A. Plausible presentation of physical symptoms that are apparently under the individual's voluntary control to such a degree that there are multiple hospitalizations.
B. The individual's goal is apparently to assume the "patient" role and is not otherwise understandable in light of the individual's environmental circumstances (as is the case in Malingering).
True physical disorders
The major diagnostic consideration is obviously true physical disorder. A high index of suspicion for Chronic Factitious Disorder with Physical Symptoms should be aroused if any combination of the following is noted: pseudologica fantastica, with emphasis on the dramatic presentation; disruptive behavior on the ward, including noncompliance with hospital rules and regulations and arguing excessively with the nurses and physicians; extensive knowledge of medical terminology and hospital routines; continued use of analgesics for "pain"; evidence of multiple surgical interventions, e.g., a "gridiron abdomen" or burr holes in the skull; extensive history of traveling; few, if any, visitors while hospitalized; and a fluctuating clinical course with the rapid production of "complications" or new "pathology" once the initial work-up proves to be negative.
In Somatoform Disorders there are also physical complaints not due to true physical disorder. However, the symptom production is not under voluntary control, and admissions to hospitals are rarely as common as in Chronic Factitious Disorder with Physical Symptoms.
Individuals with Malingering may seek hospitalization by producing symptoms in attempts to obtain compensation, evade the police, or simply "get a bed for the night." However, the goal is usually apparent, and they can "stop" the symptom when it is no longer useful to them.
Antisocial Personality Disorder is often incorrectly diagnosed on the basis of the pseudologica fantastica, the lack of close relations with others, and the occasionally associated drug and criminal histories. Antisocial Personality Disorder differs from this disorder by its earlier onset and its rare association with chronic hospitalization as a way of life.
Schizophrenia is often incorrectly diagnosed because of the bizarre life-style. However, the characteristic psychotic symptoms of Schizophrenia are not present.