Factitious Disorder

Factitious Disorder is the occurrence of intentional or feigning of physical or psychological symptoms. The primary motivation is to assume the sick role without any financial, legal or physical well-being incentives.

These symptoms or behaviors are clinically substantial as confirmed by the following:

• The essential feature of Factitious Disorder is the intentional production of physical or psychological signs or symptoms.

• The presentation may include fabrication of subjective complaints (e.g., complaints of acute abdominal pain in the absence of any such pain), falsification of objective signs (e.g., manipulating a thermometer to create the illusion of fever), self-inflicted conditions (e.g., the production of abscesses by injection of saliva into the skin), exaggeration or exacerbation of preexisting general medical conditions (e.g., feigning of a grand mal seizure by an individual with a previous history of seizure disorder), or any combination or variation of these.

• The motivation for the behavior is to assume the sick role.

• External incentives for the behavior (e.g., economic gain, avoiding legal responsibility, or improving physical well-being, as in Malingering) are absent.

These individuals can engage in pathological lying, in a captivating manner that intrigues the listener.

They often have extensive knowledge of medical terminology and hospital routines. Complaints of pain and requests for analgesics are very common. Individuals with this disorder may eagerly undergo multiple invasive procedures and operations.

Associated Features

In Factitious Disorder With Predominantly Psychological Signs and Symptoms, the individual may surreptitiously use psychoactive substances for the purpose of producing symptoms that suggest a mental disorder.

Multiple hospitalizations frequently lead to iatrogenically induced general medical conditions (e.g., the formation of scar tissue from unnecessary surgery, or adverse drug reactions). Individuals with the chronic form of this disorder may acquire a "gridiron abdomen" from multiple surgical procedures.

Possible predisposing factors to Factitious Disorder may include the presence of other mental disorders or general medical conditions during childhood or adolescence that led to extensive medical treatment and hospitalization; family disruption or emotional or physical abuse in childhood; a grudge against the medical profession; employment in a medically related position; and the presence of a severe Personality Disorder, most often Borderline Personality Disorder.

Course

The course of Factitious Disorder usually consists of intermittent episodes. Less common is a single episode or chronic, unremitting illness. The onset is usually in early adulthood, often after a hospitalization for a general medical condition or other mental disorder. In the chronic form of this disorder, a pattern of successive hospitalizations may become a lifelong pattern.

Types

Code based on type:

• Factitious Disorder with Predominantly Psychological Signs and Symptoms: if psychological signs and symptoms predominate in the clinical presentation

• Factitious Disorder 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 but neither predominates in the clinical presentation

• Factitious Disorder Not Otherwise Specified (Munchausen by Proxy): This category includes disorders with factitious symptoms that do not meet the criteria for Factitious Disorder. An example is factitious disorder by proxy: the intentional production or feigning of physical or psychological signs or symptoms in another person who is under the individual's care for the purpose of indirectly assuming the sick role (see Factitious Disorder by Proxy for suggested research criteria).

Diagnostic criteria summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.