There are some people who are highly invested in convincing others they have a medical condition and taking on the role of patient. In order to do this, they either purposely produce psychological or physical symptoms or they fake them. Unlike malingering, however, their motive for being sick is not obvious. There is no external gain, such as financial benefits or the avoidance of jail time. When this occurs, the diagnosis is factitious disorder.
Individuals with factitious disorder may:
- Make up different subjective complaints (e.g. stomach pain or headache)
- Cause symptoms by harming themselves in some way
- Intentionally worsen or exaggerate a current condition (e.g. someone with epilepsy fakes a grand mal seizure)
Individuals with factitious disorder are often very dramatic when it comes to providing their medical history. However, if they are questioned regarding specific details about their symptoms, their responses suddenly become very vague or terribly inconsistent. They may even resort to blatant lies.
The most common complaints involve pain, so requests for pain medication occur frequently with this disorder. Once a medical workup reveals no basis for their complaints, they’ll often create more symptoms or complain of other things. They’ll even allow more intensive or invasive workups to be done, including surgery.
Those who have this disorder often know a lot of medical terminology. Most are also very knowledgeable about hospital systems or routines. This knowledge is often gained from lots of experience in “being sick”. It comes in very handy as they work the system.
Once their treatment providers begin to realize the true nature of their symptoms and confront them, individuals with factitious disorder usually adamantly deny any hint of deceit. They may quickly leave the hospital, even if it means being discharged against their doctor’s advice. From there, it isn’t long before they find another doctor or hospital and continue their charade.
It’s not uncommon for individuals with factitious disorder to end up in multiple hospitals in different cities and states. In some cases, they may even go to other countries to seek treatment. Needless to say, with this disorder people often go to great lengths to perpetuate their factitious illness.
Due to the nature of this disorder, it’s often impossible to keep a steady job or have any close relationships. Connection to family is often very limited or non-existent.
Factitious disorder typically involves a chronic pattern of behavior, although in some cases there’s just one or a few episodes. It occurs more often in males than females.
Subtypes and Symptoms
There are three subtypes of factitious disorder listed below. Each subtype is determined by the primary symptoms displayed by the individual.
Factitious Disorder with Predominantly Psychological Signs and Symptoms
In this subtype, the main symptoms are mental or psychological in nature. The person is trying to appear mentally ill. It’s not uncommon for them to feign psychotic symptoms, such as hallucinations (e.g. hearing voices or seeing things that aren’t really there). The clinical presentation is often unusual and doesn’t really fit any particular diagnosis. This is because it often represents the individual’s perception of mental illness, which may have little resemblance to any specific psychiatric disorder.
With this subtype, individuals will often use a psychoactive substance to produce certain types of symptoms. For example, if they want to look manic or restless, they may use stimulants.
Factitious Disorder with Predominantly Physical Signs and Symptoms
In this subtype, the individual tries to convince others of a physical medical problem. Often, the goal is hospitalization, which is known as “Munchausen syndrome”. Fever, bleeding caused by the use of anticoagulants, nausea, vomiting, and rashes are just some of the common symptoms intentionally produced or feigned with this subtype.
Factitious Disorder with Combined Psychological and Physical Signs and Symptoms
With this subtype, both physical and psychological symptoms are present but neither one is predominant.
Factitious Disorder Not Otherwise Specified
This diagnosis is given when factitious symptoms occur that don’t meet the criteria for one of the subtypes listed above. This may include “Factitious Disorder by Proxy” (also known as Munchausen’s by Proxy), in which the person intentionally causes or fakes mental or physical symptoms in someone under their care (for example, a mother who does this to her child). The goals is to indirectly take on the sick role (i.e. to do so by proxy).
Individuals with this disorder often have:
- A significant grudge against doctors or other healthcare providers
- A history of an important relationship with a doctor
- A history of extensive treatment, including hospitalization, for a psychiatric or medical condition when they were a child or teen
- A severe personality disorder, particularly antisocial, borderline, or narcissistic
- A job in a healthcare setting
- A history of unresolved conflict with one’s parents
- A deep-seated problem with masochism
- Significant need for attention
- Diagnosing Factitious Disorders
Factitious disorders can be particularly difficult to diagnose due to the amount of deception involved. The patient’s medical history is often extensive and inconsistent, and he or she is often reluctant or refuses to allow healthcare providers obtain information from family members or previous doctors.
In many cases, the disorder is diagnosed when no physical explanation can be found for the patient’s symptoms and a referral is made to a psychologist or psychiatrist. A thorough assessment and keen observation ultimately point to a factitious disorder.
The primary treatment for factitious disorder is psychotherapy. Medication has not been shown to be effective. Psychotherapy – particularly cognitive behavioral therapy – can be effective, if the person is willing to undergo treatment. Family therapy can also play an important role in terms of helping family members understand the disorder and cease from doing things that may inadvertently reinforce the individual’s behavior.