What is Factitious Disorder?
Factitious disorder is a type of mental disorder, under which an individual uses techniques to delude others in various manners, such as, by appearing as a sick person to them, deliberately adapting sickness or intentional self-injury.(1,2,3) Factitious disorder conditions can be divided under the two heads of classification, namely:
Mild Factitious Disorder: It consists of slight exaggeration of the signs and symptoms.
Severe Factitious Disorder: This stage of the disorder is also, previously, known as Munchausen Syndrome.
It has also seen that under the influence of this mental disorder people often develop some nearly real sort of symptoms or tamper their test reports up to such extent that all of it, collectively, suggests high- risk surgery, in a way to convince others that it is a part of required treatment.
However, factitious disorder is completely different from that of the deliberately posed medical conditions, intended to collect personal benefits, such as escaping from on job responsibilities and manipulating lawsuit decisions in one’s favor. The major difference between these two conditions is, in factitious disorder people are aware of their self-created symptoms but would not be able to understand the cause of such behavior. In deliberately posed conditions for personal gains, people are well aware of the reasons as well as of the consequences of their actions.
The factitious disorder is arduous to treat as it is of very mysterious nature. However, psychological and medical assistance is provided to the patients to prevent them from any sort of self-injury events and severe consequences due to it, such as death.
Causes of Factitious Disorder
Though the causes of factitious disorder are yet not known but up to some extent, it has been found correct that physically, mentally and emotionally abused persons are at greater risk to develop this mental disorder into them. That is why psychologists use to peep into the past history of patients so that they can find the exact ground or root cause of this ailment.
Some of these factors may include:
- A family history of mental disorders(4,5)
- Having a family member who is sick
There is no clear reason as to what motivates people suffering from factitious disorder to suddenly start pretending to be sick. While some people start receiving a lot of special attention and sympathy from other people, but at the same time they also go through a lot of physical and emotional pain.
People suffering from factitious disorder may very well be aware that they are causing themselves the injury or they are self-creating their illness. However, they do not understand why they are doing this. They also are unlikely to see all the pretended behavior to be a problem.
It becomes a problem when a parent having factitious disorder starts to intentionally cause harm to a young child in order to make them appear ill or injured. A patient of factitious disorder may even harm the elderly who are under their care or other adults who suffer from physical disabilities.
The condition where individuals get diagnosed with having a factitious disorder that is imposed or carried out on another person or child is often referred to as factitious syndrome by proxy. It was earlier referred to as Munchausen syndrome by proxy. Factitious disorder by proxy, when carried out on a child or children, is a form of child abuse and punishable by law.
Symptoms of Factitious Disorder
As factitious disorder is a deliberately created mental disorder, it has no visible signs to recognize it. But it can be diagnosed on the basis of certain symptoms, counseling, and clinical tests. Some of the prominent symptoms of this ailment can be enumerated as:
- Cleverly planned and convincing medical conditions.
- Frequent hospitalization.
- Worsening of conditions without any reason.
- Eagerness to go through various clinical procedures and risky surgeries as well.
- Visiting many doctors or hospital with different names.
- Hesitate in allowing medical practitioner to consult with their caretakers and family members.
- Inconsistent or vague symptoms.
- Asking for painkillers and other narcotic drugs, frequently.
- Not responding to properly to the standard treatments.
- Extensive familiarity with the medical terms, medications, treatments, and diseases.
- Limit visitor during their hospitalization.
- Arguing with medical staff.
Factitious Disorder Vs. Munchausen
Under factitious disorder, a person appears as an unwell being which is developed by them on their own deliberately. This is done either by pretending or exaggerating symptoms. On the other hand, Munchausen syndrome is an augmented form of factitious disorder. Under this amplified form of the factitious disorder, people are more likely mentally convinced to prove their illness by contaminating or tampering urine culture like significant clinical procedures so that it would result in positive. It has also seen that many of such patients also use to inject themselves with fecal stuff in a way to produce abscess.
In short, a person may create symptoms of server illnesses is a factitious disorder and if this condition expands with the attempt of tampering various clinical test in different manners can be termed as Munchausen syndrome.
Factitious Disorder vs. Malingering
Factitious disorder is a kind of psychological condition, under which any person pretends to be unwell or present other individuals for treatment in under their care. They primarily began with exaggerating or lying about their medical history or the past medical records of the others and further try to support their statements by explaining fake symptoms. They do all these nonsensical practices deliberately so that they can go through the treatments or even high-risk surgical procedures in a way to call the attention of their near and dear ones. They may also attempt to harm themselves on their own so that they undergo the standard treatment procedures and, sometimes, surgeries as well.
On the other hand, malingering is a psychological condition which appears very much similar to that of the factitious disorder, but it is intended to achieve some materialistic gains or favors unlike to that of the attention. This psychological condition is a driven by or consequence of external motivation which are intended to grab certain advances, such as:
- Insurance fraud.
- Financial gains.
- Maneuvering lawsuit decision in own favor.
- Acquisition of restricted or controlled medicines.
- Cutting down the work obligations.
- Shrinking obligations of military services.
- Circumventing the clause of Incarceration in the case of criminal activities, etc…
It cannot be termed or put into the category of mental illness but persons adopting such tactics may get diagnosed with another sort of mental disorder, called antisocial personality disorder. Such kinds of people have a tendency to manipulate or exploit others purposefully and blatantly disregard the legal civil & constitutional rights of others.
Tests to Diagnose Factitious Disorder
It is very difficult to diagnose factitious disorder out of any patient as they are adept in faking different conditions and diseases. Sometimes, such patients do have the real severe medical condition, but that too are self-inflicted. They eventually develop a great amount of medical knowledge by going to different medical practitioners and hospitals with different names and ailments. Thus, they get aware of cross checking for medical conditions and hence, it becomes really arduous to diagnose this disorder instantly.
The behavior of patient may fall into the criteria of suspicion, if:
- The medical history of patient is nonsensical or suspicious
- Unbelievable reasons are given in support of particular injury or disease
- The illness does not follow the usual course
- Lack of healing without any genuine reason, despite standard treatment
- Inconsistent lab test reports and symptoms
- A person caught causing injury to them or in act of lying, etc…
A proper series of the test may be conducted to confirm the factitious disorder conditions if doubted on the grounds of above-given point of suspicion. Some foremost clinical procedures or tests which can be employed to diagnose this disorder can be enumerated as:
- Proper psychological counseling of a person
- Run possible tests for claimed ailments
- Complete physical examinations
- Looking into the medical history of the patient and finding the
- supporting root cause of their illness, etc…
Who is at Risk of Getting Factitious Disorder?
Some of the risk factors that put you at a higher risk of developing this mental disorder include:
- If you suffered from a severe and prolonged illness during childhood then there is high risk of factitious disorder.(4)
- If you were abused as a child – this can either be sexual, emotional or physical abuse, it increases the risk of factitious disorder.(4)
- The risk of factitious disorder increases if you have low self-esteem.
- If you have been hospitalized for a psychiatric disorder or any other medical condition then that increases the risk of factitious disorder.
- If you suffer from depression then it increases the risk of factitious disorder.(4)
- If you have a personality disorder the risk of factitious disorder increases.(4)
- If you have lost a loved one, through neglect, sickness or death; this will increase the risk of factitious disorder.
- If you have a strong desire to spend time with doctors or at a hospital.(4)
- If you are working in the medical field the risk of factitious disorder increases.(4)
- If you have some level of medical knowledge.
No one really knows how some people suddenly develop a factitious disorder, but it is an extremely rare disorder. It is also very difficult to get a real estimate of how many people are suffering from factitious disorder, as it has been observed that people suffering from factitious disorder often visit multiple healthcare centers or hospital and usually use a fake name.
When to Seek Help with Factitious Disorder?
People suffering from factitious disorder generally do not realize that they are sick or that they are at high risk of causing themselves a real injury or even death through their behavior. However, they have no control over their behavior and therefore, rarely seek medical help. Many may also refuse mental health treatment, even after being shown proof of their illness.
This is why it is very challenging to help a loved one or a friend suffering from factitious disorder. If you know someone who is suffering from a factitious disorder, then you should try to voice your concerns to them gently. Do not appear to be angry, confrontational or judgmental.
You should also encourage the patient suffering from factitious disorder to focus on positive and productive behaviors so that their focus turns away from such self-harming behaviors.
If possible, finding them mental health counseling and potential treatment will help the patient, and if you find the patient in severe distress, attempting suicide or injuring themselves severely, then you should call the emergency number of your area immediately. If possible, taking them to the emergency room at the earliest will be advisable.
Treatment for Factitious Disorder
Suffering from factitious disorder is a very challenging condition.(5) Those who suffer from factitious disorder become very good at imitating various illnesses or causing themselves injuries. Sometimes, they may even end up having a life-threatening medical condition that they end up causing themselves.
Diagnosing factitious disorder is also difficult as doctors may be basing their diagnosis on all false symptoms. Assessing the actual condition then depends primarily on conducting interviews, looking at past medical records, speaking to the family and friends and running additional tests to rule out the false symptoms.
Doctors suspect factitious disorder when a patient presents with the following:
A person has a very confusing medical history with several types of illnesses.
A person does not heal as expected following treatment.
- Patient does not have believable reasons for an existing injury or illness or is unable to explain how they got an injury.
- A person has an illness that is not following a standard course of progression and neither does it respond to treatment.
- Starts showing odd symptoms or has confusing test results.
- Is caught lying about their symptoms, their health condition.
- Is caught causing self-harm.
- Is not willing to share previous medical records with the present doctor.
The treatment for factitious disorder is very challenging and due to the nature of this disease, there is no standard format of therapies for treating factitious disorder. Furthermore, patients having factitious disorder may not be willing to accept treatment, as they do not believe that they are mentally sick.
The primary treatment for factitious disorder focuses on managing the condition and avoiding further physical and mental harm.(5)
Some of the treatment options for factitious disorder include:
- Psychotherapy sessions with a certified mental health professional helps in treating factitious disorder.(5)
- Having only one doctor to oversee all of the medical care helps in treatment and management of factitious disorder.
- Treatment of factitious disorder consists of hospitalization to provide help with mental health.
- Medication to treat underlying mental health conditions that may be coexisting, such as anxiety or depression benefits factitious disorder.(5)
There is no as such psychiatric medication available for the factitious disorder. However, patients can be put on certain scheduled drugs which are helpful in controlling mood disorders. These drugs fall under the list selective serotonin reuptake inhibitors (SSRI). There are some other drugs which were previously recorded by the means of good response in this mental disorder or as an antipsychotic drug. Pimozide is one of such drug salt in this category.
Sometimes, psychiatrists also advise patients and their family members to treat or pursue family therapy as a treatment for this disorder. Under this mode of treatment, family takes good care of the patient by providing them mental and emotional support and understanding the needs of the patient.
Complications for Factitious Disorder
A factitious disorder may show up horrible consequences if the condition gets worse. As the patients are intended to harm themselves in a way to undergo the treatment and surgical procedures, this act of patient can put them at greater risk of severe damages. It has also seen that people causing self-injury may also fall to death as well if they got injured badly by mistake.
In some cases, the patient also imposes such fake illness conditions on other and seeking treatment under their care. They also can cause damage to others in a way to prove the fake medical condition and can put their lives at great risk as well. On the other hand, if they tamper the clinical test samples of others and convenience them and medical practitioner to go through the high-risk surgical procedures, would also cause life threat to them.
It has also seen that people having untreated severe factitious disorder conditions, often develops the dangerous psychological disorder, such as schizophrenia as well. Hence it is very necessary to diagnose any of such conditions and get it treated according to its stage.
- Krahn, L.E., Li, H. and O’Connor, M.K., 2003. Patients who strive to be ill: factitious disorder with physical symptoms. American Journal of Psychiatry, 160(6), pp.1163-1168.
- Bauer, M. and Boegner, F., 1996. Neurological symptoms in factitious disorder. Journal of Nervous and Mental Disease.
- Rogers, R., Bagby, M. and Rector, N., 1989. Diagnostic legitimacy of factitious disorder with psychological symptoms. The American journal of psychiatry, 146(10), p.1312.
- Feldman, M.D. and Ford, C.V., 2000. Factitious disorder. Sadock BJ, Sadock VA. Comprehensive textbook of psychiatry. 7th ed. Philadelphia: Lippinicott Williamns & Wilkins, 1533.
- Earle Jr, J.R. and Folks, D.G., 1986. Factitious disorder and coexisting depression: a report of successful psychiatric consultation and case management. General hospital psychiatry, 8(6), pp.448-450.
- Feldman, M.D., 2013. Playing sick?: Untangling the web of Munchausen syndrome, Munchausen by proxy, malingering, and factitious disorder. Routledge.