April 2019 By PsychDB.com

Factitious Disorder

Factitious Disorder (also known as Munchausen Syndrome, named after Baron von Munchausen, an 18th-century German officer known for embellishing the stories of his life) involves the falsification of physical or psychological signs or symptoms with no obvious reward. Factitious disorder is different from hypochondriasis (an obsolete DSM-IV diagnosis) in that patients are aware that they are exaggerating, whereas sufferers of hypochondriasis actually believe they have a disease.

Risk Factors

Patients may have a history of abuse or neglect as a child, while personality disorders are common in individuals with factitious disorder.

Factitious Disorder Imposed on Self
Criterion A

Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.

Criterion B

The individual presents himself or herself to others as ill, impaired, or injured.

Criterion C

The deceptive behaviour is evident even in the absence of obvious external rewards.

Criterion D

The behaviour is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Specifiers

Specifiers

Specify if:

  • Single episode
  • Recurrent episodes (2 or more events of falsification of illness and/or induction of injury)
Factitious Disorder Imposed on Another (Previously Factitious Disorder by Proxy)
Criterion A

Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception.

Criterion B

The individual presents another individual (victim) to others as ill, impaired, or injured.

Criterion C

The deceptive behaviour is evident even in the absence of obvious external rewards.

Criterion D

The behaviour is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Note: The perpetrator, not the victim, receives this diagnosis.
Specifiers

Specifiers

Specify if:

  • Single episode
  • Recurrent episodes (2 or more events of falsification of illness and/or induction of injury)

Symptoms

Factitious disorder embodies persistent problems related to illness perception and identity. In the great majority of reported cases of factitious disorder, both imposed on self and imposed on another, individuals present with somatic symptoms and medical disease conviction. Individuals may produce or exaggerate symptoms in several ways. They might lie or fake symptoms, self-harm, or change diagnostic tests. Signs include a dramatic but inconsistent medical history, seeking treatment at numerous hospitals, extensive knowledge of hospitals and/or medical terminology, eagerness to have medical interventions, new symptoms following negative test results, presence of symptoms only when the patient is alone or not being observed, and problems with identity and self-esteem.

Factitious disorder when factitious disorder is directed at someone else, it is known as factitious disorder/Munchausen Syndrome by Proxy. They will act as if the individual that he or she is caring for has a physical or mental illness when they do not. Children or infants may commonly be the proxy for these individuals. The individual with the condition may lie about symptoms, alter diagnostic tests, falsify medical records, or induce symptoms through various means (poisoning, suffocating, starving, and causing infection). Individuals with factitious disorder by proxy are most often parents or the adult children of an elderly patient. The fabrication is not done to achieve a benefit, such as financial gain, other than sympathy and attention from others.

  • Clinicians suspecting factitious disorder should rule out early-stage medical conditions.
  • Somatic symptom disorder. In somatic symptom disorder, there may be excessive attention and treatment seeking for perceived medical concerns, but there is no evidence that the individual is providing false information or behaving deceptively.
  • Malingering. Malingering is differentiated from factitious disorder by the intentional reporting of symptoms for personal gain (e.g. - money, time off work). In contrast, the diagnosis of factitious disorder requires the absence of obvious rewards.
  • Conversion disorder (functional neurological symptom disorder). Conversion disorder is characterized by neurological symptoms that are inconsistent with neurological pathophysiology. Factitious disorder with neurological symptoms is distinguished from conversion disorder by evidence of deceptive falsification of symptoms.
  • Borderline personality disorder. Deliberate physical self-harm in the absence of suicidal intent can also occur in association with other mental disorders such as borderline personality disorder. Factitious disorder requires that the induction of injury occur in association with deception.
  • Medical condition or mental disorder not associated with intentional symptom falsification. Presentation of signs and symptoms of illness that do not conform to an identifiable medical condition or mental disorder increases the likelihood of the presence of a factitious disorder. However, the diagnosis of factitious disorder does not exclude the presence of true medical condition or mental disorder, as comorbid illness often occurs in the individual along with factitious disorder. For example, individuals who might manipulate blood sugar levels to produce symptoms may also have diabetes.

The first treatment goal is to modify the individual's behaviour and reduce misuse or overuse of medical resources. Also, any underlying psychiatric disorder should be identified and treated. The primary treatment for factitious disorder is psychotherapy, including cognitive behavioural therapy and family therapy.

In factious disorder imposed on another, treatment considerations are similar to those in factitious disorder, with the added concern about the safety of the potential victim. Management often requires a team that includes social workers, foster care organizations, and law enforcement in addition to the healthcare providers.