Causes and Symptoms (Magill’s Medical Guide, Sixth Edition)
Although factitious disorders cover a wide array of physical symptoms and are believed to be closely related to a subset of psychophysiological disorders (somatoform disorders), they are unique in all of medicine for two reasons. The first distinguishing factor is that whatever the physical disease for which treatment is sought and regardless of how serious, the patients who seek its treatment have deliberately and intentionally produced the condition. They may have done so in one of three ways, or in any combination of these three ways. First, patients fabricate, invent, lie about, and make up symptoms that they do not have; for example, they claim to have fever and night sweats or severe back pain that they actually do not have. Second, patients have the actual symptoms that they describe, but they intentionally caused them; for example, they might inject human saliva into their own skin to produce an abscess or ingest a known allergic food to cause the predictable reaction. Third, someone with a known condition such as pancreatitis has a pain episode but exaggerates its severity, or someone else with a history of migraines claims his or her headache to be yet another migraine when it is not. Factitious disorders may manifest as complaints about psychological problems, physical problems, or both.
The second element that makes these disorders unique (and at the same time both fascinating to study and frustrating to...
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Treatment and Therapy (Magill’s Medical Guide, Sixth Edition)
In the United States, estimates suggest that factitious disorders may result in costs totaling well over $40 million per year. Understanding how to identify individuals with factitious disorders early in their treatment process is crucial to public health for three important reasons. First, early identification will help the individual obtain a more appropriate referral. Second, it will conserve valuable health care resources, so that clients who have pressing medical needs get the treatment that they deserve. Third, the earlier in the process these individuals can be identified, the sooner valuable health care dollars can be saved, lowering the cost of health care as a whole.
Internists, family practitioners, and surgeons are the specialists most likely to encounter patients with factitious disorder, although psychiatrists and psychologists are often consulted in the management of these patients. These patients pose a special challenge because, in a real sense, they do not wish to become well even as they present themselves for treatment. They are not ill in the usual sense, and their indirect communication and manipulation often make them frustrating to treat using standard goals and expectations.
Sometimes mental and medical specialists’ joint, supportive confrontation of these patients results in a disappearance of the troubling and troublesome behavior. During these confrontations, the health professionals...
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For Further Information: (Magill’s Medical Guide, Sixth Edition)
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4th ed. Arlington, Va.: Author, 2000. This reference book lists the clinical criteria for psychiatric disorders, including mood disorders.
Feldman, Marc D. Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder. New York: Brunner-Routledge, 2004. Fascinating case histories of people whose conditions lead them to fake illnesses, in themselves and others, sometimes to the point of death.
Phillips, Katherine A., ed. Somatoform and Factitious Disorders. Washington, D.C.: American Psychiatric Association, 2001. A comprehensive examination of such topics as epidemiology, etiology/pathology, and treatment modalities for somatoform and factitious disorders.
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Introduction (Psychology and Mental Health)
People with factitious disorders attempt to produce or fabricate the signs and symptoms of medical and mental disorders to assume the role of a patient. They do not actually have these medical or mental disorders and are quite aware that they do not. They voluntarily fabricate an illness to become a patient but are not trying to achieve some secondary gain such as avoiding work responsibilities, obtaining money, or escaping from a particular duty. Factitious disorders share some similarities with malingering, which also involves the intentional production of symptoms associated with medical and mental disorders. However, the goal of malingering is to achieve some external reward such as worker’s compensation, insurance money, or special accommodations, while factitious disorder involves only internal needs.
Many people with factitious disorder seek to be hospitalized and often experience serial hospitalizations. If staff at one medical facility discovers that the person has intentionally fabricated the symptoms of a particular disease, the person seeks medical care at a different hospital. The person with a factitious disorder commonly seeks unnecessary surgeries, medications, and physical procedures.
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Those Affected (Psychology and Mental Health)
The prevalence of factitious disorder in the general population is unknown. Hospital and medical professionals seldom record the diagnosis in discharge records because the person may voluntarily leave the facility once the deception is discovered or suspected. Although officially the disorder appears to be fairly rare, its incidence may be underestimated because numerous cases may not receive a formal diagnosis. The disorder seems to be more common among those who work in the health care industry than among people in other occupations. Women are diagnosed more frequently than men and tend to show severe manifestations of the intentional fabrication of illness.
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Diagnosis (Psychology and Mental Health)
Factitious disorders are one of the psychiatric disorders described in the Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR (rev. 4th ed., 2000) published by the American Psychiatric Association. There are three forms of factitious disorder: predominantly psychological signs and symptoms, predominantly physical signs and symptoms, and combined psychological and physical signs and symptoms. Three central features of factitious disorders are an intentional fabrication of symptoms, a desire to assume the sick role, and a lack of external rewards for assuming that role. Munchausen syndrome is the most severe form of factitious disorder. Developing elaborate stories around a medical condition and traveling significant distances to gain medical treatments are common characteristics of this syndrome.
To make a diagnosis, the medical professional must go through a process of exclusion to determine that the signs and symptoms are not due to a true medical or psychiatric illness. This process requires careful examination of all reported signs and symptoms of illness. Typically, a psychiatrist becomes involved with the case to consider the existence of a factitious disorder.
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Diagnostic Types (Psychology and Mental Health)
One type of factitious disorder has predominantly psychological signs and symptoms. In this type, the person intentionally makes up symptoms that suggest a particular psychiatric disorder. The person wanting to become a psychiatric patient is often treated with psychoactive medications and psychotherapy until the true nature of the patient’s condition is discovered. These individuals present a false history suggestive of the psychiatric disorder that they are pretending to have. Pseudologia fantastica is often found in this type of factitious disorder and is characterized by colorful fantasies that add an element of drama to the individual’s life history. It is believed that the stories become additionally dramatic to gain the attention of health care professionals.
A second type of factitious disorder is associated with predominantly physical signs and symptoms. Munchausen syndrome most often takes this form. People with this type of the disorder describe to medical professionals a diverse grouping of physical complaints that are suggestive of medical illness. The person voluntarily seeks to have numerous medical tests and procedures, including hospitalizations. Serial hospitalizations often take place as the person moves from hospital to hospital seeking medical care. The person with this type of factitious disorder is adept at presenting symptoms and signs of illness in a manner that is very convincing to the medical...
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Possible Causes (Psychology and Mental Health)
Attempts at explaining the causes of factitious disorder have focused on psychodynamics. This type of explanation tries to identify childhood experiences that negatively affected development and produced internal worries and concerns that later motivate adult actions. When reviewing the histories of patients who have been diagnosed with factitious disorder, it is common to find evidence of early parental rejection, neglect, or abuse. As adults, these patients evaluate their parents as cold and not nurturing. Many of these patients have also experienced hospitalizations in childhood that served as respites from the deprived home environments. Some experts think that persons with factitious disorder learned at an early age that medical personnel are caring, nurturing individuals. Consequently, the goal of receiving medical care and hospitalization has the intent of forming a positive nurturing bond that was absent in the patient’s childhood.
An additional proposed psychodynamic cause of factitious disorder relates to the goal of being subjected to uncomfortable medical procedures and surgeries. Factitious disorder patients may believe that they caused their parents to reject them during their childhoods. They view the discomfort and pain of unnecessary medical procedures as a welcome punishment for causing the rejection.
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Long-Term Consequences (Psychology and Mental Health)
There are some exceptions, but the majority of cases of factitious disorder begin in young adulthood. It is common that the first manifestations of the disorder follow a real need for the individual or a close relative to be hospitalized. Typically, there are additional stressors in the person’s life that may include some significant losses. There usually is a process in which the person studies the signs and symptoms of medical and mental illnesses and becomes familiar with a number of disease states. Responding to the internal needs of finding a satisfying relationship or punishing the self for childhood abandonment or rejection, the individual seeks care from a nurturing medical professional. The person’s expansive knowledge about medical illness permits the escalation toward hospitalization and eventual serial hospitalizations.
Factitious disorder has a poor prognosis for change and often has a negative impact on occupational responsibilities. Many patients with this disorder experience economic strain and chaotic lifestyles. These patients often obtain numerous forms of identification to avoid detection and move from location to location. In general, the person with factitious disorder lacks a network of friends or social supports.
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Treatment Options (Psychology and Mental Health)
No specific treatments have been found to be consistently effective in the treatment of factitious disorders. Psychotherapy is usually offered as a treatment strategy, but the patient with factitious disorder rarely seeks to be cured. Often the patient with factitious disorder seeks medical care for false medical or mental conditions but refuses treatment for the real factitious disorder. As a result, treatment efforts have focused on identifying the disorder as soon as possible after the person enters the medical care system in an attempt to prevent unnecessary treatment, diagnostic tests, and hospitalization. Once medical personnel discover that a hospitalized person has a factitious disorder, they usually respond with anger and resentment because they feel betrayed by the patient’s lies and deceit.
Whenever a person with factitious disorder by proxy has been identified, there are a number of important considerations. Using a child as a means to gain medical treatments is a form of child abuse, and the legal system must become involved. The appropriate child protective service must be informed to protect the child and prevent any possible abuse or injury. If the child remains with the parent with factitious disorder by proxy, the child’s welfare must be carefully monitored for an extended period.
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Sources for Further Study (Psychology and Mental Health)
Eastwood, S., et al. “Management of Factitious Disorders: A Systematic Review.” Psychotherapy and Psychosomatics 77 (2008): 209-218. An excellent source for information on the treatments for factitious disorder. The authors discuss the importance of establishing an evidence-based approach in treating this disorder.
Ehrlich, S., et al. “Factitious Disorder in Children and Adolescents: A Retrospective Study.” Psychosomatics 49 (September, 2008): 392-398. To gain an understanding of the prevalence of factitious disorder, the authors completed a retrospective review of medical services to children and adolescents.
Eisendrath, S., et al. “Factitious Disorders: Potential Litigation Risks for Plastic Surgeons.” Annals of Plastic Surgery 60 (January, 2008): 64-69. Many people with factitious disorders present with self-inflicted wounds that often require the medical attention of plastic surgeons. However, they often intentionally cause problems during the healing process. This is a useful source of information that demonstrates how these patients are problems for medical caregivers.
Sanders, M., and B. Bursch. “Forensic Assessment of Illness Falsification, Munchausen by Proxy, and Factitious Disorder.” Child Mistreatment 7 (2002): 112-130. A good discussion of the importance of identifying factitious disorder by proxy to safeguard children. The evidence...
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Factitious Disorders (Encyclopedia of Medicine)
Factitious disorders are a group of mental disturbances in which patients intentionally act physically or mentally ill without obvious benefits. The name factitious comes from a Latin word that means artificial. These disorders are not malingering, which is defined as pretending illness when the "patient" has a clear motive, such as financial gain.
Patients with factitious disorders produce or exaggerate the symptoms of a physical or mental illness by a variety of methods, including contaminating urine samples with blood, taking hallucinogens, injecting themselves with bacteria to produce infections, and other similar behaviors.
There are no reliable statistics on the frequency of factitious disorders, but they are more common in men than in women. The following conditions are sometimes classified as factitious disorders:
Munchausen syndrome refers to patients whose factitious symptoms are dramatized and exaggerated.
Many persons with Munchausen go so far as to undergo major surgery repeatedly, and, to avoid detection, at several locations. Many have been employed in hospitals or in health care professions. The syndrome's onset is in early adulthood.
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Factitious disorder (Encyclopedia of Mental Disorders)
Factitious disorder (FD) is an umbrella category that covers a group of mental disturbances in which patients intentionally act physically or mentally ill without obvious benefits. According to one estimate, the unnecessary tests and waste of other medical resources caused by FD cost the United States $40 million per year. The name factitious comes from a Latin word that means "artificial" or "contrived."
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, fourth edition) distinguishes factitious disorder from malingering, which is defined as pretending illness when the individual has a clear motive-usually to benefit economically or to avoid legal trouble.
Factitious disorder is sometimes referred to as hospital addiction, pathomimia, or polysurgical addiction. Variant names for individuals with FD include hospital vagrants, hospital hoboes, peregrinating patients, problem patients, and professional patients.
Cases of factitious disorder appear in the medical literature as early as Galen, a famous Roman physician of the second century A.D. The term factitious is derived from a book by an English physician named Gavin, published in 1843,...
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