A 29-year-old factory worker develops severe low back pain on the morning he is due to be assigned night shift duties. He walks with exaggerated discomfort when observed by colleagues but is seen moving normally while unaware of observation. He admits the pain would resolve if the shift were cancelled. Investigations are normal. What is the most likely diagnosis?

• A Malingering ✓
• B Factitious disorder
• C Somatic symptom disorder
• D Illness anxiety disorder

Explanation

Malingering involves intentional production or exaggeration of symptoms motivated by an identifiable external incentive such as avoiding work, military duty, or prosecution, and it is not a mental disorder. Factitious disorder shares conscious feigning but the motive is the intrinsically gratifying patient role with no external reward. In somatic symptom disorder the symptoms are genuinely experienced and not under voluntary control.

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

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