Question about Factitious disorder......

[Knicks]

Symptom production is intentional, but the motivation is unconscious. How can the latter be true if the former is true?

I understand somatoform disorder in which both are done unconsciously and in malingering disorder they are both done intentionally,,,,, but it just seems 'weird' that the motivation for symptom production can be "unconscious" when the symptom production is, in fact, "intentional".


I feel like factitious can basically be considered malingering.

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[tulane06]

Factitious disorder ---> primary gain (psychological need)
Malingering ------> secondary gain (drugs, money, etc)

 

[Knicks]

^^ Kaplan says secondary gain is in factitious as well, albeit secondary gain is mainly in malingering.

But my question wasn't about the gains, per se.

How could someone INTENTIONALLY produce symptoms "unconsciously"?

Might be a simple explanation, but I'm just drawing a blank at the moment.

 

[smq123]

Symptom production is intentional, but the motivation is unconscious. How can the latter be true if the former is true?

I understand somatoform disorder in which both are done unconsciously and in malingering disorder they are both done intentionally,,,,, but it just seems 'weird' that the motivation for symptom production can be "unconscious" when the symptom production is, in fact, "intentional".

I feel like factitious can basically be considered malingering.

They're NOT the same, and you MUST understand the distinction - not just for Step 1, but also for your psych rotation and psych exam.

Malingering has an obvious "secondary gain." Secondary gain is an obvious benefit to being sick. For example, if you purposely break your arm in order to avoid being forcibly conscripted into the army, that is malingering.

Factitious disorder does NOT have an obvious secondary gain. These people pretend to be sick (by giving themselves unnecessary insulin, or by adding drops of blood to urine samples), but they don't get anything from it - they don't get time off work, they don't avoid jail time, they don't get money for it, etc. So they purposely produce fake symptoms, but there's no obvious reason for why they'd want to be sick.

The presence or absence of secondary gain is what distinguishes malingering from factitious disorder. I think that Kaplan is wrong in this case. Merck pretty clearly lays it out: http://www.merck.com/mmpe/sec15/ch204/ch204a.html

 

[medstylee]

someone with factitious disorder will do something to himself with the knowledge that it is going to hurt him/make him sick. however, he is not consciously aware of the underlying reason for why he is hurting himself - for example, perhaps he was neglected as a child and is trying to get attention that he never had. he can tell you that he was neglected as a child, but he does not understand that the reason he is hurting himself stems from that neglect and the need for attention. the actions he is taking are conscious, but the things that are driving his actions are unconscious. that might not be the best example, but that's kind of how i've always understood factitious.

 

[Knicks]

They're NOT the same, and you MUST understand the distinction - not just for Step 1, but also for your psych rotation and psych exam.

Malingering has an obvious "secondary gain." Secondary gain is an obvious benefit to being sick. For example, if you purposely break your arm in order to avoid being forcibly conscripted into the army, that is malingering.

Factitious disorder does NOT have an obvious secondary gain. These people pretend to be sick (by giving themselves unnecessary insulin, or by adding drops of blood to urine samples), but they don't get anything from it - they don't get time off work, they don't avoid jail time, they don't get money for it, etc. So they purposely produce fake symptoms, but there's no obvious reason for why they'd want to be sick.

The presence or absence of secondary gain is what distinguishes malingering from factitious disorder. I think that Kaplan is wrong in this case. Merck pretty clearly lays it out: http://www.merck.com/mmpe/sec15/ch204/ch204a.html

Thanks for the input. I know they're not the same, but just sorta FELT the same.

 

[smq123]

Thanks for the input. I know they're not the same, but just sorta FELT the same.

They did to me, too, until we went over the differences 800 times during my psych rotation.

Good luck on Step 1.