What is Factitious Disorder?
Munchausen syndrome, also known as factitious disorder imposed on self, is a condition where people knowingly create, fake, or enhance physical or mental health symptoms for personal benefit. These personal benefits could be seeking attention, dealing with stress, or simply taking pleasure in confusing medical professionals. These individuals can harm themselves as they often undergo various unnecessary medical procedures or create harmful symptoms.
They also commonly use more healthcare resources than needed. The deceptive nature of this condition makes it very challenging for medical professionals to diagnose it accurately. Because of the nature of the condition, it’s hard to carry out large-scale treatment trials, as people are often unwilling to participate. Therefore, the evidence to direct treatment for these patients is limited.
What guidance is available comes mostly from expert opinions, individual case studies, and reviews of multiple cases. Even based on these resources, there are only a few treatment options, and the overall outcome for these patients is generally not very good.
What Causes Factitious Disorder?
Factitious disorder is a condition where someone lies about having symptoms or illnesses that they don’t actually have. We’re not exactly sure why this happens, and the reasons behind it are mostly speculative, as there haven’t been many large, high-quality studies on this topic. However, many experts believe that this disorder develops through one’s life as a maladaptive response – an unhealthy way a person might react to certain life events, especially ones that happened during their childhood.
Two common experiences that many people with this condition share are major childhood illness and a difficult or traumatic childhood. A lot of people with a factitious disorder have had a severe illness in their childhood. It seems like this early interaction with healthcare might play a significant role not just with health but with the development of this disorder. One study showed that out of 20 patients, 12 had a history of major childhood illnesses.
In addition, this disorder often appears in people who have difficult or traumatic childhood memories. A study that examined online support groups found that many of its members described experiencing emotional and physical abuse growing up. There’s also a strong link between people with personality disorders and a factitious disorder, which gives more support to the theory that this condition develops over the course of a lifetime.
There are a few theories about why someone might behave in the way they do when they have a factitious disorder:
– Some might act unwell to feel affection, especially if they felt unloved when they were growing up.
– Sometimes they could be looking to build or keep relationships.
– They may enjoy the feeling of being taken care of by others.
– They might be dealing with stressful life events or not have a sense of who they are.
– They may feel a sense of achievement when they trick doctors.
Lastly, some experts view a factitious disorder as a type of behavioural addiction. In one study, patients with this disorder talked about having a strong urge to keep acting like they’re sick, but also a strong wish to stop doing so.
Risk Factors and Frequency for Factitious Disorder
Factitious disorder is a condition difficult to measure in the general population due to its secretive nature, making it possibly under-diagnosed. It is challenging to determine the level of deception required for a diagnosis. Researchers have tried to understand its prevalence. According to a study of 241 doctors in Germany, both in primary care and different specialities, they estimated the incidence of factitious disorder to be around 1.3%. Another research project looking at 100 successive admissions to a New York psychiatric ward found 6% of those admitted were diagnosed with the disorder.
- Being a female
- Working in the healthcare field
- Being unmarried
are factors that appear to increase the likelihood of developing this ailment. It typically begins in early adulthood or middle age.
Signs and Symptoms of Factitious Disorder
Factitious disorder is when a person pretends, exaggerates, or even self-inflicts symptoms of an illness. This can happen in any medical field. Patients may fake easy-to-understand but serious symptoms, like chest pain, which often results in hospitalization. Others might portray more complicated symptoms. Diagnosing this condition requires a careful review of the patient’s history and a thorough physical exam. Some warning signs a doctor may notice include:
- The patient gives inconsistent information
- The symptoms are overly dramatic or don’t match the suspected disease
- There is a mismatch between the symptoms and the findings of the physical exam
- Symptoms don’t line up with how the body structures or systems work
- There are discrepancies between the patient’s statements and past medical records
- The patient doesn’t want to release their medical records
- The patient has an extensive medical history or many different illnesses
- Despite extensive testing, no concrete diagnosis can be found. Sometimes, the patient may even have had unnecessary surgeries or procedures
- Physical exam findings contradict what the patient says (for example, the patient might deny having had any surgeries, but there are visible surgical scars)
Testing for Factitious Disorder
Factitious disorder is a mental health condition where a person intentionally lies about having physical or psychological symptoms or, in some cases, even causes self-injury or illness. They act as if they are ill, even though they’re not. These people don’t do it for any apparent benefit like money or to avoid responsibility. Instead, they do this for no clear reason. The primary clue that someone might have a factitious disorder is if their behavior doesn’t align with another recognized mental health condition.
How do doctors figure out if someone is pretending to be sick or actually has a factitious disorder? There are several ways a medical professional may investigate this:
– They may find that the lab results, scans, or other medical tests don’t backup the person’s claim about their disease.
– Some specific tests can even reveal the person is pretending. For instance, if someone claims they’re frequently experiencing diarrhea, doctors might test their stool. The stool sample might show signs of laxatives or excess water. For someone who feigns low blood sugar despite not having diabetes, doctors may perform tests to find out if they’re secretly using insulin.
– Doctors might catch the person in the act of creating symptoms or messing with their treatment.
– A search of their belongings might reveal devices they use to create symptoms, like syringes, laxatives, or drugs.
– The person may show an unusual enthusiasm for going through many medical tests or treatments.
– They might get worse or claim they’re getting worse when it’s time to leave the hospital.
– If confronted, they might admit that they’re pretending.
Sometimes, it’s pretty clear if someone is faking an illness or self-harming. For example, if doctors find laxatives in a patient’s stool sample who always complains about diarrhea. Yet, in many cases, it’s not that straightforward. It could be challenging to decide how much evidence is needed to diagnose a factitious disorder.
Interestingly, some people argue that the guidelines for diagnosing this disorder – outlined in a manual called the DSM (Diagnostic and Statistical Manual of Mental Disorders) – does not consider that lying or exaggerating symptoms is a common human behavior. It’s quite usual for patients to exaggerate their symptoms to get the attention they wish to get. This can make diagnosing factitious disorder more complicated, as it’s not always clear what amount of exaggeration is considered an actual disorder.
Treatment Options for Factitious Disorder
Factitious disorder is a condition where patients falsify symptoms or illnesses in themselves. Right now, therapy is the only proven effective treatment for this disorder. Studies have shown that medication doesn’t significantly improve the symptoms of this condition. However, people with factitious disorder often also suffer from other mental health conditions like depression. Treating the symptoms of these other conditions can also help to indirectly improve the behaviors linked to the factitious disorder.
There has been some controversy over how best to start treatment for this disorder. One of the main challenges comes from the patient’s willingness to accept treatment. Experts have found that the patient needs to acknowledge their behavior before they can receive suitable treatment. This needs to be carried out carefully to minimize the patient experiencing feelings of embarrassment or being accused. Some professionals suggest a very collaborative approach, involving a team of people such as nurses, psychiatrists, primary care doctors, therapists, and even the patient’s family.
However, many patients with factitious disorder will often deny their behavior and refuse treatment when told about their condition. Some experts have argued that it’s not necessary to make the patient accept their disorder to start treatment. They recommend cultivating a trusting relationship with the patient first. Then treatment strategies can be introduced to help reduce the behaviors associated with factitious disorder. In addition to that, any additional mental health conditions can be treated more effectively.
What else can Factitious Disorder be?
If doctors think a patient might have factitious disorder, where a person knowingly pretends to be sick without an obvious reason, there are a few other conditions they need to rule out. These include:
- Malingering: This is when someone purposely fakes being sick for some sort of benefit, such as getting money, avoiding work, or staying out of jail or the military. Because it’s hard to figure out a person’s motivation, it’s often difficult to tell malingering apart from factitious disorder.
- Conversion disorder and somatic symptom disorder: These conditions involve subconscious processes and can also be hard to distinguish from factitious disorder. The key to telling them apart is finding concrete proof that the person is behaving deceptively.
- Borderline personality disorder: People with this condition often behave in deceptive ways and hurt themselves. However, they usually admit to their self-injury. It’s useful to know that borderline personality disorder and factitious disorder often exist together in the same person.
Remember, it’s crucial for doctors to consider all these possibilities when diagnosing a patient suspected to have factitious disorder.
What to expect with Factitious Disorder
People suffering from factitious disorder, a mental illness where a person acts as if they have an illness when they’re actually not sick, generally don’t have a very good outlook for recovery. Most of these patients, when confronted about their actions, deny their behavior and very few agree to get treatment. Even among those who start therapy, many quit prematurely. However, evidence shows that persisting with long-term therapy can lead to better outcomes.
Many of these patients also struggle with other mental health conditions at the same time, the most common being depression. Those who have additional conditions like mood disorders, anxiety, or substance abuse usually have a better outlook. Factitious disorder patients often have personality disorders too, particularly borderline personality disorder. Unfortunately, this combination usually makes the prognosis for recovery poor.
Possible Complications When Diagnosed with Factitious Disorder
Factitious disorder is a serious condition, leading to health issues and even death. People with this disorder often hurt themselves in dangerous ways and may go through risky medical procedures. Besides the health risks, factitious disorder also burdens the healthcare system with notable expenses. There are cases where individuals with this disorder have cost the healthcare system hundreds of thousands of dollars.
Key Features of Factitious Disorder:
- It’s a serious condition
- Can lead to health problems or even death
- People with this disorder often self-harm or take risky medical procedures
- It costs the healthcare system a significant amount of money
- Individual cases have resulted in healthcare costs of hundreds of thousands of dollars
Preventing Factitious Disorder
Having a detailed health history and physical exam can prevent a patient from having to go through unnecessary tests and risky treatments. It’s important for doctors to document every finding and diagnosis, especially for patients with factitious disorder, a condition where a person acts as if they have a physical or mental illness when they are not really sick. This helps other healthcare professionals who might take care of these patients in the future.
Patients with factitious disorder often deny their behavior when asked about it, and many are lost to future medical appointments. Despite this, efforts should be made to start the right treatment and give the proper care for these patients.
