 A condition in which patient fake illness to

the point of inflicting painful, deforming, or

even life-threatening injury on themselves or
those under their care with the primary goal
of gaining the emotional care and attention
that comes with playing the role of the
patient

 Approximately 0.8 to 1.0 percent of

psychiatry consultation patients
 Intentional production or feigning of physical
or psychological signs or symptoms.

 The motivation for the behavior is to assume

the sick role.

 External incentives for the behavior (such as

economic gain, avoiding legal responsibility,
or improving physical well-being, as in
malingering) are absent.
  With predominantly psychological signs
and symptoms

 With predominantly physical signs and

symptoms (Munchausen Syndrome)

   With combined psychological and physical

signs and symptoms
 Factitious Disorder Not Otherwise Specified

 Factitiousdisorder 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;
 to be relieved of the caretaking role by having the
child hospitalized
 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
 Factitious disorders with psychological signs
and symptoms
 are mostly women who outnumber men 3 to 1.
 usually 20 to 40 years of age with a history of
employment or education in nursing or a health
care occupation
 Factitious disorder by proxy

 most commonly perpetrated by mothers against

infants or young children
 less than 0.04 percent
 The symptoms and pattern of illness are
extremely unusual, or inexplicable
physiologically.
 Repeated hospitalizations and workups by
numerous caregivers fail to reveal a
conclusive diagnosis or cause.
 Physiological parameters are consistent with
induced illness; e.g., apnea monitor tracings
disclose massive muscle artifact prior to
respiratory arrest, suggesting that the child
has been struggling against an obstruction to
the airways.
 The patient fails to respond to appropriate
treatments.
 The vitality of the patient is inconsistent
with the laboratory findings.
 The signs and symptoms abate when the
mother has not had access to the child.
 The mother is the only witness to the onset
of signs and symptoms
 Unexplained illnesses have occurred in the
mother or her other children.
 The mother has had medical or nursing
education, or exposure to models of the
illnesses afflicting the child (e.g., a parent
with sleep apnea).
 The mother welcomes even invasive and
painful tests.
 The mother grows anxious if the child
improves.
 Maternal lying is proved.
 Medical observations yield information that is
inconsistent with parental reports.
 many of the patients suffered childhood
abuse or deprivation, resulting in frequent
hospitalizations during early development

 inpatientstay 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.

 seek out painful procedures, such as surgical

operations and invasive diagnostic tests, may
have a masochistic personality makeup in
which pain serves as punishment for past
sins, imagined or real
 Patients who feign psychiatric illness may
have had a relative who was hospitalized
with the illness they are simulating.

 Through identification, patients hope to

reunite with the relative in a magical way.

 no genetic patterns have been established,

and electroencephalographic (EEG) studies
noted no specific abnormalities in patients
with factitious disorders
 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
 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
 a few of them probably die as a result of
needless medication, instrumentation, or
surgery
 No effective specific therapy
 3 Major Goals of Treatment:

 To reduce the risk of morbidity and mortality

 to address the underlying emotional needs or
psychiatric diagnosis underlying factitious illness
behavior
 to be mindful of legal and ethical issues
Guidelines for Management and Treatment of Factitious
Disorder:
1. Active pursuit of a prompt diagnosis can minimize the risk
of morbidity and mortality.
2. Minimize harm. Avoid unnecessary tests and procedures,
especially if invasive. Treat according to clinical
judgment, keeping in mind that subjective complaints may
be deceptive.
3. Regular interdisciplinary meetings to reduce conflict and
splitting among staff. Manage staff countertransference.
4. Consider facilitating healing by using the double-bind
technique or face-saving behavioral strategies, such as
self-hypnosis or biofeedback.
5. Steer the patient toward psychiatric treatment in an
empathic, nonconfrontational, face-saving manner. Avoid
aggressive direct confrontation..
6. Treat underlying psychiatric disturbances, such as Axis I
disorders and Axis II disorders. In psychotherapy, address
coping strategies and emotional conflicts.
7. Appoint a primary care provider as a gatekeeper for all
medical and psychiatric treatment.
8. Consider involving risk management professionals and
bioethicists from an early point.
9. Consider appointing a guardian for medical and
psychiatric decisions.
10. Consider prosecution for fraud, as a behavioral
disincentive
 Pharmacotherapy
 Limited use
 Antipsychotics
 SSRI’s – may be useful in decreasing impulsive
behavior.