Psychiatry Boot Camp 3.14 Malingering and Factitious Disorder: An Approach to Clinical Deception
Aug 4, 2025
Dr. Nicholas Kontos, Director of the Consultation-Liaison Psychiatry Fellowship at Massachusetts General Hospital and Harvard Medical School assistant professor, dives deep into the complexities of factitious disorders and malingering. He explores patient motivations for deception, emphasizing the importance of compassion in psychiatry. The conversation includes practical interviewing techniques, the nuances of the therapeutic discharge, and the ethical responsibilities of clinicians. Kontos highlights the balance of professionalism and dignity when navigating deceptive behaviors in healthcare.
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Thinking Dirty in Psychiatry
- Thinking dirty means considering patients may not be fully truthful.
- This approach counters our training that discourages suspicion and promotes thorough clinical inquiry.
Universality of Patient Deception
- Everyone deceives to some extent as part of impression management.
- Patients may exaggerate or minimize symptoms for attention or to be perceived favorably.
Distinguishing Factitious and Malingering
- Malingering involves secondary gain like shelter or money.
- Factitious disorder centers on primary gain, seeking the sick role benefits like attention and relief from duties.