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Somatic symptom disorders, functional disorder, factitious disorder and malingering
These conditions are separated by two questions: is the symptom produced intentionally, and if so — why; in somatic symptom disorders and functional disorder the symptoms are not intentional, in factitious disorder they are intentional in order to be ill, and in malingering they are intentional for an external gain.
Why it matters in the exam
Exam questions describe a patient with many physical symptoms or a neurological symptom that does not fit the anatomy, and ask for the diagnosis. Somatic symptom disorder: one or more distressing symptoms, with excessive thoughts, anxiety or behaviour around them, for at least 6 months — the diagnosis does not require the symptom to be "unexplained". Illness anxiety disorder: preoccupation with fear of serious illness with few or no symptoms. Functional neurological disorder (conversion): weakness, seizures or blindness with examination findings incompatible with neurological disease, such as the Hoover sign.
Factitious disorder is the deliberate production of symptoms, without external reward, in order to take the sick role — for example injecting insulin or contaminating a wound. When a parent produces symptoms in a child this is factitious disorder imposed on another, which is abuse requiring a report and protection of the child. Malingering is not a mental disorder: the deliberate production of symptoms for an external reward — compensation, leave, avoiding punishment. Treatment of somatic disorders: one regular doctor, scheduled visits rather than symptom-driven ones, fewer unnecessary tests, CBT and treatment of coexisting depression or anxiety. In functional disorder the diagnosis is explained positively and the patient is referred for physiotherapy and psychological therapy.
Key points
- Not intentional: somatic, illness anxiety, functional.
- Intentional for the sick role: factitious disorder.
- Intentional for external gain: malingering (not a mental disorder).
- Functional disorder: findings that do not fit the anatomy, such as Hoover.
- Treatment: one regular doctor, scheduled visits, fewer tests, CBT.
Summary table
| Disorder | Intentional? | Motive | Exam notes |
|---|---|---|---|
| Somatic symptom disorder | No | — | A distressing symptom with excessive thoughts and behaviour, 6 months |
| Illness anxiety disorder | No | — | Fear of serious illness with few or no symptoms |
| Functional neurological disorder (conversion) | No | — | Findings that do not fit anatomy (Hoover sign); indifference is not required |
| Factitious disorder | Yes | Internal — to be ill | Changes of care provider, medical knowledge; imposed on another — child abuse |
| Malingering | Yes | External — money, leave, avoiding punishment | Not a mental disorder |
A free exam question
איזה מהבאים לא נחשב מנגנון הגנה נרקיסיסטי-פסיכוטי? (the question as examined, in Hebrew)
- א. Denial
- ב. Projection
- ג. Passive-Aggressive
- ד. Distortion
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Sources
- DSM-5-TR, American Psychiatric Association, 2022 — Somatic Symptom and Related Disorders
- NICE guideline NG206, 2021 — Myalgic encephalomyelitis and functional symptoms: assessment principles
- Stone J, et al., Journal of Neurology, Neurosurgery and Psychiatry, 2020 — Functional neurological disorder: diagnosis and treatment
- Kaplan and Sadock's Synopsis of Psychiatry, 12th edition (2021) — Somatic Symptom and Related Disorders
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.