Somatic Symptom Disorders

Xiara Perez
Jul 25
2 min read

Conversion vs. Somatic vs. Factitious vs. Malingering — What’s the Difference?!

Let’s be real: psych disorders that involve physical symptoms can be so confusing and students always mix these up. If you've ever been like, “Wait… is this the one where they know they’re faking?” or “Is this the one that happens after trauma?”... you're not alone.

So I’m breaking this ALL the way down, as always in a way that makes sense. Let’s simplify the big 4:

Conversion Disorder = “Mind to Body”

This one shows up like a sudden neurological symptom (blindness, paralysis, seizures) but with no medical cause. The brain is under stress, and it literally converts emotional pain into a physical symptom.

Key thing: They are not faking. They truly can’t move that limb or see right now. But their tests will be normal.

QUICK TIP: Conversion = Stress turned to Symptoms

Factitious Disorder = “Fake but for emotional/internal gain”

This is where the person is intentionally causing or faking illness, but not for money or drugs. They do it to get attention or sympathy. Think of someone who wants to be the patient. They love the sick role. They might take insulin to drop their blood sugar or tamper with tests.

Key thing: It’s on purpose, but for internal/emotional gain, not external stuff.

QUICK TIP: Factitious = Faking for Feelings

Somatic Symptom Disorder = “So many symptoms, no answers”

These patients constantly worry about their health and have multiple vague symptoms (like pain, fatigue, GI issues). They believe something is wrong, but testing keeps coming back normal. They're not faking, their anxiety is just being expressed through their body.

Key thing: They’re not lying. Their symptoms feel very real to them. But there’s no medical explanation.

QUICK TIP: Somatic = Symptoms = Stress in disguise

Malingering = “Faking it for gain”

This one is all about the benefits: money, avoiding jail, getting pain meds, etc. They are consciously faking or exaggerating symptoms to get something. It’s not a psych disorder, it’s a behavior.

Key thing: It’s on purpose AND for an external reward.

QUICK TIP: Malingering = Money, Meds, or Manipulation

📝 Quick Recap Chart:

Disorder	Intentional?	Real to patient?	Motivation
Conversion	❌ No	✅ Yes	Unconscious relief from stress
Factitious	✅ Yes	❌ No	To get emotional attention
Somatic	❌ No	✅ Yes	Unconscious need for care
Malingering	✅ Yes	❌ No	Money, meds, jail, etc.

📌 These always show up on NCLEX-style questions, especially when the scenario talks about motives or lab tests being normal. Read the question and ask yourself: