Differentiating Conversion vs Factitious vs Malingering Disorders – Hughes

Difficulty is that these cannot be differentiated by self-report only; the clinician HAS to investigate other sources of information.


  • Symptoms or deficits affecting voluntary motor or sensory functioning
  • Actually very rare
  • Commonly recurs (25% in the first year)
  • Risk factors:  maladaptive personality traits (borderline, histrionic traits), history of childhood abuse/neglect, stressful life events may precipitate
  • Does not require that the symptoms are “intentionally produced.”  Conversion symptoms are not strictly voluntary from the patient’s subjective experience.
  • If there’s no true LOSS of function, consider Somatic Symptom Disorder.


  • External incentives are absent.  Patients are not voluntarily “faking” it.  Internal motivations may include enjoyment or benefiting from the sick role.
  • Also very rare.
  • Usually comes on in early adulthood.  Often comes on after hospitalization for a general medical or psychiatric disorder.
  • Course is intermittent.


  • Intentional, voluntary.  This is truly “faking” for secondary gain.
  • Secondary gains may include legal, occupational benefits; medications; etc.


  • Focus on accurately identifying behaviors, verifying or refuting medical conditions.
  • Does not need to focus on motivation anymore.
  • Conversion vs Malingering:  usually requires long-term relationship and observation of patient’s course.  Collateral examination for symptom production (neuropsych testing) may be helpful.

Source:  Rachel Hughes, PhD, behavioral health fellow, SMFMR.



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