Factitious disorder

A factitious disorder is a condition in which a person, without a malingering motive, acts as if they have an illness 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 samples, taking hallucinogens, injecting fecal material to produce abscesses, and similar behaviour.

Factitious disorder
SpecialtyPsychiatry, psychology

Factitious disorder imposed on self (also called Munchausen syndrome) was for some time the umbrella term for all such disorders.[1] Factitious disorder imposed on another (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 disorders, though also diagnoses of exclusion, are characterized by physical complaints that are not produced intentionally.[2]

Causes

The causes are mostly unknown. One possible cause is trauma but the rest is still going through a testing process. It is also been suspected that it might be hereditary, like depression. There are still many possible causes for this disorder which haven't been defined yet.[3]

These individuals may be trying to reenact unresolved issues with their parents. A history of frequent illnesses may also contribute to the development of this disorder. In some cases, individuals with factitious disorder are accustomed to actually being sick, and thus return to their previous state to recapture what they once considered the "norm". Another cause is a history of close contact with someone (a friend or family member) who had a severe or chronic condition. The patients found themselves subconsciously envious of the attention said relation received, and felt that they themselves faded into the background. Thus medical attention makes them feel glamorous and special.[4]

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 differentiates among two types:

  • Factitious disorder imposed on self (Munchausen syndrome)
  • Factitious disorder imposed on another (Munchausen syndrome by proxy),[5] defined as: When an individual falsifies illness in another, whether that be a child, pet, or older adult.[6]

Factitious disorder imposed on self

Factitious disorder imposed on self, previously called Munchausen syndrome, or factitious disorder with predominantly physical signs and symptoms,[7][8] 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, 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. 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 (formerly called somatization disorder), in which the patient is truly experiencing the symptoms and has no intention to deceive. In conversion disorder (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.[9] However, selective serotonin reuptake inhibitors (SSRIs) can help manage underlying problems. Medicines such as SSRIs that are used to treat mood disorders 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 drugs such as Pimozide. Family therapy 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. 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[10]

See also

References
  1. Factitious Disorder Imposed on Self at eMedicine
  2. Somatoform Disorders Archived 2007-10-24 at the Wayback Machine
  3. Sadock, B.J.; Sadock, V.A; Ruiz, P. (2014). Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Lippincott Williams and Wilkins. pp. 465–503. ISBN 978-1609139711.
  4. Mohammad, J. MD, FAPA; Khalid, Z. MD; McDonald, K.A, BScH; Shelley, A.J., BScH (2018). "Psychological aspects of factitious disorder. Prim Care Companion CNS Disord". Ehe Primary Companion for CNS Disorders. 20 (1): 17nr02229. doi:10.4088/PCC.17nr02229. PMID 29489075. Retrieved June 24, 2021.
  5. "Factitious Disorders". Cleveland Clinic. Archived from the original on 4 April 2015. Retrieved 1 April 2015. Reference for the two as described 1 April 2015
  6. Nolan- Hoeksema, Susan. (2014). Abnormal Psychology. McGraw Hill Publishing; 6th int ed. p. 159
  7. Jerald Kay and Allan Tasman (2006). Essentials of psychiatry. John Wiley & Sons, Ltd. pp. 680. ISBN 0-470-01854-2.
  8. Sadock, Benjamin J.; Sadock, Virginia A., eds. (January 15, 2000). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (2 Volume Set) (7th ed.). Lippincott Williams & Wilkins Publishers. p. 1747. ISBN 0683301284.
  9. "Factitious Disorder". Mayo Clinic.
  10. Jerald Kay and Allan Tasman (2006). Essentials of psychiatry. John Wiley & Sons, Ltd. pp. 680. ISBN 0-470-01854-2. Reference for the three types as described 20 January 2013
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