Factitious or fictitious brain injury? An adventure in applying the DSM–IV

This case was chosen because it exemplifies the conceptual and practical problems in the DSM-IV diagnosis of medically unexplained presentations. By either design or oversight, the DSM-IV approach to atypical somatic or cognitive presentations ignores the multilevel nature of behavior causation and disability consequences (Cunnien, 1997). My purpose is to describe the difficulties in DSM-IV differential diagnosis and offer practical guidelines for resolving them.