Factitious Disorders

Definition

Factitious disorders are a group of mental disturbances in which patients intentionally act physically or mentally ill without obvious benefits. The name factitious comes from a Latin word that means artificial. These disorders are not malingering, which is defined as pretending illness when the "patient" has a clear motive, such as financial gain.

Description

Patients with factitious disorders produce or exaggerate the symptoms of a physical or mental illness by a variety of methods, including contaminating urine samples with blood, taking hallucinogens, injecting themselves with bacteria to produce infections, and other similar behaviors.

There are no reliable statistics on the frequency of factitious disorders, but they are more common in men than in women. The following conditions are sometimes classified as factitious disorders:

Munchausen syndrome

Munchausen syndrome refers to patients whose factitious symptoms are dramatized and exaggerated. Many persons with Munchausen go so far as to undergo major surgery repeatedly, and, to avoid detection, at several locations. Many have been employed in hospitals or in health care professions. The syndrome's onset is in early adulthood.

Munchausen by proxy

Munchausen by proxy is the name given to factitious disorders in children produced by parents or other caregivers. The parent may falsify the child's medical history or tamper with laboratory tests in order to make the child appear sick. Occasionally, they may actually injure the child to assure that the child will be treated.

Ganser's syndrome

Ganser's syndrome is an unusual dissociative reaction to extreme stress in which the patient gives absurd or silly answers to simple questions. It has sometimes been labeled as psychiatric malingering, but is more often classified as a factitious disorder.

Causes and symptoms

No single explanation of factitious disorders covers all cases. These disorders are variously attributed to underlying personality disorders; child abuse; the wish to repeat a satisfying childhood relationship with a doctor; and the desire to deceive or test authority figures. Also, the wish to assume the role of patient and be cared for is involved. In many cases, the suffering of a major personal loss has been implicated.

The following are regarded as indications of a factitious disorder:

• dramatic but inconsistent medical history
• extensive knowledge of medicine and/or hospitals
• negative test results followed by further symptom development
• symptoms that occur only when the patient is not being observed
• few visitors
• arguments with hospital staff or similar acting-out behaviors
• eagerness to undergo operations and other procedures

When patients with factitious disorders are confronted, they usually deny that their symptoms are intentional. They may become angry and leave the hospital. In many cases they enter another hospital, which has led to the nickname "hospital hoboes."

Diagnosis

Diagnosis of factitious disorders is usually based on the exclusion of bona fide medical or psychiatric conditions, together with a combination of the signs listed earlier. In some cases, the diagnosis is made on the basis of records from other hospitals.

Treatment

Treatment of factitious disorders is usually limited to prompt recognition of the condition and the refusal to give unnecessary medications or to perform unneeded procedures. Factitious disorder patients do not usually remain in the hospital long enough for effective psychiatric treatment. Some clinicians have tried psychotherapeutic treatment for factitious disorder patients, and there are anecdotal reports that antidepressant or antipsychotic medications are helpful in certain cases.

Prognosis

Some patients have only one or two episodes of factitious disorders; others develop a chronic form that may be lifelong. Successful treatment of the chronic form appears to be rare.

Resources

BOOKS

Eisendrath, Stuart J. "Psychiatric Disorders." In Current Medical Diagnosis & Treatment, 1998, edited by Stephen J. McPhee, et al., 37th ed. Stamford: Appleton & Lange, 1997.

KEY TERMS

Ganser's syndrome— An unusual factitious disorder characterized by dissociative symptoms and absurd answers to direct questions.

Malingering— Pretending to be sick in order to be relieved of an unwanted duty or obtain some other obvious benefit.

Munchausen by proxy— A factitious disorder in children produced by a parent or other caregiver.

Munchausen syndrome— A factitious disorder in which the patient's symptoms are dramatized and exaggerated.