Chart — Mental Health
Somatic Symptom Disorders Comparison
Five look-alikes sorted by two questions: is the symptom consciously produced, and what is the gain? That grid separates somatic symptom disorder, illness anxiety, conversion, factitious disorder, and malingering.
Educational use only. These are diagnoses of careful clinical evaluation after organic disease is ruled out, and are provider-directed. This chart is an educational comparison aid. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Side by Side
| Disorder | Hallmark | Symptom produced consciously? | Gain |
|---|---|---|---|
| Somatic symptom disorder | One+ real, distressing physical symptoms with excessive thoughts/anxiety about them | No (unconscious) | Primary (relief of internal anxiety) |
| Illness anxiety disorder | Preoccupation with HAVING a serious illness despite few/no symptoms | No (unconscious) | Primary |
| Conversion disorder (FND) | Neurologic deficit (paralysis, blindness, nonepileptic seizures) incompatible with disease, often after a stressor; may show la belle indifférence | No (unconscious) | Primary |
| Factitious disorder | Intentionally feigns/produces illness to assume the SICK ROLE | Yes (conscious) | Primary (psychological — be the patient) |
| Malingering | Fakes illness for an external reward (NOT a mental disorder) | Yes (conscious) | Secondary (money, drugs, time off, avoiding duty) |
Exam Traps
- ✦SSD, illness anxiety, and conversion = symptoms are REAL and unconscious — never say 'it's all in your head.'
- ✦Factitious disorder and malingering = the symptom is consciously/intentionally produced.
- ✦Factitious = wants the SICK ROLE (internal/psychological gain); malingering = wants an EXTERNAL reward (secondary gain).
- ✦Malingering is NOT a mental disorder — it's intentional deception for money, drugs, or avoiding duty.
- ✦Conversion disorder = neurologic deficit with no organic cause after a stressor; watch for la belle indifférence.
- ✦Factitious disorder imposed on another (Munchausen by proxy) is abuse — protect the victim and report.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Psychiatric Association (DSM-5-TR) · American Psychiatric Nurses Association (APNA) · SAMHSA. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →