There are many controversial disability syndromes, representing medicolegal and social dilemmas for a variety of medical disciplines. Health care professionals are at a loss to cure these patients, and judges and disability review boards struggle to be fair while at the same time trying to understand the basis and appropriateness of the ever-growing claims of disability. We review these disability syndromes, examining the basis for their existence, their mechanism, and how these patients can better be understood in a constructive and helpful manner. In doing so, we emphasize the sick role, illness behavior, secondary and tertiary gain, and somatization.