A 26-year-old man awaiting sentencing for assault reports sudden total blindness. Ophthalmic examination, pupillary reflexes, fundoscopy, and visual evoked potentials are all normal. He is informed that a favourable psychiatric report will not alter his sentence, and his symptoms persist unchanged. Which statement best characterises this condition?

• A It is produced unconsciously for psychological relief, satisfying an internal need to be ill
• B It is an identity disturbance arising from childhood trauma
• C It results from genuine retinal disease with normal early findings
• D It is consciously feigned for an external incentive such as evading punishment ✓

Explanation

Symptoms feigned deliberately in pursuit of an obvious external gain, here avoidance of sentencing, define malingering. The distinguishing axis from factitious disorder is motivation: factitious disorder involves conscious production of symptoms driven by the internal need to assume the sick role, with no external reward. Normal pupillary reflexes and visual evoked potentials exclude organic blindness and confirm the feigned nature of the complaint.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.