What distinguishes malingering from factitious disorder?

The distinction between malingering and factitious disorder primarily lies in the presence of external incentives. In factitious disorder, individuals intentionally produce or feign physical or psychological symptoms, but their motivation is not driven by external rewards; rather, it stems from a psychological need to assume the sick role or to gain attention and sympathy. This creates a complex relationship with their own symptoms, as individuals may genuinely believe they need to be ill to meet their emotional needs.

In contrast, malingering clearly involves a conscious act of deception where the individual is motivated by specific external incentives, such as financial gain, avoiding work or legal responsibilities, or obtaining medication. The identification of this external incentive is a key aspect that separates malingering from factitious disorder. Therefore, the correct answer highlights that factitious disorder is characterized by the absence of these external motivations, centering instead on an internal psychological need. This understanding is crucial for accurate diagnosis and appropriate treatment in clinical practice.