Factitious Disorder
Factitious Disorder
Simulate, induce or aggravate illness to receive medical
attention whether they are ill or not.
may inflict painful, deform or life threatening injury on
themselves or their dependents
Motivation is simply to receive medical care and partake
in the medical system
Can lead to significant morbidity or mortality
Patient must be taken seriously
Richard Asher
Coined the term manchausen syndrome
Refer to syndrome in which patients embellish their
personal history, fabricate symptoms to gain hospital
admission and move from hospital to hospital.
Epidemiology
Approximately 0.8% 1.0% of psychiatric consults.
2/3 with manchausen syndrome are male
Unemployed / unmarried
Without significant social & family attachment
Patients diagnosed with factitious disorder with physical
signs and symptoms are mostly women
3:1
20 40 years old
With history to employer or educ in nursing or health
care
Begins 20 30s
Factitious disorder by proxy
Imposed on another in DSM V
Perpetrated by mothers against infant or young children
0.04%
Rare or unrecognized
Comorbidity
Person with factitious disorder have comorbid psych diagnosis
Etiology
Psychosocial factors
Anecdotal case reports indicate that many of the patients
suffered childhood abuse or deprivation resulting in frequent
hospitalization delay early dev
Inpatient stay may have been regarded as an escape from
traumatic home situations
Patients may have found a series of caretakers to be loving
and caring
Patients family of origin include a neglecting mother or an
Masochist personality makeup
Patient seek out painful procedures such as surgical operation
and invasive diagnostic test. Pain serves as punishment for
past sins, imagined or real.
Patients have poor identity formation and disturbed self
image (borderline personal disorder)
As if personality
Assumed the identities of those around them
Cooperation or encouraged of other person in factitious
disorder is rare.
significant defense mechanisms are repression,
identification with the aggressor, (di mabasa) and
symbolization
Biological factors
Brain dysfunction
Impaired info processing contributing to pseudologia
fantastica
Diagnostic and clinical features
It is essential to verify all the facts presented by the
patient about previous hospitalization
Psych evaluation is requested in about 50% cases after
a simulated illness is suspected
Avoid pointed or accusatory questioning that may
provoke flight from hospital
2 groups of factitious disorder
1. FD with predominantly psychological signs and
symptoms
Depression
Hallucination
Disscoiative symptoms and conversion
Bizzare behavior
Resembles phenomenon of pseudomalingering
some patients use psychoactive substances such as
stimulants or hallucinogens for the purpose of producing
symptoms
Patient may appear depressed and offer a false history of
Elements of history that suggest bereavement
Violent or bloody death
Death under dramatic circumstance
Dead person being child or young adult
Other symptoms
Pseudologia fantastica
Impostorship assume identity of prestigious person (war
heroes, surgical scars)
2. FD with predominantly physical signs and symptoms
Best known type of manchausen syndrome
Hospital addiction
Polysurgical addiction
Professional px syndrome
Essential feature is their ability to present physical symptoms so well to
gain admission to the hospital
They feign symptoms suggesting disease involving any organ system
They are familiar with the diagnosis of disorders that require hospital
admission or medication
Can give excellent histories capable of deceiving experienced clinicians
Clinical presentation includes
Hematoma
Hemoptysis
Abdominal pain
Fever
Hypoglycemia
Nausea, vomiting
Dizziness and seizures
They may acquire gridiron or washboard like abdomen from
multiple procedures
The often insist surgery
They may complain of pain and demand treatment with
specific medications
As each test is returned negative, they may accuse
doctors of incompetence
Some sign out abruptly shortly before they believe they
are going to be confronted with their factitious behavior.
They then go to another hospital and begin the cycle
again.
Factitious Disorder with combined psychiatric and
physical signs and symptoms.
-Presentation of combined form of factitious disorder
Factitious disorder by Proxy
- Intentionally produces physical sign & symptoms in another
person who is under higher care
- DSM 5 (factitious disorder imposed on another)
- One apparent purpose of the behavior is for the caretaker to
indirectly assume the sick role.
- Another purpose is to be relieved of the caretaking role by
having the child hospitalized.
Example : A mother who deceives medical personnel into
believing that her child is ill (false History, contaminating lab
samples or induction of injury and illness to the child)
Pathology and Lab exam
Psychological testing may reveal underlying pathology.
Overpresented features include:
Normal of above average IQ
Absence of formal thought disorder
Poor sense of identity
Poor sexual adjustment
Poor frustration tolerance
Strong dependence needs
Narcissism
No laboratory test are diagnostic od factitious disorder
Drug screening may help confirm or rule out specific mental or medical
disorder
Course & prognosis
Typically begin in early adulthood
The onset may follow real illness, loss, rejection or abandonment.
Usually the patient or close relative had a hospitalization in childhood for
genuine physical illness.
As disorder progresses, the patient becomes knowledgeable about
medication and hospitalization.
The prognosis in most cases is poor.
The patient occasionally spend time in jail for minor crimes (burglary,
vagrancy, disorderly conduct).
Few patient die as a result of needless medication, instrumentation or
surgery
Possible features that indicate a favorable prognosis.
Presence of depressive-masochist personality
Functioning at a borderline not a continuously psychotic
level
Attributes of an antisocial personality disorder with
minimal symptoms.
Treatment:
Treatment best focused on management rather than cure.
3 Major goals of treatment and
management
1. Reduce the risk of morbidity & mortality
2. To address the underlying emotional needs or
psychiatric disorder underlying factitious illness.
3. To be mindful of legal and ethical issue.
The single most important factor in successful
management is the physicians early recognition of the
disorder.
Pharmacotherapy is of limited use
SSRIs may be useful in decreasing impulsive behavior
when that is a major component in acting factitious
disorder
