Factitious Disorder
Physical Signs and Symptoms of Factitious Disorder
Photo courtesy of Kauvery HospitalOpens in new window
Whereas other somatic symptom and related disorders are not under conscious control, people with a factitious disorder consciously pretend to be ill to get emotional needs met and attain the status of patient. |
The term factitious is of Latin orgin, meaning “artificial,” or “contrived.”
Patients with factious disorder artificially, deliberately, and dramatically fabricate symptoms or self-inflict injury with the goal of assuming the sick role.
Similar to substance use disorders, this problem is compulsive and individuals consciously conceal the true nature of the illness through deception. Factitious disorder results in disability and immeasurable costs to the healthcare system.
The contrived illness may be physical or psychiatric. Examples of manufactured illnesses include bleeding, fever, hypoglycemia, seizures, hallucinations, and even cancer. Individuals with factitious disorder may report depression and suicidality after the death of a spouse despite the fact that the death is not true or that he was not even married (APA, 2013).
An older term for factitious disorder is Munchausen syndromeOpens in new window, which was named for Baron Karl Friedrich Hieronymus von Münchausen (1720 – 1797). He was an 18th-century German officer with a reputation for fabricating outrageous tales such as traveling to the moon, riding a cannonball, or fighting a 40-foot crocodile.
Clinical Picture
- Factitious Disorder Imposed on Self
Admission to the hospital often begins in the emergency room with a dramatic description of an illness using unusually proper medical terminology. The patient is often reluctant for professionals to speak with family members, friends, or previous healthcare providers.
Once admitted, the patient is frequenty demanding and requests specific treatments and interventions. Negative test results are often followed by new or additional symptoms. If the healthcare team sets limits and does not follow through with requests, the patient may become angry and accuse the staff of incompetence and maltreatment.
Patients go from one primary care provider or hospital to another. Serious complications and sepsis may result from self-injections of toxins such as E. coli. Patients may have “crisscrossed” or “railroad-track” abdomens due to scars from numerous exploratory surgeries to investigate unexplained symptoms. In the extreme, amputations may even result from this disorder.
| Table X-1 Case Example of Factitious Disorder Characterized by Multiple Symptoms |
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| A man presented alone and disorganized to the emergency room. He was able to provide only limited medical history and no contacts for parallels history. After a negative medical workup, he was admitted to psychiatric inpatient unit for treatment of psychosis. On admission, he appeared to be responding to internal stimuli, often shouting out in a threatening voice to people who were not there. Despite increasing levels of antipsychotic medications, he remained severely disorganized in his behavior and began to report frightening visual hallucinations of knights on white horses attacking him. Brain imaging was negative. On the second week of his hospital admission, the patient suddenly developed stiff, slowed movements and began drooling excessively. The night nurse, after hearing the report, became very concerned about him and decided to stop by the patient’s room to check in on him. Much to the nurse’s surprise, the patient was comfortably doing pus-ups on the floor. A room search later revealed a stash of apparently “cheeked” medications hidden in the mattress. Additional history uncovered that the patient had an older brother with schizophrenia, whom he left never got the care he deserved. |
- Factitious Disorder Imposed on Another
The most insidious form of factitious disorder is factitious disorder imposed on another (also known as Munchausen syndrome by proxy) in which a caregiver deliberately falsifies illness in a vulnerable dependent. The diagnosis is imposed on the perpetrator and not the victim.
People with this disorder do not do it to receive awards such as insurance money or other compensation. They do it for the purpose of the attention and excitement and to perpetuate the relationship with healthcare providers of that dependent.
The parent or guardian is frequently a healthcare worker or someone with extensive knowledge of the healthcare system. The disorder results in unnecessary medical visits and sometimes-harmful medical procedures.
Examples of this falsified problem include inducing premature delivery by rupturing the amniotic sac with a fingernail, infant apnea and sudden infant death, and introducing microorganisms into a child’s wound. Falsification of illnesses results in extreme pain, surgical procedures, and even the death of dependents.
Epidemiology
Epidemiological studies estimate an incidence rate of 0.8% to 1.3%. explanation for the low incidence rate includes the belief that a large number of cases are missed due to frequent denial of factitious disorder behaviors, the challenge to differentiate between real and feigned illness, and the fact that many patients often flee the healthcare setting.
Factitious disorder, however, is more prevalent than previously recognized with suggestions that up to 6% of healthcare provider contacts may involve factitious disorder.
Nurses should consider this diagnosis in complicated patients, especially those with a history of emotional or physical distress, excessive dependence, and resistance to discharge.
Comorbidity
People with factitious disorders tend to complain of physical problems although some patients may also try to convince clinicians that they have a psychiatric disorder.
Patients may describe symptoms of depression, dissociation, conversion, and psychoses and seek treatment for these problems. According to some reports, substance use, borderline personality disorders, and sexual disorders are frequently present along with a normal to high intelligence quotient (IQ) and an intimate knowledge of the healthcare system.
See also:
- Hagglund, L. (2009). Challenges in ther treatment of factitious disorder: A case study, Archives of Psychiatric Nursing, 23 (1), 58 – 64.
- Barsky A. J. Forgetting, fabricating, and telescoping: the instability of the medical history. Archives of Internal Medicine 162: 981 – 984, 2002.
