Psychiatry 1

Factitious Disorders
Hyacinth C. Manuod, MD, FPPA | 14 August 2018 | Topic 1
Outline  to be relieved of the caretaking role by having the
I. Factitious Disorders child hospitalized
II. Types of Factitious Disorder
A. Factitious Disorders with Psychological Signs and Symptoms
B. Munchausen Syndrome
C. Factitious Disorder Not Otherwise Specified D. Factitious Disorders by Proxy
D. Factitious Disorders by Proxy – most commonly perpetrated by mothers against infants or
III. Clinical Indicators that may suggest Factitious Disorder by Proxy
IV. Etiology young children
V. Differential Diagnosis
VI. Course and Prognosis – less than 0.04 percent
VII. Outcome
VIII. Treatment
III. CLINICAL INDICATORS THAT MAY SUGGEST FACTITIOUS
I. FACTITIOUS DISORDERS DISORDER BY PROXY
– A condition in which patient fake illness to the point of inflicting – The symptoms and pattern of illness are extremely unusual, or
painful, deforming, or even life-threatening injury on themselves inexplicable physiologically.
or those under their care with the primary goal of gaining the – Repeated hospitalizations and workups by numerous
emotional care and attention that comes with playing the role of caregivers fail to reveal a conclusive diagnosis or cause.
the patient – Physiological parameters are consistent with induced illness;
– Approximately 0.8 to 1.0 percent of psychiatry consultation e.g., apnea monitor tracings disclose massive muscle artifact
patients. prior to respiratory arrest, suggesting that the child has been
– Intentional production or feigning of physical or psychological struggling against an obstruction to the airways.
signs or symptoms. – The patient fails to respond to appropriate treatments.
– The motivation for the behavior is to assume the sick role. – The vitality of the patient is inconsistent with the laboratory
– External incentives for the behavior (such as economic gain, findings.
avoiding legal responsibility, or improving physical well-being, as – The signs and symptoms abate when the mother has not had
in malingering) are absent. access to the child.
– The mother is the only witness to the onset of signs and
II. TYPES OF FACTITIOUS DISORDERS symptoms
– With predominantly psychological signs and symptoms – Unexplained illnesses have occurred in the mother or her
– With predominantly physical signs and symptoms other children.
(Munchausen Syndrome) – The mother has had medical or nursing education, or
– With combined psychological and physical signs and exposure to models of the illnesses afflicting the child (e.g., a
symptoms parent with sleep apnea).
– The mother welcomes even invasive and painful tests.
– The mother grows anxious if the child improves.
A. Factitious Disorders with Psychological Signs and Symptoms
– Maternal lying is proved.
– are mostly women who outnumber men 3 to 1.
– Medical observations yield information that is inconsistent
– usually 20 to 40 years of age with a history of employment or
with parental reports.
education in nursing or a health care occupation.

B. Munchausen Syndrome
– a syndrome in which patients embellish their personal history,
chronically fabricate symptoms to gain hospital admission,
and move from hospital to hospital.
– Approx. 2/3 are male
– white, middle-aged, unemployed, unmarried, and without
significant social or family attachments
– essential feature of patients with the disorder is their ability to
present physical symptoms so well that they can gain
admission to, and stay in, a hospital.
C. Factitious Disorder Not Otherwise Specified
– Factitious disorder by proxy - a person intentionally produces
physical signs or symptoms in another person who is under
the first person's care.
 for the caretaker to indirectly assume the sick role;
IV. ETIOLOGY
– many of the patients suffered childhood abuse or deprivation,
resulting in frequent hospitalizations during early
development
– inpatient stay may have been regarded as an escape from a
traumatic home situation, and the patient may have found a
series of caretakers to be loving and caring.
– The usual history reveals that the patient perceives one or
both parents as rejecting figures who are unable to form close
relationships.
– The facsimile of genuine illness, therefore, is used to recreate
the desired positive parent -child bond.
– basic conflict of needing and seeking acceptance and love
while expecting that they will not be forthcoming
– patient transforms the physicians and staff members into
rejecting parents.

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PSY202 FACTITIOUS DISORDERS T1
– patient transforms the physicians and staff members into VIII. TREATMENT
rejecting parents.
– 3 Major Goals of Treatment
– Patients who feign psychiatric illness may have had a relative
 To reduce the risk of morbidity and mortality
who was hospitalized with the illness they are simulating.
 to address the underlying emotional needs or
– Through identification, patients hope to reunite with the
psychiatric diagnosis underlying factitious illness
relative in a magical way.
behavior
– no genetic patterns have been established, and
 to be mindful of legal and ethical issues
electroencephalographic (EEG) studies noted no specific
abnormalities in patients with factitious disorders
REFERENCES

1. Doc Manuod’s Lecture and PPT

V. DIFFERENTIAL DIAGNOSIS
– Somatoform Disorders
 voluntary production of factitious symptoms
 the extreme course of multiple hospitalizations
 seeming willingness of patients with a factitious
disorder to undergo an extraordinary number of
mutilating procedures
– Personality Disorders
 Antisocial PD
 Histrionic PD
 Borderline PD
– Schizophrenia
– Malingering
– Substance Abuse
– Ganser’s Syndrome

VI. COURSE AND PROGNOSIS

– begin in early adulthood
– onset of the disorder or of discrete episodes of seeking
treatment may follow real illness, loss, rejection, or
abandonment
– long pattern of successive hospitalizations
– patient becomes knowledgeable about medicine and
hospitals
– prognosis in most cases is poor

VII. OUTCOMES
– a few of them probably die as a result of needless medication,
instrumentation, or surgery

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