Factitious disorder
Encyclopedia
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
Munchausen syndrome
Münchausen syndrome is a psychiatric factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention or sympathy to themselves. It is also sometimes known as hospital addiction syndrome or hospital hopper syndrome...

is an older term for Factitious disorder. People with this condition may produce symptoms by contaminating urine
Urine
Urine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...

 samples, taking hallucinogens, injecting themselves with bacteria to produce infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...

s, 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
Attention
Attention is the cognitive process of paying attention to one aspect of the environment while ignoring others. Attention is one of the most intensely studied topics within psychology and cognitive neuroscience....

, nurturance, sympathy
Sympathy
Sympathy is a social affinity in which one person stands with another person, closely understanding his or her feelings. Also known as empathic concern, it is the feeling of compassion or concern for another, the wish to see them better off or happier. Although empathy and sympathy are often used...

, and leniency that are unobtainable any other way. Somatoform disorder
Somatoform disorder
In psychology, a somatoform disorder is a mental disorder characterized by physical symptoms that suggest physical illness or injury - symptoms that cannot be explained fully by a general medical condition, direct effect of a substance, or attributable to another mental disorder . The symptoms that...

s are characterised by multiple somatic
Somatic
The term somatic means 'of the body',, relating to the body. In medicine, somatic illness is bodily, not mental, illness. The term is often used in biology to refer to the cells of the body in contrast to the germ line cells which usually give rise to the gametes...

 complaints.

Motives

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. This is in contrast to malingering
Malingering
Malingering is a medical term that refers to fabricating or exaggerating the symptoms of mental or physical disorders for a variety of "secondary gain" motives, which may include financial compensation ; avoiding school, work or military service; obtaining drugs; getting lighter criminal sentences;...

, 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. While they are both listed in the DSM-IV-TR, factitious disorder is considered a mental disorder, while malingering is not.

Differential diagnosis

Factitious disorders should be distinguished from somatoform disorder
Somatoform disorder
In psychology, a somatoform disorder is a mental disorder characterized by physical symptoms that suggest physical illness or injury - symptoms that cannot be explained fully by a general medical condition, direct effect of a substance, or attributable to another mental disorder . The symptoms that...

s, 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

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
Munchausen syndrome
Münchausen syndrome is a psychiatric factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention or sympathy to themselves. It is also sometimes known as hospital addiction syndrome or hospital hopper 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

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
Ganser syndrome
Ganser syndrome is a rare dissociative disorder previously classified as a factitious disorder. It is characterized by nonsensical or wrong answers to questions or doing things incorrectly, other dissociative symptoms such as fugue, amnesia or conversion disorder, often with visual...

 was in the past regarded to be a separate factitious disorder. It is a reaction to extreme stress 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
Echolalia
Echolalia is the automatic repetition of vocalizations made by another person. It is closely related to echopraxia, the automatic repetition of movements made by another person....

, and echopraxia
Echopraxia
Echopraxia is the involuntary repetition or imitation of the observed movements of another. It is closely related to echolalia, the involuntary repetition of another's speech. The etymology of the term is from Ancient Greek: "ἠχώ from ἠχή " and "πρᾶξις "...

. 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 return 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.

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
Pimozide
Pimozide is an antipsychotic drug of the diphenylbutylpiperidine class. It was discovered at Janssen Pharmaceutica in 1963. It has a high potency compared to chlorpromazine . On a weight basis it is even more potent than haloperidol. It also has special neurologic indications for Tourette syndrome...

. 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.

External links

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