Physical symptoms such as pain, that are alleged to be related to trauma, are often the subject of litigation. Differentiating among physical symptoms that are related to true medical conditions, substance abuse or actual mental disorders as compared to those related to exaggeration or faking can be difficult. The following article offers some guidelines that lawyers for plaintiffs and defendants can use in understanding the differences among these conditions. Actual diagnosis will, of course, require appropriate examination by physicians and psychologists.

What is somatization? Some people express psychological distress by means of bodily symptoms. Sometimes called "somatizers", these individuals may be preoccupied with the belief they have a serious illness, complain of multiple unexplained physical problems or describe chronic pain. Not surprisingly, they tend to overuse medical services. Ford noted that in some cases these symptoms are not voluntarily produced while in others there may be a deliberate attempt to produce false or exaggerated symptoms in order to obtain an external incentive or to assume the sick role. Somatization, whether intentional or unintentional, may occur within the context of a Personal Injury lawsuit or a Workman's Compensation or disability claim. It should be noted that the presence of somatization behaviors does not imply there is no medical condition; somatization sometimes co-exists with real medical problems.

Somatizing behavior tends to occur most often among certain groups. Individuals who are low in mental ability, limited in education or weak in self-understanding or insight may be unable or unwilling to communicate their feelings and be more likely to manifest emotional distress as physical symptoms. Individuals who have significant symptoms of depression or anxiety often focus on related physical symptoms, such as loss of appetite or weight changes, and believe their discomfort is caused by a medical disorder. Some religious people and those whose philosophy it is to view psychological problems as a loss of faith or weakness are more likely to attribute their distress to a medical disease than to a mental disorder. Higher rates of somatization are also reported among individuals who have experienced trauma.

Somatoform Disorders and similar syndromes: Somatoform Disorders are a type of psychological disorder in which physical symptoms are present but cannot be fully explained by a medical disorder. The Somatoform Disorders have been defined in the Diagnostic and Statistical Manual of Mental Disorders and several of them will be briefly described here. In addition, Malingering and Factitious Disorder will also be described and the similarities and differences among these conditions will be discussed.

Somatization Disorder: This disorder consists of multiple and recurrent physical complaints that are chronic but apparently not due to any medical disorder. The physical symptoms tend to be dramatic, vague or exaggerated and the individual with this disorder has typically sought medical care from a number of physicians. The symptoms of Somatization Disorder are not intentionally produced.

Conversion Disorder: The essential features of this disorder are symptoms affecting voluntary motor or sensory function that suggests a neurological or other medical condition. The symptoms cannot be explained by a known physical disorder and psychological factors are thought to be associated with the symptoms. Although the individual diagnosed with this condition may derive external benefits called "secondary gain", which can impede recovery, the Conversion symptoms are not intentionally produced.

Pain Disorder: The essential feature of this disorder is a preoccupation with pain without physical findings adequate to account for the pain or its intensity. Psychological factors are thought to play an important role in the pain and the pain causes significant distress or impairment in ability to function. The pain is not intentionally produced.

Hypochondriasis: In this disorder, there is preoccupation with fears of having or with the idea that one has a serious disease based on a misinterpretation of physical signs or symptoms. The preoccupation in Hypochondriasis may be with bodily functioning, with minor physical abnormalities or with vague physical sensations. This preoccupation persists despite medical reassurance. The symptoms of this disorder are not intentionally produced.

Malingering: "Malingering" is the term psychologists and other mental health professionals use to describe "the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution or obtaining drugs". In contrast to the Somatoform Disorders, the physical symptoms in Malingering are intentionally produced. There should be a strong suspicion of malingering if any two or more of the following are identified:

Factitious Disorder: This disorder is manifested by psychological or physical symptoms that are not identifiable as a true medical condition or true mental disorder. Unlike Somatoform Disorder, the symptoms of Factitious Disorder are intentionally produced. The essential difference between Factitious Disorder and Malingering is that in Factitious Disorder the motivation is to assume the sick role rather than to obtain external incentives.

Pain and other physical symptoms that are the subject of litigation can be caused by physical disorders and mental disorders but can also be intentionally produced as in Malingering and Factitious Disorders. The possibility that a medical condition is causing physical symptoms must first be carefully evaluated by physicians. When physical illness has been ruled out or cannot fully explain such symptoms, psychologists can help. Psychologists use extensive interviews, careful medical records reviews and psychological tests such as the Minnesota Multiphasic Personality Inventory (MMPI-2) to determine the likelihood of Malingering and to differentiate other among various possible explanations for physical symptoms without explanatory medical illness.