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What are factitious disorders?
Mental illness describes abnormal cognitive or emotional patterns related to how
a person thinks, feels, acts, and/or relates to others and his or her
surroundings. Factitious disorders are mental disorders in which a person acts
as if he or she has a physical or mental illness when, in fact, he or she has
consciously created his or her symptoms. (The name factitious comes from the Latin word for
"artificial.")
People with factitious disorders deliberately create or exaggerate symptoms
of an illness in several ways. They may lie about or fake symptoms, hurt
themselves to bring on symptoms, or alter diagnostic tests (such as
contaminating a urine sample). People with factitious disorders behave this way
because of an inner need to be seen as ill or injured, not to achieve a concrete
benefit, such as a financial gain. People with factitious disorders are even
willing to undergo painful or risky tests and operations in order to obtain the
sympathy and special attention given to people who are truly ill. Factitious
disorders are considered mental illnesses because they are associated with
severe emotional difficulties.
Many people with factitious disorders also suffer from other mental
disorders, particularly personality disorders. People with personality disorders
have long-standing patterns of thinking and acting that differ from what society
considers usual or normal. People with personality disorders generally also have
poor coping skills and problems forming healthy relationships.
Factitious disorders are similar to another group of mental disorders called
somatoform disorders, which also involve the presence of symptoms that are not
due to actual physical illnesses. The main difference between the two
groups of disorders is that people with somatoform disorders do not
intentionally fake symptoms or mislead others about their symptoms. Similarly,
the behavior of people with factitious disorders is not malingering, a term that
refers to faking illness for financial gain (such as to collect insurance
money), food or shelter, or to avoid criminal prosecution or other responsibilities.
Types of factitious disorders
The Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition (DSM-IV), which is the standard reference book for recognized mental
illnesses in the United States, organizes factitious disorders into four main
types:
Factitious disorder with mostly psychological symptoms —
As the description implies, people with this disorder mimic behavior that is
typical of a mental illness, such as schizophrenia. They may appear confused,
make absurd statements and report hallucinations (the experience of sensing
things that are not there; for example, hearing voices). Ganser syndrome,
sometimes called prison psychosis, is a factitious disorder that was first
observed in prisoners. People with Ganser syndrome have short-term episodes of
bizarre behavior similar to that shown by people with serious mental illnesses.
Factitious disorder with mostly physical symptoms —
People with this disorder claim to have symptoms related to a physical
illness, symptoms such as chest pain, stomach problems or fever. This disorder
is sometimes referred to as Munchausen syndrome, named for Baron von
Munchausen, an 18th century German officer who was known for
embellishing the stories of his life and experiences. NOTE: Although
Munchausen syndrome most properly refers to a factitious disorder with
physical symptoms, the term is sometimes used to refer to factitious disorders
in general.
Factitious disorder with both psychological and physical symptoms
— People with this disorder report symptoms of both physical and mental
illness.
Factitious disorder not otherwise specified — This type
includes a disorder called factitious disorder by proxy (also called
Munchausen syndrome by proxy). People with this disorder produce or fabricate
symptoms of illness in another person under their care. It most often occurs
in mothers (although it can occur in fathers) who intentionally harm their
children in order to receive attention. (The term "by proxy" means
"through a substitute.")
What are the symptoms of factitious disorders?
Possible warning signs of factitious disorders include the following:
- Dramatic but inconsistent medical history
- Unclear symptoms that are not controllable and that 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 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
What causes factitious disorders?
The exact cause of factitious disorders is not known, but researchers believe
both biological and psychological factors play a role in the development
of these disorders. Some theories suggest that a history of abuse or neglect as
a child, or a history of frequent illnesses that required hospitalization may be
factors in the development of the disorder.
How common are factitious disorders?
There are no reliable statistics regarding the number of people in the United
States who suffer from factitious disorders. Obtaining accurate statistics is
difficult because dishonesty is common with this disorder. In addition, people
with factitious disorders tend to seek treatment at many different health care
facilities, which can lead to statistics that are misleading.
While Munchausen syndrome can occur in children,
it most often affects young adults.
How are factitious disorders diagnosed?
Diagnosing factitious disorders is very difficult because of the dishonesty
that is involved. 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 imagery, and psychological assessment tools 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 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 the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), which is
the standard reference book for recognized mental illnesses in the United
States.
How are factitious disorders treated?
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 work
out any underlying psychological issues that may be causing the person’s
behavior
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