Preview build — content shown here has not yet cleared independent review and is not the public release.
ICD-10 Learning Lab Exit Presentation Mode

Category: F60 F61 F62 F63 F64 F65 F66 F68 F69

F68 — Other disorders of adult personality and behaviour: facilitator sheet

Teaching objective

The decisive three-way distinction this category completes is: a genuine, involuntary symptom (F44/F45, produced unconsciously, not under voluntary control); a factitious symptom (F68.1, consciously and intentionally produced, but for an internal psychological need with no external material incentive); and malingering (consciously and intentionally produced for an external, material incentive such as financial compensation or avoiding legal responsibility — not itself a mental disorder at all). Confusing any two of these three leads to a fundamentally different, and often harmful, classification error.

Choose material

Worked example · Case: Tampering with the sample · Case: Feigned, but why?

Worked example

Show scenario

A patient has presented to multiple hospitals over several years with recurrent, dramatic symptoms that investigations repeatedly fail to substantiate, and on one occasion staff discovered evidence that the patient had deliberately tampered with a diagnostic sample to produce an abnormal result. The patient has no pending legal case, disability claim, or other identifiable financial or material incentive, and appears to derive no benefit beyond extensive medical attention and repeated hospital admission.

(or reveal one step at a time below)
  1. Reveal step 1

    Step 1 — Establish conscious production: deliberate tampering with a diagnostic sample confirms the symptoms are being intentionally produced, not unconscious.

  2. Reveal step 2

    Step 2 — Check for an external material incentive: none is present — no pending legal case, disability claim, or financial motive.

  3. Reveal step 3

    Step 3 — Identify the apparent function: extensive medical attention and the patient role itself, an internal psychological need.

  4. Reveal step 4

    Conclusion — F68.1, Factitious disorder — conscious production, no external material incentive, and an apparent internal psychological need together distinguish this from both a genuine involuntary presentation and from malingering.

Comparison points

F68.1 requires conscious, intentional symptom production for an internal psychological need with no external material incentive — genuine involuntary symptoms point to F44/F45, and conscious production for external gain points to malingering, not a mental disorder.

Discussion prompts

(or reveal one at a time below)
  1. Prompt 1

    Name the three-way distinction F68.1 sits within, and state what separates each from the other two.

  2. Prompt 2

    Explain why malingering is not itself classified as a mental disorder.

  3. Prompt 3

    State the single piece of evidence that would most shift a case from factitious disorder toward malingering.

Summary

F68.1 requires conscious symptom production for an internal psychological need with no external material incentive — distinct from both genuine involuntary symptoms (F44/F45) and malingering (external incentive, not a mental disorder).