Rosh Psychiatry Board Practice Exam

Which disorder is indicated by a patient exhibiting signs of abdominal pain and a history of numerous medication allergies, with symptoms persisting over multiple years?

1. Borderline personality disorder

2. Conversion disorder

3. Factitious disorder

4. Malingering

The correct answer is: Factitious disorder

The scenario describes a patient with abdominal pain and a significant history of medication allergies, with symptoms lasting for several years. This presentation aligns closely with factitious disorder, in which individuals intentionally produce or feign symptoms of a health condition, often to assume the role of a patient and gain emotional benefits such as sympathy or attention. In factitious disorder, the symptoms are under the patient's voluntary control, but the motivation is to be seen as ill rather than to achieve a specific external gain, such as financial compensation, which would denote malingering. Given the long-term nature of the symptoms, this suggests a chronic need for medical attention that is characteristic of factitious disorder. Other disorders do not fit this particular presentation as well. Borderline personality disorder may involve unstable interpersonal relationships and self-image but is not specifically characterized by the manufacturing of symptoms. Conversion disorder could explain physical symptoms arising from psychological conflict, yet it typically does not include a long-standing history of multiple medication allergies in the context presented. Malingering involves deliberate fabrication of symptoms for tangible external rewards, which is not indicated here since the focus is more on the long-term maintenance of the patient role rather than an immediate gain. Thus, the situation described is most consistent with factitious disorder, emphasizing the