Factitious Disorder: Symptoms and Treatment

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What is Factitious Disorder?

Factitious disorder is a condition in which a person fakes a physical or mental illness to gain sympathy and attention. It is a serious mental illness that previously went by the name Munchausen syndrome. It is also referred to as factitious disorder imposed on self.

Factitious disorder by proxy is when a person acts as if someone in their care has an illness when they are actually normal. It also goes by the names Munchausen disorder by proxy or factitious disorder imposed on another.

Line drawing of person with factitious disorder (Munchausen syndrome)

They may lie about or produce symptoms by hurting themselves or altering tests (such as contaminating a urine sample), or taking hallucinogens. People with factitious disorder know they are causing their symptoms. But, they may not be fully aware of why they fake symptoms or induce illness. And, they do not recognize themselves as having a problem.

People with factitious disorder may suffer from other mental illnesses, in particular personality disorders. Their thinking patterns and acting generally tend to be unusual or abnormal compared to societal standards. Their coping skills are poor and they have trouble forming healthy relationships.

Factitious disorder is challenging to diagnose and hard to treat. However, medical help is critical for preventing serious injury and even death due to self-harm. Factitious disorder is different from malingering where one does it for practical benefits, such as winning a lawsuit or getting out of a work situation. Factitious disorder is similar to somatoform disorder but differs from it in that people with somatoform disorder do not fake symptoms.

Prevalence of Factitious Disorder

It is difficult to estimate how common the condition is because they usually deny that they have a mental health problem. The Cleveland Clinic estimates that roughly 1% of people admitted to hospitals have factitious disorder. Roughly two-thirds of factitious disorder patients are female, with an average age of 34 years. Quite a few of these patients have depression in addition, and almost 60% prefer self-inducing injury rather than faking it or lying about an illness.

Symptoms of Factitious Disorder

The symptoms include:

  • Dramatic but vague or inconsistent symptoms
  • Absence of physical signs consistent with the history (e.g., no signs of dehydration in patients complaining of vomiting and diarrhea)
  • Presence of symptoms only when the patient is under observation or being examined and not when they are unaware of being observed
  • Extensive knowledge of medical terms and textbook descriptions of diseases
  • Often, employment or education in a medically related field
  • Long medical history with multiple admissions at various hospitals in different cities, which may include using fake names
  • Reluctance to allow doctors to talk to family members or friends or to previous doctors
  • Having few visitors when hospitalized
  • Arguing with doctors and staff
  • Eagerness to have frequent medical tests or risky procedures and operations
  • Presence of multiple surgical scars or evidence of numerous procedures
  • Predictable relapses after improvement of the condition
  • Mood and affect better than would be expected given the ostensible medical condition
  • A complaint of additional or new symptoms if tests are negative
  • Refusal to have a psychological evaluation performed

Causes

The exact cause of factitious disorder is not known. A variety of factors can increase the risk, including:

  • Childhood neglect or abuse
  • History of frequent illnesses that required hospitalizations
  • History of a severe or chronic condition in a family member or friend
  • Chronic illness in childhood
  • Trauma
  • Family dysfunction
  • Unresolved issues with parents
  • Social isolation
  • Professional experience in healthcare
  • Personality disorders

Diagnosis

Factitious Disorder Imposed on Self

  • Faking of physical or mental signs or symptoms, or induction of injury or disease, associated with identified deception.
  • The individual presents himself or herself to others as ill, impaired, or injured.
  • The deceptive behavior is not due to seeking of external rewards.
  • The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Factitious Disorder Imposed on Another

  • Faking of physical or mental signs or symptoms, or induction of injury or disease, in another, associated with identified deception.
  • The individual presents another individual (victim) to others as ill, impaired, or injured.
  • The deceptive behavior is not seeking any obvious external rewards.
  • The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Treatment of Factitious Disorder

The mainstay of treatment is psychotherapy. Cognitive-behavioral therapy tries to change the thinking patterns and behavior of the individual. It also helps nurture positive coping skills to build self-esteem and help manage stress. Family therapy may be necessary to educate the members not to reinforce or reward the behavior of the person with the disorder.

There are no specific medications to treat the disorder. Antidepressants in the form of selective serotonin reuptake inhibitors are necessary if there is associated anxiety or depression.

Monitor them for substance abuse and potential self-harm or suicidality.

Adopt a non-judgmental approach. Direct accusations make them angry and defensive. So ensure that the patient has an escape route to spare the humiliation of admitting to faking symptoms. For example, the doctor may reassure that stress may be responsible for some of the symptoms.

In the case of factitious disorder imposed on another, the doctor assesses for abuse and reports the abuse to the appropriate authorities, if necessary.

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Summary
Factitious Disorder: Symptoms and Treatment
Article Name
Factitious Disorder: Symptoms and Treatment
Description
Factitious disorder is a condition in which a person fakes a physical or mental illness to gain sympathy and attention. It was known as Munchausen syndrome.
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DepressionPedia.org
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