Types of Factitious Disorder, Types - OmniMedicalSearch.com

Conditions & Diseases: Psychological & Mental Health

Factitious Disorder

Factitious Disorder Types

According to the DSM-IV, there are three distinct subtypes of factitious disorder based on the predominant symptoms.

I. Factitious disorder with predominantly psychological signs and symptoms

Individuals with this subtype of FD (as the description implies) intentionally produce and feign psychological symptoms that resemble a mental condition in an attempt "to assume the patient role." Patients with this form of FD can feign a wide-range of symptoms and although they can "discern from the examiner's questions the symptoms to endorse" such symptoms "do not correspond to a typical syndromal pattern, an unusual course and response to treatment."

These symptoms often do not belong to any diagnostic category, and usually get worse when the person knows that they are being observed. Some of the psychological symptoms displayed by individuals suffering from this subtype of FD resemble depression, suicidal ideation (following the death of a spouse although the death was not being conformed by others), memory loss, hallucinations or delusions, post-traumatic stress disorder, and dissociative and conversion symptoms. (1) Some of these individuals can use different psychoactive substances with the intent to produce/induce psychological symptoms of certain mental conditions, such as stimulants to produce insomnia or restlessness, hallucinogens to induce altered perceptual states, analgesics to induce euphoria, or hypnotics to cause lethargy.

II. Factitious disorder with predominantly physical signs and symptoms

Individuals with this subtype of FD intentionally produce or feign physical signs or symptoms of an apparent general medical condition in an attempt to be admitted to the hospital. These patients can feign a wide-range of symptoms based on the person's medical knowledge, sophistication, and imagination where complaints include disorders of any organ system. Due to their advanced medical knowledge, they will feign disorders that require hospital admission or medication. The medical conditions targeted include infections, impaired wound healing, pain, hematoma, hemoptysis, hypoglycemia, anemia, bleeding, rashes, seizures, dizziness, blacking out, vomiting, diarrhea, stomach problems, fevers of undetermined origin, autoimmune or connective tissue diseases.

In order to support their claims, these patients can contaminate the laboratory tests' samples (blood, urine, stool), or use medications such anticoagulants or insulin in order to deceive the medical staff. Although these patients can deceive even the most experienced physicians, a detailed examination of their past medical history can reveal incompatibilities with their employment history, family ties, and interpersonal relationships. Approximately half of these patients demand medication especially narcotics, analgesics and sedatives (possibly due to their substance abuse). Once they are admitted in the hospital they are often "difficult patients." For example, when test results return with a negative answer, they can become abusive, accuse the doctor of incompetence, threaten litigation, and in some cases -leave the hospital without the doctor's approval so they do not have to be confronted about their disorder. Shortly after, they will be admited to another hospital in the same or other city, starting the process all over again.

The most severe and chronic form of FD with predominantly physical signs and symptoms is being referred to as "Munchausen syndrome," which is characterized by recurrent hospitalization, nomadic hospitalization, and pseudologia fantastica (pathological lying).

III. Factitious disorder with combined psychological and physical signs and symptoms

Individuals with this subtype of FD intentionally produce and feign both type of symptoms, psychological and physical.

Although DSM IV accepts as diagnostic categories only the three subtypes of FD described above, other psychiatric reference works talk about a fourth subtype called factitious disorder not otherwise specified, also known as factitious disorder by proxy. Individuals diagnosed with this subtype intentionally produce physical signs or symptoms in another person usually someone that is in their care. One of the most common examples of this subtype of FD is a mother who deceives the medical staff into believing her child is sick by presenting a false medical history, contaminating the laboratory samples, altering records, and even inducing injuries or illness on the child. (4)

Article by Alina Morrow,
MS Psychology
OmniMedicalSearch.com