A person with a factitious disorder intentionally produces, feigns or exaggerates the symptoms of a disease, illness or psychological condition with the aim of assuming the patient role. The motive varies but may include a desire to seek comfort and attention, attempt to gain access to drugs, or a fascination with the medical field. The sufferer may have a personality disorder and/or unresolved issues from childhood, such as physical or emotional abuse, or early detachment. These motives differ from those of malingering in which one fakes symptoms to gain disability payments or medical leave.
Münchausen syndrome is a serious form of factitious disorder in which the person often visits doctors and hospitals. The sufferer may produce his/her own symptoms by taking medication and other substances, contaminating urine tests or creating infections. The person may take injections to produce symptoms. An example is a woman who simulated arrhythmias by taking caffeine overdoses and using an ECG rhythm generator, demonstrating knowledge of medical equipment (Vaglio, Schoenhard, Saavedra, Williams, & Raj, 2011).
Those with FD may have personality disorders. They often have a history with the medical field. They may have faced a serious illness as a child, worked in a medical environment or aspired to work in the medical field. The person may seek the attention and comfort one receives in a hospital environment. Thus, when one symptom is under control, they may then fake a new illness. Factitious disorder by proxy (FDP) is when a caregiver creates false symptoms in another person.
Symptoms of Factitious Disorder
In factitious disorder, the person is consciously creating false symptoms. This differs from somatic disorders in which the person genuinely believes he/she is experiencing the symptoms of an illness and the faking of illness is an unconscious act. DSM-5 by replacing ‘somatoform’ with ‘somatic symptom disorders’ recognizes that somatic symptoms are prevalent across a number of disorders (Dimsdale, 2013). The somatic symptom related disorders include factitious disorder, as well as somatic symptom disorder, illness anxiety disorder, conversion disorder, and psychological factors affecting other medical conditions. In addition, DSM-5 has added new severity ratings of somatic symptoms.
DSM-5 recognizes three types of fictitious disorder (APA, 2013):
- 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.
The symptoms manifested in factitious disorder are only limited by those displayed in the types of diseases, illnesses and psychological disorders one can imitate. It is widely believed that any medical or psychological condition can be faked.
Factitious disorder has varying degrees of impact on daily functioning, depending on its severity. It is most commonly experienced by men in the middle-to-late stages of life. Impacts of FD on daily life includes occupational difficulties, social dysfunction and a high reliance on the medical system. FD is often a lifelong, chronic illness. FD places a major strain on the health system. It is estimated that 25% to 75% of physician visits are related to a somatic disorder (McCahi, 2013).
Factitious Disorder by proxy can not only affect the quality of life of a family member or loved one but also pose serious threats to health and life. It is considered a form of child or elderly abuse.
Factitious Disorder Therapy
Treatment of factitious disorder can be difficult, especially when it is comorbid with other mental disorders. In patients with FD and somatoform disorder, one must distinguish the symptoms that are legitimately felt but cannot be traced to an underlying cause from those that are purposely created through drugs, injections, falsified tests and other means. A patient with bipolar disorder may swing between experiencing psychosis with somatic and suicidal complaints to a “manic or mixed phase” in which he/she creates the symptoms and/or manipulates medical professionals into believing they exist (Casale et al., 2012). New classifications in DSM-V of somatic symptoms are aimed at making it easier to identify and treat these disorders.
There are different schools of thought on how to treat somatic symptom-related disorders. More emphasis is being placed on treating the underlying psychological problems and symptoms such as anxiety and depression. The DSM-5 task force on somatic disorders has emphasized the need to focus more on the underlying causes of these disorders. A better understanding of the causes can lead to more individualized behavioral therapy approaches. Confrontation of the patient to address factitious disorder can lead to aggression. Diagnosis may be further confounded by pathological lying.
Patients prefer psychotherapy over medication, which may partly reflect their desire for attention from the medical system. Interpersonal and cognitive behavioral therapy (CBT) are recommended for mild forms. Selective serotonin uptake inhibitors (SSRIs) may be subscribed for underlying mood disorders such as anxiety and depression.
Behavioral therapy and cognitive behavioral therapy (CBT) are used to treat mild-to-severe forms of FD. In some cases, CBT may be a form of mild self-harm. CBT has been successfully used to treat an adolescent female with superficial scratch marks and feigning dizziness (Malhotra, Rajender, Bhatia, & Singh, 2011). In other cases, the faking of an illness may be life threatening, such as taking medication to induce a cardiac arrest, and may indicate comorbid psychological disorders. Combined medication plus CBT therapy may be recommended.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Del Casale, A., Ferracuti, S., Rapinesi, C., Serata, D., Simonetti, A., Caloro, M., et al. (2012). Factitious disorder comorbid with bipolar I disorder. A case report. Forensic Science International, 219(1), e37-e40.
Dimsdale, J. E. (2013). Somatic Symptom Disorders: a new approach in DSM-5. Die Psychiatrie, 10, 30-32.
Malhotra, S., Rajender, G., Bhatia, M. S., & Singh, T. B. (2011). Cognitive Behavioural Management of a Child with Factitious Disorder. Indian Journal of Clinical Psychology, 38(2), 169-174.
McCahi, M. E. (2013). Related Syndromes. Family Medicine: Principles and Practice, 300.
Vaglio, J. C., Schoenhard, J. A., Saavedra, P. J., Williams, S. R., & Raj, S. R. (2011). Arrhythmogenic Munchausen syndrome culminating in caffeine-induced ventricular tachycardia. Journal of electrocardiology, 44(2), 229-231.
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