When Munchausen becomes malingering: factitious disorders that penetrate the legal system.

Psychiatrists and other physicians are usually familiar with factitious disorders, but attorneys and judges usually are not. Cases involving factitious disorders may enter the civil legal system in a number of ways and cause incorrect judgements, financial costs, and inappropriate medical care if these disorders are not identified. Psychiatric consultants may play a key role in identifying these cases and educating legal personnel about factitious disorders. This article describes three cases in which persons with factitious disorders entered the civil litigation system. The role of the psychiatrist in these cases is discussed. Clues to the identification of factitious disorders are described. The article also discusses the differentiation of factitious disorders from malingering and other forms of abnormal illness behavior, such as conversion, hypochondriasis, and somatization disorders. The concepts of primary and secondary gain in relationship to illness behaviors are elaborated.