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Hardcover
First published January 1, 2004
Researchers classify patients with unexplained medical complaints (UMCs) into two general categories. One category includes patients who consciously create symptoms in themselves, either for secondary (material) gain as in malingering, or for more subtle benefits such as emotional support as in factitious disorder.My sister-in-law appears to have Munchausen's and M. by Proxy, her greatest pride is in impressing doctors with her knowledge of medicine and use of technical terms. She has ruined the life of her eldest son and enabled her daughter to live the live of an entitled sloth. But her second son, born only 11 months after the eldest, has escaped and is a tall, handsome, successful man, the sort of person they might all have been if my SIL had had a better character.
The second category includes patients whose symptoms are purely unconscious expressions of stress, as illustrated by somatoform disorders. Somatoform disorders include somatization disorder, which is distinguished by a history of an inordinate number of unexplained physical problems; pain disorder, in which emotional distress is communicated through complaints of persistent pain; hypochondriasis, which is a faulty conviction, despite supporting aches and pains, that one is diseased; and conversion disorder, which involves a loss of or alteration in physical functioning, such as sudden paralysis, blindness, or mutism. Unlike the somatoform disorders, malingering and factitious disorder involve deliberate, willful disease forgeries.
Thus, UMCs range from malingering—in which the person knowingly lies and acts sick for obvious, tangible gains such as narcotics, malpractice payments, Social Security Disability dollars, or insurance compensation—to the aforementioned conversion disorder (further discussed below). Unlike conversion disorder, malingering may be viewed more as a crime than a psychological disorder, though it could suggest the presence of some underlying personality problem.
Factitious disorder, which falls between malingering and conversion in the range of UMCs, is a conscious act as malingering is; however, the goal is intangible and psychologically complex, involving some form of emotional satisfaction. That duality places it in the middle.