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Factitious Disorder

People with Factitious Disorder create and feign illnesses in themselves or in someone who is in their care, such as a child. They do this not to receive disability payments or to get out of work but rather for the attention and sympathy that comes with being sick. These people go from hospital to hospital, from doctor to doctor getting endless, unnecessary examinations, treatments, and surgeries.

Because the risk of missing a real medical illness is so high, symptoms usually go on for a long time before a doctor confronts an individual about the true nature of their disorder. These people often give lengthy, complicated medical histories and may have multiple scars from surgeries. Despite these long histories, people may make it hard for doctors to get copies of their previous medical records to avoid revealing their secret. Also, doctors may notice these stories may change over time or be remarkably unusual. People with this disorder do their research, though, so their descriptions of medical problems will be spot-on.

As these people spend more time in the care of one doctor or hospital, the situations gradually become more suspicious. Their signs and symptoms may suddenly go away when doctors are present and return after they leave. People will pile on and exaggerate their symptoms when anything threatens to betray the truth. Symptoms may get worse even though tests and imaging turn up nothing, and treatments can have little to no effect at all. Sometimes they will play along with the treatments – which they are usually very eager to get – and report their symptoms are subsiding, but they will ultimately come back again and again.

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Causes and Risk Factors

Rates

Factitious Disorder is relatively rare and only appears in less than 1% of hospital patients. Roughly two-thirds of people with this disorder are women, and it most commonly appears in people age 20 to 40.

Early illness

Severe or extended sickness during early childhood is a fairly common theme in people with Factitious Disorder. These experiences can teach people that illness gains them positive attention and sympathy that they otherwise would not receive. Not everyone who gets sick as a child turns out this way, but when it is combined with a neglectful or abusive environment, the risk of Factitious Disorder is much higher. Additionally, people with childhood trauma and Factitious Disorder may injure themselves as a form of self-punishment.

Identity and relation to Borderline Personality Disorder

People with Factitious Disorder share a lot with those with Borderline Personality Disorder, including a struggle to maintain stable relationships with others. Their personal identity – how they view themselves – is fragile and murky. With Factitious Disorder, adopting a role as a perpetual patient helps them define themselves as individuals, and gaining the concern of others gives them a sense of importance. These people, who may have otherwise found it difficult to fit in, find a guaranteed source of acceptance in being sick.

Coexisting Disorders

Over 40% of these people also have a depressive disorder, making those the most common type of disorders to appear alongside Factitious Disorder. Other common problems include personality disorders, substance use disorders, and anxiety disorders, which all occur in about 15% of these people. Additionally, around 14% of people with Factitious Disorder will contemplate or attempt suicide at some point in their lives.

Diagnosing Factitious Disorder

The criteria

People with this disorder pretend to be physically or mentally ill, and they seek medical care frequently, reporting fake signs and symptoms to medical personnel. Sometimes they will injure themselves on purpose or falsify medical tests to help their cause. Their reasons for doing this are often unclear to others and even to them. They may play up their false symptoms around others to gain attention and sympathy, but the potential benefits stop there. This is what sets it apart from “malingering”, which is when people fake symptoms and present themselves as sick to get more tangible benefits, like disability pay or time off from work.

Factitious Disorder Imposed on Another Person

The alternate form of this disorder is when someone imposes the sick symptoms on another person who is in their care. The most common duo is a parent who insists his or her child is ill, but the victim can also be a disabled adult, an elderly relative, or anyone who cannot advocate for themselves.

Additional information

Because these people come in for medical care so frequently, they end up needlessly suffering through huge numbers of invasive tests, procedures, and surgeries and taking many unnecessary medications. The consequential side effects, infections, and scarring all have a lasting impact on their long term health.

These people go to great lengths to keep their secret safe. When doctors and nurses caring for them begin to suspect they are making up symptoms, they quickly change to a new set of health care providers. They give false medical histories to their new providers, preventing them from contacting the previous doctors and getting the full picture. They do this over and over – a practice known as “doctor shopping” – to avoid discovery and to maintain their “sick identity”. Additionally, they keep their families from getting involved as well to prevent them from revealing the secret.

Treating Factitious Disorder

Psychological evaluation

The vast majority of these people have trouble recognizing their own disorder and rarely look for psychiatric treatment. Instead, the most common way they first see a mental health professional is when a suspicious doctor recommends an evaluation during one of their many hospital visits. However, since the consequences of missing a true medical illness are so high, these people undergo many tests and exams before doctors consider a possible psychiatric issue.

Therapy strategies

In the first meeting with the individual, psychiatrists and therapists need to tread lightly when they first approach the subject of Factitious Disorder. People frequently refuse to admit they have the disorder and are often unwilling to engage in treatment. Doctors in these situations need to communicate the risks of the disorder, including real injuries and illnesses as side effects. When they are ready to really explore their disorder in therapy, one of the most important keys to treatment is a good, trusting doctor-patient bond. Developing this trust is crucial since these people have spent so much time lying to healthcare providers in the past that being able to speak openly and honestly is a major step.

Types of therapy

Supportive therapy and Cognitive Behavioral Therapy are the two most appropriate options for treating Factitious Disorder. A good relationship with a therapist creates an environment where people will be more willing to reflect on the emotional issues behind their disorder. Family therapy can help relatives of someone with Factitious Disorder learn to support the individual’s recovery and avoid playing into their symptoms. Unfortunately, no medications exist to treat Factitious Disorder, though treating other coexisting disorders will help.

Managing Factitious Disorder

Dealing with Factitious Disorder Imposed on Another Person

When a parent lies about or deliberately makes their child sick, social services need to step in. They will get the child out of that dangerous environment and ensure placement with a safe caretaker. The primary goal is protecting the victim, otherwise they face a 1 in 10 risk of death. This disorder is considered child abuse, and individuals will likely face criminal charges. Additionally, children in these situations run a higher risk of developing Factitious Disorder themselves when they grow up.

Strategies for care

Doctors encountering people who refuse to admit to feigning their sickness should distance themselves from them. By lying about their symptoms, the person has violated the trust of the doctor-patient bond, and continuing treatment is unhealthy and potentially dangerous. When an individual does finally acknowledge it and consents to treatment, doctors, nurses, therapists, and any other medical caregivers must stay in close, regular contact about treatment plans. Teaching both the individuals and their families about the symptoms of the disorder, how it develops, and why people do it will help all those involved take a more empathic and effective approach.

Ethical questions

A major part of this disorder is that people withhold information from their doctors, and privacy laws and customs usually support their ability to do this. Getting medical records and searching a person’s belongings for evidence there are injuring themselves may help confirm Factitious Disorder, but both are forbidden without the person’s consent. Unfortunately, the nature of this disorder often prevents doctors from getting people the help they really need. Legal gray areas abound as well. Not only have people sued medical providers for failing to diagnose their Factitious Disorder, but also hospitals and insurance companies have sued these individuals for fraud.

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References
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