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Factitious Disorders

Factitious disorder is a fancy term for “faking it.” It’s also known as Munchausen’s disorder, and it’s an issue that is frustrating for family members and medical professionals alike.

 

It is assumed that, in general, no one wants to be sick. It’s also assumed that those who seek medical treatment are providing an honest medical history in order to get the most accurate treatment possible and will follow the prescribed treatment through to the end with the goal of a complete recovery.

This is not the case for those who are diagnosed with factitious disorder. Patients who make up symptoms in order to gain a certain diagnosis that they believe will garner them the attention, care and interest of others have no intention of getting better. Why? Experts believe that those with factitious disorder simply feel more comfortable in the “sick role.” In fact, it’s a diagnosis handed out when there is no other reward or gain (e.g., financial, legal, etc.).

Signs of Factitious Disorder

  • Evasive and vague when answering questions about symptoms
  • Avoid providing documentation of former discharge notices or insurance claims
  • Offer a dramatic medical history that sounds questionable
  • Claims symptoms of pain and distress that are hard to document

Subtypes of Factitious Disorder

  • Predominantly psychological symptoms
  • Predominantly physical symptoms
  • Physical and psychological symptoms
  • Factitious disorder not otherwise specified (NOS) (e.g., Munchausen syndrome by proxy)

Factitious Disorder NOS

Perhaps even more disturbing than pretending physical and psychological symptoms themselves are those patients who pretend that someone in their care (e.g., a child or an elderly family member) has symptoms that require treatment. This is diagnosed when:

  • The individual feigns symptoms in another person who is under their care.
  • There is no financial or legal gain from pretending that the person they are caring for is ill.
  • The motivation is to garner the sympathy of others and the identity of the victim by proxy.
  • There are no other identified mental health disorders that explain the behavior.

Case Study: Factitious Disorder

A young woman comes to the hospital seeking treatment for abdominal pain. Preliminary workups reveal that there is no cyst or obstruction, no infection, and no apparent reason for the pain. The young woman demands surgery to remove her appendix. Doctors comply only to find that her appendix is fine and not the source of the pain.

The young woman returns to the emergency room a few weeks later, again complaining of abdominal pain. Again, no cause is found and doctors release her. She becomes angry, demanding exploratory surgery to determine the cause. This demand is denied for lack of medical cause, and she leaves angry.

Weeks later, doctors find that she was admitted to a nearby hospital with an abscess in her stomach. It was determined that that abscess was self-imposed when she stabbed herself with a fork. She again demanded surgery, and was denied here too. When confronted with her self-imposed wounds and unfounded demand for surgery, she became defensive. Ultimately, she was diagnosed with factitious disorder.

Treatment for Factitious Disorder

It is difficult to diagnose and treat factitious disorder because, by definition, patients do not want to get help. However, family members who recognize the problem can play a role in helping them find treatment to heal. Treatment options often include:

  • Psychiatric care to address the underlying issues and drive to identify as a victim of illness
  • Medication to reduce compulsive behavior and reduce the act of self-inflicted harm
  • Family therapy can benefit everyone hurt by the patient’s need to be in the sick role
  • Dual diagnosis treatment when other mental health issues are identified