Factitious Disorder

Remaining in the role of a patient

What is factitious disorder?

First let us address what it is not:

Factitious disorders are not malingering (wherein the individual is falsifying symptoms in order to receive tangible gain such as financial remuneration). Malingering is not a mental disorder, and the malingering individual is aware of, and has control over, the goals being sought. The malingerer uses contrived symptoms solely to obtain a specific goal such as avoidance of a responsibility, securing time off from work or distracting others from some illegal or immoral act in which he/she has been involved. Some individuals malinger to avoid criminal prosecution for crimes of which they are guilty.

Factitious disorders are not one of the somatoform disorders (a group of mental disorders in which a person develops bodily symptoms such as pain, paralysis or numbness or even visual and hearing deficits as a means of dealing with an emotional conflict). The person with somatoform disorder does not have control over the production of the symptoms and does not understand why they are occurring. The individual with somatoform disorders believes that he/she is truly physically ill.

The term factitious derives from the Latin meaning artificial. Patients with factitious disorders behave as though they have a physical or mental illness when, in fact, they deliberately and consciously manufacture their symptoms.

Sometimes these disorders are referred to as Münchausen syndrome (named for Baron von Munchausen an 18th century German officer who was known for embellishing the stories of his life and experiences). Such patients may be very knowledgeable regarding medical tests and procedures. They know how to create symptoms and signs and will go to great lengths to induce infection or injury that will bring them into the health care system. Long hospital stays, lengthy procedures, repeated diagnostic tests hold the patients in hospitals where they feel the most comfortable.

What are the signs and symptoms of factitious disorder?

Patients with factitious disorders create or exaggerate symptoms of an illness in multiple ways:

· They may lie about, emulate or mimic symptoms,

· They may harm themselves to trigger the symptoms,

· They may alter diagnostic tests by contaminating them

What type of impact does factitious disorder have on a person’s life?

Factitious Disorders interfere with occupational and social functioning and, therefore, are considered a mental disorder. The individual creates an entire existence in which they are continually seeking medical care, nurturance from friends and family while concurrently attempting to keep themselves from being detected for the falsehoods they are creating.

An even more serious concern is Munchausen by Proxy in which individuals will harm others in order to be involved in the care provided, for example, injury a child in order to share the attention.

Many people with factitious disorders also suffer from personality disorders which are developmentally maladaptive patterns of thinking and behaving that differ from what society considers normal. Individuals with personality have poor coping skills and problems forming healthy relationships.

Individuals with factitious disorder obviously are inadequate in their role as worker, spouse or parent. The entirety of their emotional life is tied to skillfully creating the symptoms yet avoiding detection. Loved ones are often duped into seeing the patient with factitious disorder as a victim of endless problems for which they need care, support and affection.

Types of factitious disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR), which is the standard reference book for recognized mental illnesses in the United States, organizes factitious disorders into four main types:

Factitious disorder with psychological symptoms —people with this disorder mimic behavior that is typical of a mental illness, such as schizophrenia. They may appear confused, make absurd statements, and report hallucinations and delusions. Ganser syndrome, sometimes called prison psychosis, is a factitious disorder that was first observed used by prisoners.

Factitious disorder with physical symptoms ‚Äî People with this disorder claim to have symptoms related to a physical illness–symptoms such as chest pain, stomach problems, or fever.

Factitious disorder with both psychological and physical symptoms — People with this disorder report symptoms of both physical and mental illness.

What type of help is available for a person who has factitious disorder?

The first order of business is to recognize the symptoms of factitious disorders

Possible warning signs of factitious disorders include the following:

  • Dramatic, theatrical and elaborate, but also inconsistent, medical history
  • Unclear symptoms that are not controllable, become more severe, or change once treatment has begun
  • A cycle of what becomes predictable relapses following improvement in the condition
  • Extensive knowledge of hospitals and/or medical terminology, as well as the textbook descriptions of illness and use of terms which most patients do not
  • Presence of multiple and diffuse surgical scars
  • Appearance of new or additional symptoms following negative test results
  • Presence of symptoms only when the patient is alone or not being observed
  • Willingness or eagerness to have medical tests, operations, or other procedures
  • History of seeking treatment at many hospitals, clinics, and doctors‚Äô offices, possibly even in different cities
  • Reluctance by the patient to allow health care professionals to meet with or talk to family members, friends, and prior health care providers

Researchers believe both biological and psychological factors play a role in the development of these disorders. Some theories suggest that a history of abuse or neglect as a child, or a history of frequent illnesses in themselves or family that required hospitalization, may be factors in the development of the disorder. Obtaining accurate statistics on the prevalence of factitious disorders is difficult because dishonesty is the hallmark of these disorders. In addition, people with factitious disorders tend to seek treatment at many different health care facilities, resulting in statistics that are misleading.

Detection is the first goal leading to treatment

  1. Do the patient’s reported symptoms make sense in the context of all test results and assessments?
  2. Do we have information from other sources that confirm the patient’s information
  3. Does the patient permit us to seek these other
  4. Is the patient more willing to take the risk for more procedures and tests than would be expected?
  5. Does the patient respond to treatment in a predictable way?

The first goal of treatment is to reduce overuse of medical resources. In factitious disorder by proxy, the immediate goal is to ensure the safety and protection of potential victims.

The primary treatment for factitious disorders is psychotherapy. Treatment likely will focus on changing the thinking and behavior of the individual with the disorder (cognitive-behavioral therapy well as family therapy teaching family members not to reinforce the behavior of the person with the disorder.

People with factitious disorders are at risk for health problems associated with hurting themselves by causing symptoms. In addition, they may suffer health problems related to multiple tests, procedures, and treatments, and are at high risk for substance abuse and suicide attempts. A complication of factitious disorder by proxy is the abuse and potential death of the victims.

Some people with factitious disorders suffer one or two brief episodes of symptoms. In most cases, however, factitious disorder is a chronic, or long-term, condition that can be very difficult to treat. Additionally, many people with factitious disorders deny they are faking symptoms and will not seek or follow treatment.

There is no known way to prevent factitious disorders. However, it may be helpful to start treatment in people as soon as they begin to have symptoms.

What advice would you like to leave for someone who has a family member or friend with factitious disorder?

This can be a grave disorder which is quite often missed because of the patient’s skillful orchestrating of those attempting to deliver care. The disorder can lead to tests and procedures that are harmful to the patient. Early detection and reporting of concerns (especially in factitious disorder by proxy in which harm is inflicted on others) to medical and, often, legal authorities is necessary. As with most disorders, as society becomes more familiar with the behavioral patterns, detection becomes more probable.