F68 vs F44
F44 — Dissociative [conversion] disorders
Distinguish intentionally produced or feigned symptoms with no external incentive, apparently to assume the sick role (F68.1, factitious disorder), from genuine, involuntary symptoms that the person does not consciously produce (F44) — completing the genuineness-of-symptoms reasoning triangle alongside malingering (not itself a mental disorder).
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Show overlap — what both share
Both can present with physical or psychological symptoms that lack a clear organic explanation and can appear medically puzzling.
Show decisive evidence
- F44 requires the symptoms to be genuine and involuntary from the person's own perspective, even though no organic cause is found — the person is not consciously producing them.
- F68.1 requires evidence that the symptoms are intentionally produced or feigned, without any external incentive, apparently to assume the sick role.
- Evidence of deliberate tampering, staging, or fabrication (e.g. tampering with a specimen, secretly self-inducing a finding) favours F68.1; the absence of any such evidence, with the person experiencing the symptoms as genuinely involuntary, favours F44.
- A third possibility, malingering, should also be considered and ruled in or out: it requires an identifiable external incentive, which neither F44 nor F68.1 involves.
What weakens F68: Evidence of deliberate, secretive symptom production with no external incentive favours F68.1; the genuine absence of any such evidence, with symptoms experienced as involuntary, favours F44.
Show duration / course
Not duration-based; the decisive factor is whether the symptoms are genuinely involuntary or intentionally produced, and if intentional, whether an external incentive is present.
Show exclusions / context
Medically puzzling or inconsistent findings alone should not be taken as evidence of intentional production; genuine dissociative or conversion symptoms can also be inconsistent with known organic disease.
Show information still needed
Whether there is direct or strong circumstantial evidence of deliberate symptom production, and if so, whether any external incentive is identifiable.
Show the common trap
Assuming that medically puzzling or inconsistent symptoms must be intentionally produced, when genuine dissociative or conversion symptoms (F44) can present the same way.
Mini challenge — practise this distinction
Apply the discriminating evidence above to a fresh case before checking the full feedback.