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
| Feature | Conversion Disorder | Factitious Disorder vs Malingering |
|---|---|---|
| At a glance | Neurologic 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 presentation | Motor: limb weakness or paralysis, tremor, abnormal gait, dystonia; Sensory: anesthesia or paresthesia in nonanatomic distribution; Special sensory: blindness, deafness, diplopia; Speech: dysphonia, dysarthria, mutism; Seizure-like: nonepileptic attacks with retained awareness, asynchronous limb movement, eyes closed, side-to-side head… | Dramatic, atypical, or 'textbook' symptom presentations; Symptoms worsen when patient observed; inconsistent with objective findings; Eagerness to undergo invasive procedures; Multiple hospitalizations across institutions, often with feigned identities or addresses; Resistance to letting providers communicate with prior caregivers;… |
| Workup / key labs | DSM-5-TR: ≥1 altered motor/sensory symptom; clinical findings show incompatibility with known disease (positive signs); not better explained otherwise; impairment/distress. Specify acute (<6 mo) vs persistent (>6 mo); with vs without psychological stressor.; Targeted to exclude mimics — TSH, CMP, glucose, B12, autoimmune panel as… | Factitious: deception with falsification or induction; presents self/other as ill; behavior evident even without external reward; not better explained by another disorder. Malingering: intentional symptom production for external incentive — coded as V65.2 / Z76.5 (not a mental disorder).; Targeted testing based on presentation;… |
| Imaging | MRI brain/spine if focal neurologic symptoms; Video EEG — gold standard for PNES; captures event and confirms absence of epileptiform discharge; Nerve conduction/EMG if peripheral weakness or sensory loss; Avoid open-ended scanning that prolongs uncertainty | — |
| First-line treatment | Clear, confident communication of the diagnosis using positive signs — explain it as a 'software, not hardware' problem; do NOT frame as 'no disease found'; Physical therapy / occupational therapy for motor symptoms — neurorehabilitation tailored to FND; Cognitive behavioral therapy, especially for PNES; Treat comorbid depression,… | — |
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