Differential Diagnosis in the DSM Framework

Differentiating illness anxiety disorder, factitious disorder, and malingering requires more than noticing unexplained symptoms or questioning whether a report is accurate. Clinicians need a careful, evidence-based process for examining intentionality, motivation, context, and the full clinical picture.

This focused training offers an opportunity to strengthen that process and revisit essential DSM-5-TR distinctions that may not have been addressed in depth since graduate training. A clearer framework can support more defensible diagnostic reasoning, case formulation, and treatment planning.

Jason Buckles, Ph.D., LPCC, is a practicing mental health counselor with more than 25 years of experience and over two decades of experience teaching DSM-based assessment at the graduate level. He has also served as a statewide clinical director, a behavioral health consultant to the New Mexico Department of Health, and an instructor for continuing education programs. His combined teaching and clinical experience allows him to connect diagnostic concepts with the complexities professionals encounter in practice.

Dr. Buckles uses a straightforward, lecture-based approach grounded in current literature and practice-based examples. He breaks down this complex differential diagnosis into clear considerations that clinicians can apply when evaluating somatic complaints, suspected symptom production, and presentations that may change over time.

The course begins by examining the challenges involved in distinguishing illness anxiety disorder, factitious disorder, and malingering. Participants will review the symptom profiles of each and explore how intentionality, motivation, external incentives, context, and available evidence inform differential diagnosis. The training also considers mixed or evolving presentations and related conditions such as somatic symptom disorder, psychotic processes, and obsessive-compulsive patterns. Example assessment questions, brief cases, and a basic diagnostic algorithm help organize the clinical reasoning process. The course also emphasizes that unexplained symptoms do not establish factitious behavior, external incentives do not prove malingering, and genuine illness may coexist with any of these processes.

Key Takeaways:

• Clarify the essential distinctions: Recognize illness anxiety disorder as pathological health anxiety and illness preoccupation, understand intentional falsification or induction in factitious disorder, and identify malingering as intentional fabrication or gross exaggeration for external incentives rather than a mental disorder.
• Strengthen differential diagnosis: Distinguish illness anxiety disorder from somatic symptom disorder and intentional symptom production by considering motivation, intentionality, context, symptom patterns, and alternative explanations.
• Respond more ethically and defensibly: Use objective evidence, longitudinal records, collateral information, and neutral clinical reasoning when deception is suspected rather than relying on intuition, stigma, or a single unexplained finding.

Why this course?

• A focused review of a difficult clinical distinction: Build a more organized way to evaluate somatic complaint–related presentations when the boundaries among health anxiety, factitious behavior, and malingering are unclear.
• Instruction grounded in extensive experience: Learn from an instructor who has taught DSM assessment and related clinical topics to graduate students, professionals, and community audiences for more than two decades.
• Practical continuing education from TCI: Telehealth Certification Institute provides clinician-centered education designed to help behavioral health professionals strengthen their knowledge, ethical practice, and quality of care.

Learning Objectives:

• Describe DSM-5-TR IAD and Factitious Disorder.
• Explain malingering as a non-disorder condition that may be a focus of clinical attention.
• Differentiate the three using intentionality, motivation, context, and evidence.
• Distinguish IAD from Somatic Symptom Disorder and intentional symptom production.
• Apply an ethical, evidence-based approach to suspected deception.

Regardless of theoretical orientation, mental health professionals need a disciplined and replicable approach to diagnostic consideration and differentiation. This one-hour live webinar provides an accessible way to return to the fundamentals, examine a particularly challenging differential, and add practical tools to your clinical toolbox.