Factitious Disorders
“Factitious” comes from the Latin word meaning “artificial,” and as the name suggests, people with factitious disorders will present artificial symptoms of real medical conditions. They will often go to incredible lengths to imitate symptoms of a real medical condition. In some cases, people with factitious disorders have intentionally harmed themselves, injected bacteria into their bodies, contaminated lab tests, and taken hallucinogenic drugs to feign symptoms. People with factitious disorders are often hospitalized and will even undergo unpleasant or painful medical tests in order to further their lies.
Factitious disorders are similar to somatoform disorders in that the symptoms or complaints are not from tangible medical conditions. However, there is one key difference between factitious disorders and somatoform disorders: people with somatoform disorders believe that they are ill whereas people with factitious disorders do not.
There are three types of factitious disorders:
Someone with Munchausen syndrome will fake symptoms of an illness.
- Munchausen syndrome: people with Munchausen syndrome will repeatedly fake symptoms of medical problems. The symptoms will be exaggerated and they may go to other great lengths to convince others that their symptoms are real. Munchausen syndrome patients have been known to undergo unnecessary medical procedures including surgeries. They may also go to different medical facilities so not to be detected.
- Munchausen by proxy: With Munchausen by proxy, the person suffering from factitious disorder will force someone else in the patient role. Most commonly, it is parents/caregivers forcing children through medical procedures. They will make up symptoms that the child had, encourage the child to lie, falsify medical reports, and/or alter tests to give the appearance of a sick child.
- Ganser syndrome: This factitious disorder is very rare and mostly occurs amongst prisoners. With Ganser syndrome, a person will display faked psychological symptoms such as psychosis.
How prevalent are factitious disorders?
It is incredibly difficult to get an accurate depiction of how prevalent factitious disorders are. This is because many people with factitious disorders are very masterful at faking their symptoms. In one year-long study of patients in a Berlin hospital, it was shown that approximately .3% of hospitalized patients had a factitious disorder. This study shows that factitious disorders may be much more common than previously thought.
What are the characteristics of factitious disorders?
For a factitious disorder to be diagnosed, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DMS IV), requires that these criteria be met:
- intentional production or feigning of physical or psychological signs or symptoms
- motivation for the behavior is to assume the sick role
- absence of external incentives for the behavior (such as, economic gain, avoiding legal responsibility, improving physical well-being, as in malingering).
The DSM IV further goes on to define the criteria for diagnosing a factitious disorder by proxy:
- Factitious disorder by proxy is the intentional production or feigning of physical or psychological signs or symptoms in another person who is under the individual’s care.
- The motivation for the perpetrator’s behavior is to assume the sick role by proxy.
- External incentives for the behavior (such as economic gain) are absent.
- The behavior is not better accounted for by another mental disorder.
Diagnosing Factitious Disorders
It can be very difficult to identify factitious disorders because the perpetrators are often very adept in feigning symptoms or may even go to great lengths to physically cause symptoms. In one case, a woman was admitted to a hospital complaining about hematamesis and insisted on receiving surgery. When an endoscopy did not show any stomach bleeding, the woman shoved her fingers up her nose to make it bleed down her throat.
Since people with factitious disorders can be very persistent, physicians must carefully monitor for people with the disorder. A physician will need to:
- Analyze the patient’s symptoms to see if they are sensible
- Review the patient’s medical history to see if there is a pattern of symptoms without concrete test results to back them up
- Determine whether treatment is working as expected and
- Assess whether the patient is overly willing to undergo medical procedures.
If a physician suspects that a factitious disorder is present, he/she may need to contact law enforcement.
What causes factitious disorders?
Experts have not identified one solid cause of factitious disorders. Most likely, factitious disorders are caused from a combination of emotional aspects. Some experts believe that people with factitious disorders suffer from a sense of inadequacy or unstable self worth. They then use the factitious behaviors to get attention and sympathy so define their self worth.
Factitious disorders could also be linked to a history of hospitalization or sickness during childhood. Then, the patient tries to recreate this state in order to return to normalization. Another possible cause of factitious disorders is that someone close to the person really was chronically ill. Thus, the person became jealous of the attention and began to feign symptoms in order to get attention.
What You Need to Know About Personality Disorders and Addiction
Personality disorders and addictions can display similar symptoms, and often exacerbate one another.
How is are factitious disorders treated?
People with factitious disorders will almost always insist that their symptoms are real, despite medical evidence to the contrary. This makes factitious disorders incredibly difficult to treat and most patients will refuse any sort of treatment.
The initial goal of treatment is to prevent the person from abusing the medical system or another person in Munchausen by proxy. After these goals are met, then treatment of the disorder can begin. Typically, factitious disorders will be treated with counseling such as family therapy. During family therapy, the family members will be made aware of the condition and taught not to reward the factitious behaviors. Antidepressants may also be effective in treating factitious disorders but it is important that someone ensures the patient is actually taking the medicine properly.
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (Revised 4th ed.). Washington, DC: Author.
Rodin, Spivak, A. Sutherland. “The psychology of factitious disorders. A reconsideration.” Psychosomatics 35 (1994): 25-34.
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