Factitious Disorder Information & Overview

Conditions & Diseases: Psychological & Mental Health

Factitious Disorder

Factitious Disorder Introduction and Overview

Factitious disorder (FD) is a mental disorder in which the person intentionally produces or feigns physical or psychological symptoms with the obvious intent of assuming the role of a sick person. "The judgment that a particular symptom is intentionally produced is made both by direct evidence and by excluding other causes of the symptom." (1)

Individuals suffering from factitious disorder will deliberately create or exaggerate symptoms of an illness in several ways:

1) By fabricating subjective complaints (such as abdominal pain in the absence of the any real pain),

2) By falsifying objective signs of a disease (such as manipulating a thermometer to create the illusion of fever or contaminating a urine sample),

3) By self-inflicting conditions (such as causing skin abscesses by injecting saliva into the skin or causing hematuria by taking anticoagulants), and

4) By exaggerating or exacerbating pre-existing medical conditions (an individual with a history of seizure disorders feigns a serious seizure).

The main motivation for such behavior is to assume the sick role, an inner, psychological need to be seen as ill or injured and to receive the attention and sympathy normally given to a genuinely sick person, and not to achieve an external incentives or concrete benefits such as financial gain or avoiding legal responsibilities specific for a similar condition called Malingering.

Individuals with FD are willing to undergo painful, risky, and expensive tests, procedures, and operations, and usually move from hospital to hospital to receive the care they crave. For this reason, this disorder is sometimes referred to as hospital addiction, pathomimia, or polysurgical addiction, and the individuals affected by it as hospital vagrants, hospital hoboes, peregrinating patients, problem patients, or professional patients. (2)

Patients with FD can be easily identified because they break the unspoken rules of an ACTUAL sick person: (1) to provide a reasonably honest medical history (patients with FD present their medical history with a "dramatic flair, but are extremely vague and inconsistent when questioned in greater detail."), (2) to display symptoms resulting from a real accident, injury, or medical condition, and (3) to exhibit the desire to recover and the will to cooperate with the medical team. These patients possess extensive medical knowledge, are very familiar with the medical terminology and hospital routine, and tend to engage in pathological lying creating a continuum of factitious symptoms when their initial complains are proven negative. Usually, the factitious nature of their condition is revealed at a certain point either because the patient encounters a person who will remember them from a previous admission, or other hospitals confirm a rich history of previous hospitalizations for factitious symptoms. When confronted, individuals with FD deny the allegations and will rapidly discharge themselves, against medical advice, in order to be admitted to another hospital soon after. (1) If one hospital won't give them what they crave, they'll find another one that will.

History:
There is evidence that factitious disorder has been present throughout history. Some of the earliest signs of the disorder are the cases described in medical literature by Galen, a famous Roman physician in the second century B.C. The disorder itself has been later described by Gavin, an English physician, in the book On Feigned and Factitious Disorder in 1843. Despite several remarkable articles written by Dupre and Dieulafoy in 1905 and 1908, the interest towards this disorder waned drastically to the fact that it received little attention until 1951 when Richard Asher, a British psychiatrist, described several cases of individuals who "habitually migrated from hospital to hospital, seeking admission for feigned symptoms while embellishing their personal story."

Asher introduced the term Munchausen syndrome to describe the disorder, after an eighteenth-century well-respected, cavalry German officer, Baron von Munchhausen who embellished his stories in order to impress the listeners. The type of patients described by Asher is now thought to represent a chronic form of FD with predominantly physical signs and symptoms. Some of the most recent case of factitious disorder described with their psychiatric symptomatology belong to Gellengerg and were published in 1977. The disorder was officially recognized as a formal diagnosis category and included in the Diagnostic and Statistical Manual of Mental Disorders Third Edition (DSM III) in 1980. (2)

Article by Alina Morrow,
MS Psychology
OmniMedicalSearch.com