Malingering is different from somatoform disorder because the former:
A. Has evidence of an organic basis.
B. It is a deliberate effort to handle upsetting events.
C. Gratification from the environment is obtained.
D. Stress is expressed through physical symptoms.
Correct Answer: B. It is a deliberate effort to handle upsetting events
Malingering is a conscious simulation of an illness while somatoform disorder occurs unconsciously. Malingering is falsification or profound exaggeration of illness (physical or mental) to gain external benefits such as avoiding work or responsibility, seeking drugs, avoiding trial (law), seeking attention, avoiding military services, leave from school, paid leave from a job, among others.
Option A: Both disorders do not have an organic or structural basis. It is not a psychiatric illness according to DSM-5 (Diagnostic and Statistical Manual of Mental Diseases, Fifth edition). The DSM-IV-TR failed to provide any precise criteria because malingering is not considered a psychiatric diagnosis, but the manual does state it is a “condition that may be a focus of clinical attention.”
Option C: Both have primary gains. External (secondary) gain is necessary for differentiating malingering from factitious disorder (a disorder in which a patient consciously creates physical or psychological symptoms to assume a sick role, the primary gain). Malingerers show poor compliance with treatment and stop complaining about the assumed illness only after gaining the external benefit.
Option D: This is a characteristic of the somatoform disorder. The unexplained symptoms of somatoform disorders often lead to general health anxiety; frequent or recurrent and excessive preoccupation with unexplained physical symptoms; inaccurate or exaggerated beliefs about somatic symptoms; difficult encounters with the health care system; disproportionate disability; displays of strong, often negative emotions toward the physician or office staff; unrealistic expectations; and, occasionally, resistance to or noncompliance with diagnostic or treatment efforts.