Factitious disorder

Factitious disorder is a chronic, long-term psychological condition that is difficult to treat and is sometimes referred to as “hospital addiction”. Read on to know more about the types, symptoms, causes, diagnosis and treatment of this rare disorder.

Factitious disorder Definition

It is a mental condition wherein an individual acts as if he/she is suffering from a disorder and may even deliberately create or exaggerate symptoms of the ailment. Patients with this form of psychiatric disorder may put on a false appearance of being sick. This is possibly done by patients to draw attention from others and gain sympathy, love, affection or care from people known to them.

The term “Factitious” comes from a Latin word meaning “artificial” or “contrived”. The condition is generally abbreviated as FD.

Factitious disorder and Malingering

It is completely opposite to Malingering – a condition where a sufferer exaggerates false symptoms of a physical/mental disorder for personal gains, such as monetary benefits. Patients who display symptoms of malingering do not usually suffer from FD. Both the disorders have been mentioned in the Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision (DSM-IV-TR). However, the former condition is not considered as a mental disorder.

Factitious disorder Types

In accordance with the DSM-IV, FD can be categorized into four major subtypes. These include:

FD with mostly psychological symptoms

This form of FD is present in some patients in the form of Ganser syndrome, which was initially assumed to be a separate disorder. The condition is also known as “Prisoner psychosis” as it was first observed in prisoners. It is very similar to schizophrenia, where sufferers experience hallucinations. It is normally marked by problems like:

• Mental confusion
• Stress
• Speech repetition
• Imitation of the movements of one or more individuals
• Loss of identity

Affected individuals have a tendency to give absurd answers to simple questions.

FD with mostly physical symptoms

The disorder is denoted as “Munchausen Syndrome”. It was named after a German officer called Baron von Munchausen in the 18^th century who was known for making up interesting stories related to his life. Affected patients may claim to have symptoms of a physical ailment such as cardiac or stomach pain. Such individuals undergo repeated surgical interventions and frequently move from one health care centre to another in order to avoid diagnosis.

FD with both psychological and physical symptoms

In this type of FD, patients may exhibit almost all the characteristics of Ganser and Munchausen Syndrome.

FD by proxy

It is also called Munchausen syndrome by proxy (substitute). Unlike individuals affected with the other forms, patients with this condition deliberately induce symptoms in another individual who is under their care. It is most often reported in mothers who are known to inflict or fabricate psychological or physical problems in their children. This is done to receive attention from others. In a few cases, such caregivers may give wrong medical history about their children. They may even mishandle laboratory reports with the intention to make the child appear sick.

Factitious disorder Symptoms

Individuals with this condition may go to the extent of injuring themselves to produce the symptoms. They may also tamper with the diagnostic tests. Contamination of urine or blood samples, injection of bacterial pathogens or ingestion of psychoactive drugs is frequently done to give rise to false symptoms. Patients also have poor coping skills and are unable to develop healthy relationships with others. A few possible warning signs of this unusual disorder involve:

• Unclear and uncontrollable symptoms that changes or gets more severe once treatment is initiated
• Inconsistent medical history
• Relapse of the symptoms after improvement in the condition
• Presence of surgical marks all over the body
• Inclusive knowledge of various medical terms, ailments and hospitals
• Visibility of new or secondary symptoms after negative test results
• Appearance of symptoms in the presence of others or on being noticed
• A history of appointments with various physicians, diagnosis, and treatments in different places
• Readiness to undergo risky medical tests or surgeries
• Unwillingness to permit physicians to consult or interact with family members, relatives or friends

Factitious disorder Causes

Medical experts are yet to determine the underlying causes of this mental disorder. A variety of biological and psychological factors could play a predominant role in the development of this condition. Patients usually have an inner desire to be seen as ill or injured to obtain the same sympathy and attention given to people who are actually sick. Some of the plausible causes are:

• Childhood abuse or neglect
• Abandonment by parents at a young age
• Deep desire to resurface past issues with parents
• A history of close contacts with individuals who were afflicted with a severe disorder
• Willingness to challenge or mislead authoritative powers
• A significant disorder of the past that required immediate hospitalization and medical attention
• A series of personality disorders manifested by abnormal patterns of thinking and behavior

Factitious disorder Diagnosis

There are no reliable techniques to detect this condition. Physicians generally refer patients with FD to mental health experts who use various assessment tools for evaluation. A thorough observation of the behavior and attitude of an affected patient is necessary to note any aberration. Mental health professionals use certain criteria to diagnose FD. Some of these include:

• Presentation of false physical or psychological symptoms
• Absence of any other psychotic illness
• The aim behind acting sick is only to draw attention

Factitious disorder Differential Diagnosis

The differential diagnosis of FD is normally conducted to rule out the presence of any other psychiatric disorder or somatic disorders. Some of these conditions include:

• Pain disorder
• Conversion disorder
• Somatization disorder
• Body dysmorphic disorder

These are generally mental conditions characterized by physical symptoms that mimic some physical illness or injury. However, the causes are normally unexplainable and even diagnostic tests yield normal results.

Factitious disorder Treatment

It is very essential to modify the behavior of a patient in order to prevent misuse or overuse of medical facilities. Some of the common methods used for behavioral treatment of FD include:

Selective serotonin reuptake inhibitors (SSRIs)

These are a class of compounds used as antidepressants for the treatment of a host of psychiatric disorders. SSRIs that are specifically used for treating mood disorders are often administered to patients with FD.

Antipsychotic drugs

These medications are usually prescribed to patients suffering from delusions or hallucinations. In a few cases, however, drugs such as Pimozide have been proved to be effective on FD sufferers.

Family therapy

In this mode of treatment, family members of FD sufferers are generally encouraged to understand the various needs and desires of the latter. It is a form of counseling where families of such patients are strictly instructed not to support such type of abnormal behavior. However, this therapeutic procedure may not yield any result if the family remains uncooperative and ignorant.

Psychotherapy

In this method, mental health providers conduct a number of sessions with the affected individuals to understand the exact condition. Patients are taught various ways to respond to challenging situations with healthy coping skills.

Factitious disorder and legal considerations

In the case of Munchausen by proxy, hospitals can inform legal authorities immediately. Video surveillance can benefit the legal authorities to find out the truth although it may have certain limitations. Criminal charges could be filed against caregivers for causing harm to the child. Protection to proxy sufferers can only be given after monitoring the family for a long time.

Factitious disorder Prognosis

Although a rare form of mental disorder, FD may prove to be life-threatening for its sufferers. Despite the use of various therapeutic procedures, only a few cases have been found to show positive outcomes. However, some patients can gradually recover from this disorder.

Factitious disorder is a serious mental ailment and is associated with severe emotional issues, which are difficult to recognize. Timely monitoring and diagnosis is highly essential before the condition turns detrimental for its patients.

References:

http://en.wikipedia.org/wiki/Factitious_disorder

http://emedicine.medscape.com/article/291304-overview

http://www.medicinenet.com/factitious_disorders/page2.htm

http://www.minddisorders.com/Del-Fi/Factitious-disorder.html#b