(p. 316) Malingering and Factitious Disorder 

Malingering is the intentional feigning, induction, or exacerbation of symptoms to achieve a conscious, tangible goal; factitious disorder is the intentional manipulation of symptoms to achieve the subconscious goal of assuming the sick role. These disorders impose great costs in terms of dollars spent, inappropriate diversion of resources to unnecessary clinical care, and negative effects on clinicians faced with patient deception. They challenge the assumption that patients provide accurate histories and accounts of their symptoms and are motivated to address the symptoms and concerns that they report. Malingering and factitious disorder are typically diagnoses of exclusion. Signs of a deception syndrome include numerous prior hospital admissions and emergency department visits and a history of suspected deception. Evaluations require careful history taking and physical examination; prudent use of studies, tests, and consultation; gathering of collateral information; thorough review of available records; and monitoring of the patient’s behavior in the medical setting.