Somatoform disorders need to be distinguished from other body-related mental disorders such as malingering and factitious disorders in which people feign or intentionally produce symptoms for some purpose or gain. In malinger-ing and factitious disorders, people willfully control the symptoms. In somatoform disorders, clients do not volun-tarily control their physical symptoms.
Malingering is the intentional production of false or grossly exaggerated physical or psychologic symptoms; it is motivated by external incentives such as avoiding work, evading criminal prosecution, obtaining financial com-pensation, or obtaining drugs. People who malinger have no real physical symptoms or grossly exaggerate relatively minor symptoms. Their purpose is some external incen-tive or outcome that they view as important and results directly from the illness. People who malinger can stop the physical symptoms as soon as they have gained what they wanted (Wang, Nadiga, & Jenson, 2005).
Factitious disorder occurs when a person intention-ally produces or feigns physical or psychologic symptoms solely to gain attention. People with factitious disorder may even inflict injury on themselves to receive attention. The common term for factitious disorder is Munchausen syndrome. A variation of factitious disorder, Munchausen syndrome by proxy, occurs when a person inflicts illness or injury on someone else to gain the attention of emer-gency medical personnel or to be a “hero” for saving the victim. An example would be a nurse who gives excess intravenous potassium to a client and then “saves his life” by performing cardiopulmonary resuscitation. Although factitious disorders are uncommon, they occur most often in people who are in or familiar with medical professions, such as nurses, physicians, medical technicians, or hospi-tal volunteers. People who injure clients or their children through Munchausen syndrome by proxy generally are arrested and prosecuted in the legal system (Stirling, 2007).
Body identity integrity disorder (BIID) is the term given to people who feel alienated from a part of their body and desire amputation. This condition is also known as ampu-tee identity disorder and apotemnophilia or “amputation love.” This is not an officially accepted Diagnostic and Sta-tistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) diagnosis, and there is disagreement about the existence of the condition. People describe feel-ings of anguish and distress with their intact bodies, and report feeling “natural, like they were intended to be” after an amputation. From an ethical standpoint, few surgeons will amputate a limb merely on a person’s request. People with BIID resort to actions such as packing the limb in dry ice until the damage is so advanced that amputation becomes a medical necessity, or in some cases, amputation is done with a power tool by nonmedical persons, leaving a physician to save the person’s life and deal with the damage.