ABSTRACT
This chapter discusses the key differences between malingering and similarly presenting issues including somatic symptom disorder, conversion disorder, factitious disorder, and anxiety disorder. Essential to a diagnosis of malingering is secondary gain which can include medications, disability status, financial gain, employment factors, avoidance of school, occupational, military duty, legal duty, including incarceration. Back pain symptoms range from the simple backache, which most people have at some time in their lifetime, to serious spinal diseases and lower back disabilities. While back pain may have several causes, a large percentage of patients are diagnosed with nonspecific acute back pain with no proof of any major structural disease. As in many areas of malingering, objective diagnostic testing proving causation and supporting symptomatology is all but impossible. Notably, the history in the malingering patient may be either consistent or inconsistent. Physical examination findings to look for in a malingerer center on consistency of effort and compliance.
