Malingering, factitious disorders and somatoform disorders: Pathology review

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.