Factitious Disorder

Factitious Disorder: Description, Causes and Risk Factors: Factitious DisorderFactitious disorder refers to the psychiatric condition in which a patient deliberately produces or falsifies symptoms of illness for the sole purpose of assuming the sick role. Patients with factitious disorder waste precious time and resources through unnecessary hospital admissions, expensive investigatory tests, and sometimes, lengthy hospital stays. Moreover, patients with factitious disorder are among the most challenging and troublesome for busy clinicians. Patients with factitious disorder can generate feelings of anger, frustration, or bewilderment, because they violate the expectations of physicians and staff that patients should "behave like patients." Patients with factitious disorder disobey the following unwritten rules of being a patient: (1) patients attempt to provide an honest history; (2) symptoms result from accident, injury, or chance; and (3) patients are seeking treatment with the goal of recovering and so will cooperate with treatment toward that end. Patients with factitious disorder likely have been present throughout human history. Their appearance in the literature extends back to the time of the Roman physician Galen who wrote about them in the second century. In the 1800s, the British physician Gavin described how some soldiers and seamen pretended illness to excite compassion or interest. As with many psychiatric illnesses, the pathophysiology of factitious disorder is unclear. Case reports of abnormalities on MRIs of the brains of patients with chronic factitious disorder suggest that brain biology may play a role in some cases. For example, in one report, a patient with Munchausen syndrome that underwent SPECT scan was found to have marked hyperperfusion of the right hemithalamus. In addition, some patients with factitious disorder have displayed abnormalities on psychological testing. Results of EEG studies have thus far been nonspecific. Risk Factors May Include: Lack of a support system at home (illness of parent, loss of parent or little parent involvement).
  • Depression.
  • Dependence.
  • Lifelong involvement with physicians.
  • Poor sense of self.
  • Suicidal tendencies.
  • Sexual/physical abuse.
  • Extreme poverty/homelessness.
  • Chronic lying.
  • Institutionalization.
  • Chronic illness.
The prevalence of factitious disorder is unclear. Many authorities believe the condition is underdiagnosed because it involves willful deception, which may be missed by medical staff. Symptoms: Possible warning signs of factitious disorders include the following: 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.
Diagnosis: Due to the dishonesty involved, diagnosing factitious disorders is very difficult. In addition, doctors must rule out any possible physical and mental illnesses, and often use a variety of diagnostic tests and procedures before considering a diagnosis of factitious disorder. If the health care provider finds no physical reason for the symptoms, he or she may refer the person to a psychiatrist or psychologist -- mental health professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use thorough history, physical, laboratory tests, imagery, and psychological testing to evaluate a person for Munchausen syndrome. The doctor bases his or her diagnosis on the exclusion of actual physical or mental illness, and his or her observation of the patient's attitude and behavior. Questions to be answered include: Do the patient's reported symptoms make sense in the context of all test results and assessments?
  • Do we have collateral information from other sources that confirm the patient's information? (If the patient does not allow this, this is a helpful clue.)
  • Is the patient more willing to take the risk for more procedures and tests than you would expect?
  • Are treatments working in a predictable way?
The doctor then determines if the patient's symptoms point to Munchausen syndrome as outlined in DSM-IV. The Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV-TR) requires that the following three criteria be met for the diagnosis of factitious disorder: (1) intentional production or feigning of physical or psychological signs or symptoms, (2) motivation for the behavior is to assume the sick role, and (3) absence of external incentives for the behavior (eg, economic gain, avoiding legal responsibility, improving physical well-being, as in malingering). 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. There are no medications to actually treat factitious disorders. Medication may be used, however, to treat any related disorder, such as depression or anxiety. The use of medications must be carefully monitored in people with factitious disorders due to the risk that the drugs may never be picked up from the pharmacy or may be used in a harmful way. NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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