FACTITIOUS DISORDER

• Intentionally produce signs and symptoms of medical and mental disorder

• Misrepresent their histories and symptoms

• Objective: assume the role of a patient

• Compulsive quality; voluntary, deliberate and purposeful behavior

Epidemiology

• Prevalence in the general population is unknown

• Occur more frequent in hospital and health care workers

• Females > males

Etiology

• Psychosocial Factors: History of childhood abuse or deprivation Masochistic personality: seek out painful

procedures Identification: reunite with a relative in a

magical way Borderline PD: poor identity formation and

disturbed self-image Significant defense mechanisms: repression,

identification, regression, symbolization

• Biological Factors Brain dysfunction: impaired information

processing

Diagnosis and Clinical Features

• Diagnostic Criteria:1. Intentional production or feigning of physical

or psychological s/sxs

2. The motivation for the behavior is to assume the sick role

3. External incentives for the behavior is absent

• Types:

1. FD with predominantly Psychological S/Sxs

• Depression, hallucinations, dissociative and conversion sxs, bizarre behavior

2. FD with predominantly Physical S/Sxs• Munchausen Syndrome

3. FD with Combined Psychological and Physical S/Sxs

4. FD NOS• FD by Proxy: a person intentionally

produces physical signs or symptoms in another person who is under the first person’s care; to indirectly assume the sick role or to be relieved of the caretaking role

Differential Diagnosis

1. Somatoform Disorder

2. PD: antisocial PD, histrionic PD, borderline PD, schizotypal PD

3. Schizophrenia

4. Malingering

5. Substance abuse

6. Ganser’s syndrome

Course and Prognosis

• Onset: early adulthood• May follow real illness, loss, rejection, or

abandonment• Long pattern of successive hospitalizations -

knowledgeable about medications and hospitalization

• Incapacitating and often produce severe trauma or untowward reactions related to treatment

• Prognosis is poor

Treatment

• Focus on management rather than on cure

• Early recognition

• Educate the hospital staff members