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Factitious Disorders
A factitious disorder is a condition in which a person acts as if they have an illness by deliberately producing, feigning, or exaggerating symptoms.
Motives:
The motives of the patient can vary: for a patient with factitious disorder, the primary aim is to obtain sympathy, nurturance, and attention accompanying the sick role. This is in contrast to malingering, in which the patient wishes to obtain external gains such as disability payments or to avoid an unpleasant situation, such as military duty. Factitious disorder and malingering cannot be diagnosed in the same patient, and the diagnosis of factitious disorder depends on the absence of any other psychiatric disorder.
Types of Factitious Disorders:
Factitious disorder with mostly psychological symptoms — People with this disorder mimic behavior that is typical of a mental illness, such as schizophrenia. They may appear confused, make absurd statements, and report hallucinations (the experience of sensing things that are not there; for example, hearing voices).
Factitious disorder with mostly physical symptoms — People with this disorder claim to have symptoms related to a physical illness–symptoms such as chest pain, stomach problems, or fever.
Factitious disorder with both psychological and physical symptoms — People with this disorder report symptoms of both physical and mental illness.
Factitious disorder not otherwise specified — People with this disorder produce or fabricate symptoms of illness in another person under their care. It most often occurs in mothers (although it can occur in fathers) who intentionally harm their children in order to receive attention.
Symptoms:
- Dramatic but inconsistent medical history
- Unclear symptoms that are not controllable, become more severe, or change once treatment has begun
- Predictable relapses following improvement in the condition
- Extensive knowledge of hospitals and/or medical terminology, as well as the textbook descriptions of illness
- Presence of many surgical scars
- Appearance of new or additional symptoms following negative test results
- Presence of symptoms only when the patient is alone or not being observed
- Willingness or eagerness to have medical tests, operations, or other procedures
- History of seeking treatment at many hospitals, clinics, and doctors’ offices, possibly even in different cities
- Reluctance by the patient to allow health care professionals to meet with or talk to family members, friends, and prior health care providers
Treatment:
The first goal of treatment is to modify the person’s behavior and reduce his or her misuse or overuse of medical resources. In the case of factitious disorder by proxy, the main goal is to ensure the safety and protection of any real or potential victims. Once the initial goal is met, treatment aims to resolve any underlying psychological issues that may be causing the person’s behavior or help them find solutions to housing or other social needs.
The primary treatment for factitious disorders is psychotherapy (a type of counseling). Treatment likely will focus on changing the thinking and behavior of the individual with the disorder (cognitive-behavioral therapy). Family therapy also may be helpful in teaching family members not to reward or reinforce the behavior of the person with the disorder.