Factitious Disorder Causes and Prevalence

Factitious disorder is a chronic condition that typically develops in early adulthood usually in individuals who have been exposed to hospitalization or severe illnesses in themselves or others. Its onset can follow a real illness the patient or a close family member suffered, or by loss, rejection, or abandonment suffered by the individual. The progress of the disease is low and involves a long pattern of successive hospitalizations, while the patient "becomes knowledgeable about medicine and hospitals. The disorder can severely impair social and occupational functioning and is usually associated with serious character pathology." Although, "the patient is aware of their role in producing signs and symptoms of the illness yet are typically unaware of their motivation for doing so." (5)

Factitious disorder seems to be more common in women than in men, however its chronic and severe forms (such as Munchausen syndrome) seems to be more common in men than women. Persons with FD tend to be women between 20 and 40 years old, while individuals with chronic forms of the disorder are usually middle-aged men.

The etiology (cause of the disorder), pathophysiology (study of the disturbance of normal mechanical, physical, and biochemical functions caused by or resulting from a disease), and psychopathology of factitious disorder are unclear. The exact causes of the disorder are difficult to determine due to several factors: (1) diagnosing the disorder is a difficult process, (2) individuals with FD don't return for follow-ups once they sign out of the hospital, and (3) these individuals are usually reluctant to undergo psychological testing and evaluation.

The presence of some brain abnormalities on MRIs in some patients with chronic factitious disorder might suggest a possible connection between the brain's biology or genetic factors and the disorder. There is evidence that some patients with FD also display abnormalities on psychological testing.

In an attempt to explain the psychological causes that can lead to the development of factitious disorder, the opinions vary. Some clinicians believe that factitious disorder is related to traumatic events encountered during childhood (such as abuse, deprivation, or numerous hospitalizations) and through repeated hospitalizations these individuals unconsciously recreate the desired "parent-child bond" that they lacked. A second opinion suggests that through this disorder, the individual is able to feel in control as they never felt in the past as children. A third opinion is that factitious disorder is a coping mechanism learned and reinforced during childhood. Some of the psychodynamic explanations proposed for factitious disorder is that individuals with FD feel the need to be the center of attention and feel important, are bothered by feelings of vulnerability, or feel superior to an authority figure when deceiving a physician.

Although, the prevalence of factitious disorder is unknown due to the belief that many cases go undetected, it is still unclear whether the condition is underdiagnosed (due to its deceitful nature, some patients with FD can pass as real patients for a long time) or overdiagnosed (because same patients with FD migrated in between different hospitals). Based on the few studies conducted on the prevalence of the disorder, the results showed that "...of the patients referred for evolution of fever of unknown origin at the US National Institute for Allergies and Infectious Disease, approximately 9.3 percent had factitious disorder." and "...of the material submitted by patients as kidney stones, 2.6 percent was found to be nonphysiologic and probably fraudulent." Regarding the question of which subtype of factitious disorder is more frequent, most scientists believe that "the prevalence of factitious psychological symptoms is much lower than the prevalence of factitious physical symptoms." (3)

Conditions & Diseases: Psychological & Mental Health

Factitious Disorder