Malingering, hysteria, and the factitious disorders

The arguments contained within this paper take as their starting point the suggestion that malingering is related along three separate continua to the nosological entities of antisocial behaviour, hysteria and the factitious disorders. The paper is both an attempt to show how these continua can be underwritten and at the same time a discussion of the aetiology of the disorders in question. It will be argued that the aetiological accounts of hysteria and the factitious disorders found in the psychiatric literature fail to make room for an account of the nature of the relationships of these disorders with malingering and thereby fail to fulfil the most important constraint on the acceptability of explanations in this area. In discussing the factitious disorders in the light of this constraint it will be suggested that psychodynamic explanations are vacuous and folk-psychological explanations in principle unavailable. With regard to hysteria it will be suggested that an explanatory account which embraces all the required phenomena and accommodates the close relationship of the disorder to malingering must make use of cognitive-psychologically informed account of self-deception which treats hysterical beliefs as beliefs which are formed as a result of a failure to accurately appraise the subjectively available evidence.