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A factitious disorder is a condition in which a person, ''without'' a malingering motive, acts as if they have an
illness A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
by deliberately producing, feigning, or exaggerating symptoms, purely to attain (for themselves or for another) a patient's role. People with a factitious disorder may produce symptoms by contaminating
urine Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder. Urination results in urine being excreted from the body through the urethra. Cellul ...
samples, taking
hallucinogen Hallucinogens are a large, diverse class of psychoactive drugs that can produce altered states of consciousness characterized by major alterations in thought, mood, and perception as well as other changes. Most hallucinogens can be categorize ...
s, injecting fecal material to produce
abscess An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends ...
es, and similar behaviour.
Factitious disorder imposed on self Factitious disorder imposed on self, also known as Munchausen syndrome, is a factitious disorder in which those affected feign or induce disease, illness, injury, abuse, or psychological trauma to draw attention, sympathy, or reassurance to th ...
(also called Munchausen syndrome) was for some time the umbrella term for all such disorders.
Factitious disorder imposed on another Factitious disorder imposed on another (FDIA), also known as fabricated or induced illness by carers (FII), and first named as Munchausen syndrome by proxy (MSbP), is a condition in which a caregiver creates the appearance of health problems in a ...
(also called Munchausen syndrome by proxy, Munchausen by proxy, or factitious disorder by proxy) is a condition in which a person deliberately produces, feigns, or exaggerates the symptoms of someone in their care. In either case, the perpetrator's motive is to perpetrate factitious disorders, either as a patient or by proxy as a caregiver, in order to attain (for themselves or for another) a patient's role. Malingering differs fundamentally from factitious disorders in that the malingerer simulates illness intending to obtain a material benefit or avoid an obligation or responsibility.
Somatic symptom disorder A somatic symptom disorder, formerly known as a somatoform disorder,(2013) dsm5.org. Retrieved April 8, 2014. is any mental disorder that manifests as physical symptoms that suggest illness or injury, but cannot be explained fully by a general ...
s, though also diagnoses of exclusion, are characterized by physical complaints that are not produced intentionally.


Etiology

What causes factitious disorder is not well understood, however there is a handful of possible motives that drive this pattern of behavior. Individuals may experience a heightened thrill from medical procedures, a desire for attention and care, or feelings of control or accomplishment when deceiving medical professionals. They may partake in this behavior in order to seek and maintain relationships or use the sick-patient role as a coping strategy in response to stressful life events. If an individual did not form a healthy attachment to a caregiver as a child, there is a possibility that the person may develop factitious disorder in order to fulfill the need of receiving care. Attention from medical professionals may act as a replacement in satisfying important needs that the person never received as a child. Individuals may also use invasive or painful tests or procedures as a way to punish oneself for past mistakes or to cope with guilt associated with abuse. This is considered masochistic behavior. Individuals diagnosed with this disorder are more likely to have a history of emotional or physical abuse, neglect, and/or turbulent childhoods. This upbringing can cause an unstable sense of identity and low self-esteem. Abuse may prompt a feeling of lack of control, and the person may use faked symptoms and a fabricated medical history to gain back a sense of autonomy. Those with factitious disorder are also more likely to have experienced a severe illness in childhood, with the early exposure to healthcare being a major contributor to the onset of the disorder. There is a significant correlation found between the comorbidity of factitious disorder and personality disorders, specifically borderline personality disorder. Depressive disorders are also often diagnosed concurrently with factitious disorder. The causality cannot be known about whether one disorder causes the other, but it can be deduced that these diagnoses share similar etiologies and some overlapping symptoms. Each particular case of factitious disorder presents itself differently and is derived from various etiologies. However, there is an overarching belief that patients experience the uncontrollable urge to maintain the sick-patient role, acting as a type of behavioral addiction. This contributes to the prolonged behaviors associated with the disorder.


Diagnosis

Criteria for diagnosis include intentionally fabricating to produce physical or psychological signs or symptoms and the absence of any other mental disorder. Motivation for their behavior must be to assume the "sick" role, and they do not act sick for personal gain as in the case of malingering sentiments. When the individual applies this pretended sickness to a dependent, for example, a child, it is often referred to as "factitious disorder by proxy". The
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatri ...
differentiates among two types: *
Factitious disorder imposed on self Factitious disorder imposed on self, also known as Munchausen syndrome, is a factitious disorder in which those affected feign or induce disease, illness, injury, abuse, or psychological trauma to draw attention, sympathy, or reassurance to th ...
(Munchausen syndrome) *
Factitious disorder imposed on another Factitious disorder imposed on another (FDIA), also known as fabricated or induced illness by carers (FII), and first named as Munchausen syndrome by proxy (MSbP), is a condition in which a caregiver creates the appearance of health problems in a ...
(Munchausen syndrome by proxy), defined as: When an individual falsifies illness in another, whether that be a child, pet, or older adult.


Factitious disorder imposed on self

Factitious disorder imposed on self Factitious disorder imposed on self, also known as Munchausen syndrome, is a factitious disorder in which those affected feign or induce disease, illness, injury, abuse, or psychological trauma to draw attention, sympathy, or reassurance to th ...
, previously called Munchausen syndrome, or factitious disorder with predominantly physical signs and symptoms, has specified symptoms. Factitious disorder symptoms may seem exaggerated; individuals undergo major surgery repeatedly, and they "hospital jump" or migrate to avoid detection.


Factitious disorder imposed on another

Factitious disorder imposed on another, previously Munchausen syndrome by
proxy Proxy may refer to: * Proxy or agent (law), a substitute authorized to act for another entity or a document which authorizes the agent so to act * Proxy (climate), a measured variable used to infer the value of a variable of interest in climate re ...
, is the involuntary use of another individual to play the patient role. For example, false symptoms are produced in children by the caregivers or parents, to produce the appearance of illness, or they may give misleading medical histories about their children. The parent may falsify the child's medical history or tamper with laboratory tests to make the child appear sick. Occasionally, in Munchausen by proxy, the caregiver actually injures the child or makes them sick to ensure that the child is treated. For instance, a father whose son has celiac disease might knowingly introduce gluten into the diet. Such parents may be validated by the attention that they receive from having a sick child.


Ganser syndrome

Ganser syndrome was once considered a separate factitious disorder, but is now considered a
dissociative disorder Dissociative disorders (DD) are conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception. People with dissociative disorders use dissociation as a defense mechanism, pathologically and involuntarily. The i ...
. It is a disorder of extreme stress or an organic condition. The patient experiences approximation or giving absurd answers to simple questions. The syndrome is sometimes diagnosed as merely malingering—however, it is more often defined as a factitious disorder. This has been seen in prisoners following solitary confinement, and the symptoms are consistent in different prisons, though the patients do not know one another. Symptoms include a clouding of consciousness, somatic conversion symptoms, confusion, stress, loss of personal identity, echolalia, and echopraxia. Individuals also give approximate answers to simple questions such as, "How many legs on a cat?" "Three"; "What's the day after Wednesday?" "Friday"; and so on. The disorder is extraordinarily rare with fewer than 100 recorded cases. While individuals of all backgrounds have been reported with the disorder, there is a higher inclination towards males (75% or more). The average age of those with Ganser syndrome is 32, though it stretches from ages 15–62 years old.


Differential diagnosis

Factitious disorder should be distinguished from
somatic symptom disorder A somatic symptom disorder, formerly known as a somatoform disorder,(2013) dsm5.org. Retrieved April 8, 2014. is any mental disorder that manifests as physical symptoms that suggest illness or injury, but cannot be explained fully by a general ...
(formerly called
somatization disorder Somatization disorder is a mental and behavioral disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic symptoms. It was recognized in the DSM-IV-TR classification system, but in the latest ve ...
), in which the patient is truly experiencing the symptoms and has no intention to deceive. In
conversion disorder Conversion disorder (CD), or functional neurologic symptom disorder, is a diagnostic category used in some psychiatric classification systems. It is sometimes applied to patients who present with neurological symptoms, such as numbness, blindnes ...
(previously called hysteria), a neurological deficit appears with no organic cause. The patient, again, is truly experiencing the symptoms and signs and has no intention to deceive. The differential also includes body dysmorphic disorder and pain disorder.


Treatment

No true psychiatric medications are prescribed for factitious disorder. However, selective serotonin reuptake inhibitors (SSRIs) can help manage underlying problems. Medicines such as SSRIs that are used to treat
mood disorder A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where a disturbance in the person's mood is the main underlying feature. The classification is in the '' Diagnostic and St ...
s can be used to treat factitious disorder, as a mood disorder may be the underlying cause of factitious disorder. Some authors (such as Prior and Gordon 1997) also report good responses to
antipsychotic Antipsychotics, also known as neuroleptics, are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but also in a range of ...
drugs such as Pimozide.
Family therapy Family therapy (also referred to as family counseling, family systems therapy, marriage and family therapy, couple and family therapy) is a branch of psychology and clinical social work that works with families and couples in intimate relation ...
can also help. In such therapy, families are helped to better understand patients (the individual in the family with factitious disorder) and that person's need for attention. In this therapeutic setting, the family is urged not to condone or reward the factitious disorder individual's behavior. This form of treatment can be unsuccessful if the family is uncooperative or displays signs of denial and/or antisocial disorder. Psychotherapy is another method used to treat the disorder. These sessions should focus on the psychiatrist's establishing and maintaining a relationship with the patient. Such a relationship may help to contain symptoms of factitious disorder. Monitoring is also a form that may be indicated for the factitious disorder patient's own good; factitious disorder (especially proxy) can be detrimental to an individual's health—if they are, in fact, causing true physiological illnesses. Even faked illnesses and injuries can be dangerous and might be monitored for fear that unnecessary surgery may subsequently be performed.


Prognosis

Some individuals experience only a few outbreaks of the disorder. However, in most cases, factitious disorder is a chronic long-term condition that is difficult to treat. There are relatively few positive outcomes for this disorder; in fact, treatment provided a lower percentage of positive outcomes than did the treatment of individuals with obvious psychotic symptoms such as people with
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social w ...
. In addition, many individuals with factitious disorder do not present for treatment, often insisting their symptoms are genuine. Some degree of recovery, however, is possible. The passage of time seems to help the disorder greatly. There are many possible explanations for this occurrence, although none are currently considered definitive. It may be that a factitious disorder individual has mastered the art of feigning sickness over so many years of practice that the disorder can no longer be discerned. Another hypothesis is that many times a factitious disorder individual is placed in a home, or experiences health issues that are not self-induced or feigned. In this way, the problem with obtaining the "patient" status is resolved because symptoms arise without any effort on the part of the individual.


History

Previously, the DSM-IV differentiated among three types: *Factitious disorders with predominantly psychological signs and symptoms: if psychological signs and symptoms predominate in the clinical presentation *Factitious disorders with predominantly physical signs and symptoms: if physical signs and symptoms predominate in the clinical presentation *Factitious disorders with combined psychological and physical signs and symptoms: if both psychological and physical signs and symptoms are present and neither predominates in the clinical presentation Reference for the three types as described 20 January 2013


See also

* Attention seeking *
Somatic symptom disorder A somatic symptom disorder, formerly known as a somatoform disorder,(2013) dsm5.org. Retrieved April 8, 2014. is any mental disorder that manifests as physical symptoms that suggest illness or injury, but cannot be explained fully by a general ...
*
Victim playing Victim playing (also known as playing the victim, victim card, or self-victimization) is the fabrication or exaggeration of victimhood for a variety of reasons such as to justify abuse to others, to manipulate others, a coping strategy, attention ...


References


External links

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