Factitious disorders are conditions in which a person acts as if he or she has an illness by deliberately

producing, feigning, or exaggerating symptoms. Factitious disorder by proxy is a condition in which a

person deliberately produces, feigns, or exaggerates symptoms in a person who is in their care.
Münchausen syndrome is an older term for Factitious disorder. People with this condition may produce
symptoms by contaminating urine samples, taking hallucinogens, injecting themselves with bacteria to
produce infections, and other such similar behaviour. They might be motivated to perpetrate factitious
disorders either as a patient or by proxy as a caregiver to gain any variety of benefits including attention,
nurturance, sympathy, and leniency that are unobtainable any other way. Somatoform disorders are
characterised by multiple somatic complaints.[1]

The motives of the patient can vary: for a patient with factitious disorder, the primary aim is to obtain
sympathy, nurturance, and attention accompanying the sick role. [2] This is in contrast to malingering, in
which the patient wishes to obtain external gains such as disability payments or to avoid an unpleasant
situation, such as military duty. Factitious disorder and malingering cannot be diagnosed in the same
patient, and the diagnosis of factitious disorder depends on the absence of any other psychiatric disorder.
[2]
While they are both listed in the DSM-IV-TR, factitious disorder is considered a mental disorder, while
malingering is not.

Factitious disorders should be distinguished from somatoform disorders, in which the patient is truly
experiencing the symptoms and has no intention to deceive. These disorders include body dysmorphic
disorder, conversion disorder, somatization disorder, and pain disorder. In these conditions the patient
believes he or she has a particular medical disorder and, like the Factitious disorder patient, may seek
contact from multiple physicians, emergency departments, and hospitals. A person with factitious
disorder often works in a medical environment.

Criteria for diagnosis includes intentionally fabricating (or faking) to produce physical or psychological
signs or symptoms and the absence of any other mental disorder. Motivation for their behaviour must be
to assume the 'sick role', and they do not act sick for personal gain as in the case of malingering
sentiments. When the individual applies this pretended sickness to a dependent, for example a child, it is
often referred to as 'factitious disorder by proxy.'

Münchausen syndrome

Münchausen syndrome, or Factitious disorder, has specified symptoms. Factitious disorder symptoms
may seem exaggerated; individuals undergo major surgery repeatedly, and they 'hospital jump' or migrate
in order to avoid detection.

Münchausen by proxy

Main article: Münchausen syndrome by proxy

The word 'proxy' means 'substitute'. It is coded in the DSM-IV under Factitious Disorder NOS (not
otherwise specified). Münchausen by proxy is the involuntary use of another individual to play the patient
role. For example, false symptoms are produced in children by the caregivers or parents (almost always
mothers), to produce the appearance of illness, or they may give misleading medical histories about their
children. The parent may falsify the child's medical history or tamper with laboratory tests in order to
make the child appear sick. Occasionally, in Münchausen by proxy, the caregiver will actually injure the
child to ensure that the child will be treated. Such parents enjoy the attention that they receive from
having a sick child.

Ganser syndrome

Ganser syndrome was in the past regarded to be a separate factitious disorder. It is a reaction to extreme
stress[citation needed] or an organic condition; the patient suffers from approximation or giving absurd answers
to simple questions. The syndrome is sometimes diagnosed as merely malingering; however, it is more
often defined as a Factitious disorder. This has been seen in prisoners following solitary confinement, and
the symptoms are consistent in different prisons, though the patients do not know one another.

Symptoms include a clouding of consciousness, somatic conversion symptoms, confusion, stress, loss of
personal identity, echolalia, and echopraxia. Individuals also give approximate answers to simple
questions such as, "How many legs on a cat?" "Three"; "What's the day after Wednesday?" "Friday"; and
so on. The disorder is extraordinarily rare with fewer than 100 recorded cases. While individuals of all
backgrounds have been reported with the disorder, there is a higher inclination towards males (75% or
more). The average age of those with Ganser syndrome is 32 and it stretches from ages 15–62 years old.

Causes of factitious disorder

There are many possible causes for this disorder. One such possibility is an underlying personality
disorder. Individuals with FD may be trying to repeat a satisfying childhood relationship with a doctor.
Perhaps also an individual has a desire to deceive or test authority figures. The underlying desire to
resume the role of a patient and to be cared for can also be considered an underlying personality disorder.
Abuse in childhood is also another probable cause for the disorder. A background of neglect and
abandonment may contribute to the development of FD.

These individuals may be trying to reenact unresolved issues with their parents. A history of frequent
illnesses may also contribute to the development of this disorder. Perhaps individuals afflicted with FD
are accustomed to actually being sick, and thus returns to their previous state in order to recapture what
was once considered to be the 'norm.' Another cause is a history of close contact with someone (a friend
or family member) who had a severe or chronic condition. The patients found themselves subconsciously
envious of the attention said relation received, and felt that they themselves faded into the background.
Thus medical attention makes them feel glamorous and special.

A person who has exhibited factitious disorder for mental illness often does develop a mental illness soon
afterward.[citation needed]

Treatment

No true psychiatric medications are prescribed for factitious disorder. However, selective serotonin
reuptake inhibitors (SSRIs) can help manage underlying problems. Medicines such as SSRIs which are
used to treat mood disorders can be used to treat FD, as a mood disorder may be the underlying cause of
FD. Some authors (such as Prior and Gordon 1997) also report good responses to antipsychotic drugs
such as Pimozide. Family therapy can also prove to be of assistance. In such therapy, families are helped
to better understand patients (the individual in his or her family with FD) and his or her need for attention.
In this therapeutic setting, the family is urged not to condone or reward the FD individual's behavior. This
form of treatment can be unsuccessful if the family is uncooperative or displays signs of denial and/or
antisocial disorder. Psychotherapy is another method used to treat the disorder. These sessions should
focus on the psychiatrist's establishing and maintaining a relationship with the patient. Such a relationship
may help to contain symptoms of FD. Monitoring is also a form that may be indicated for the FD patient's
own good; FD (especially proxy) can prove to be very detrimental to an individual's health—if they are,
in fact, causing true physiological illnesses. Even faked illnesses/injuries can be dangerous and might be
monitored for fear that unnecessary surgery may subsequently be performed.

Treatment of Münchausen by proxy

Treatment for FD proxy is not so subtle. Physicians who suspect the disorder should notify authorities
immediately. Authorities will then initiate steps for immediate protection of the proxy (i.e. victim).
Criminal charges may be deemed necessary. Many times, help may be sought for the caregiver with
Münchausen by proxy as well as for the affected target. Careful monitoring of the family for an extended
period of time is often a necessary precaution – with a goal of preventing either translocation or the
insinuation of a possible upheaval of the detrimental disorder.

Prognosis

Some individuals experience only a few outbreaks of the disorder. However, in most cases, factitious
disorder is a chronic and long-term condition that is difficult to treat. There are relatively few positive
outcomes for this disorder; in fact, treatment provided a lower percentage of positive outcomes than did
treatment of individuals with obvious psychotic symptoms such as schizophrenics. In addition, many
individuals with factitious disorder do not present for treatment, often insisting their symptoms are
genuine. Some degree of recovery, however, is possible. The passage of time seems to help the disorder
greatly. There are many possible explanations for this occurrence, although none are currently considered
definitive. It may be that an FD individual has mastered the art of feigning sickness over so many years of
practice that the disorder can no longer be discerned. Another hypothesis is that many times an FD
individual will be placed in a home or experience health issues that are not self-induced or feigned. In this
way, the problem with obtaining the 'patient' status is resolved because symptoms arise without any effort
on the part of the individual.