Confusable diagnoses · PANCE / PANRE

Conversion Disorder vs Factitious Disorder vs Malingering

Conversion Disorder and Factitious Disorder vs Malingering are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.

Conversion Disorder vs Factitious Disorder vs Malingering at a glance

  • Conversion Disorder: Neurologic symptoms (motor, sensory, seizure-like) incompatible with recognized neurologic disease.
  • Factitious Disorder vs Malingering: Both involve intentional symptom production; factitious is motivated by the sick role, malingering by external incentive (only factitious is a mental disorder).
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Side-by-side comparison

FeatureConversion DisorderFactitious Disorder vs Malingering
At a glanceNeurologic symptoms (motor, sensory, seizure-like) incompatible with recognized neurologic disease.Both involve intentional symptom production; factitious is motivated by the sick role, malingering by external incentive (only factitious is a mental disorder).
Classic presentationMotor: limb weakness or paralysis, tremor, abnormal gait, dystonia; Sensory: anesthesia or paresthesia in nonanatomic distribution; Special sensory:…
Workup / key labsDSM-5-TR: ≥1 altered motor/sensory symptom; clinical findings show incompatibility with known disease (positive signs); not better explained otherwise;…Factitious: deception with falsification or induction; presents self/other as ill; behavior evident even without external reward; not better explained by…
ImagingMRI brain/spine if focal neurologic symptoms; Video EEG — gold standard for PNES; captures event and confirms absence of epileptiform discharge; Nerve…
First-line treatmentClear, confident communication of the diagnosis using positive signs — explain it as a 'software, not hardware' problem; do NOT frame as 'no disease found';…

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Educational use only. This outline is a study aid for PA students and is not medical advice or a substitute for clinical judgment. FirstPassPA is an independent study tool and is not affiliated with, endorsed by, or sponsored by NCCPA. PANCE® and PANRE® are registered trademarks of the National Commission on Certification of Physician Assistants.