states, “I can’t lift my right leg, and it feels numb too. I haven’t been able to walk or go to school because of my symptoms.” The patient's parent states, “I don’t know what’s wrong. I know school has been hard this year with her applying to college, but all of this just came out of the blue.” The patient is otherwise healthy and neither uses illicit substances nor consumes alcohol. Vital signs are within normal limits. The patient has 2+ symmetric reflexes in the bilateral lower extremities on physical examination. Plantar reflex testing results in flexion of the big toe bilaterally. While the patient lies supine, the physician places a hand under the right heel; when asked to lift the left leg against resistance, the patient exerts downward pressure with the right heel. Further history gathering is most likely to reveal which of the following?  


A 5 year old girl named Celia is brought to the emergency department by her mother due to a sudden episode of loss of consciousness.

You decide to run some blood tests, which reveal low glucose levels.

After glucose administration, Celia fully recovers.

You admit her to the hospital to do exhaustive studies to start looking for a cause of her hypoglycemia.

The tests all come back normal, so you decide to discharge Celia.

The next morning, Celia has another unexplained episode of hypoglycemia, so you decide to check her blood insulin levels, which are found high, while her C-peptide levels are slightly low.

Some days later, 32 year old Sofia presents to the emergency department.

Sofia is complaining of severe chest pain that has been going on for the past couple hours, and she is certain that she is having a heart attack.

According to the hospital records, she has presented to the emergency department with similar symptoms 7 times within the past 12 months.

And each time, cardiac evaluation was normal.

Upon examination, both cardiac auscultation and ECG are normal.

Sofia becomes frustrated and storms out of the hospital demanding a second opinion.

Based on the initial presentation, both Celia and Sofia have some form of malingering, factitious, or somatic symptom and related disorders.

What all these have in common is that the affected individual claims to have physical or psychological symptoms that aren’t explained by any known physical or mental disorder.

Okay, starting with malingering, this is when individuals are intentionally faking or exaggerating their symptoms in order to achieve some secondary gain or external goal.

This may include getting money, housing, time off from work, access to medications, or even escaping jail time.

In other words, they’re conscious or aware of their specific motivation.

For your exams, remember that these individuals are typically uncooperative, meaning that they demand an extensive workup, but are not satisfied with negative results and don’t adhere to the diagnostic follow-up or treatment plan.

Another clue is that symptoms stop once they achieve their goal.

On the other hand, in factitious disorder, the individuals are intentionally faking or inducing symptoms, but the goal here is to get the attention and sympathy that is often given to someone who’s sick.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Excessive Illness Behavior" Psychiatric Care of the Medical Patient (2015)
  4. "Essentials of Psychiatry" Wiley (2006)
  5. "The diagnosis and treatment of Munchausen’s syndrome" General Hospital Psychiatry (2003)
  6. "Kaplan & Sadock's Comprehensive Textbook of Psychiatry" NA (2000)
  7. "Diagnostic and Statistical Manual of Mental Disorders" Amer Psychiatric Pub Incorporated (2000)
  8. "Multisomatoform Disorder" Archives of General Psychiatry (1997)

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