Factitious Disorder

Clinical Picture

Factitious Disorder is a psychological disorder in which an individual deliberately produces, falsifies or exaggerates their physical or psychological symptoms in order to appear sick and receive medical or psychological attention. The person knows that the symptoms are being created or exaggerated but they strongly desire to be treated as a real patient.

Factitious Disorder is not malingering, the main purpose is not an obvious external benefit like financial compensation, avoiding work, obtaining drugs or escaping legal responsibility.

Individuals who have factitious disorder may go to great lengths to convince others that they are actually ill. They may report symptoms that are difficult to verify, alter medical records, interfere with laboratory tests, take unnecessary medicine so they feel others to believe they have symptoms or even intentionally injure themselves

Factitious Disorder vs Malingering

The important difference between factitious disorder and malingering is the motivation behind the certain behavior. In Factitious Disorder the person deliberately produces symptoms primarily to be regarded as ill and receive the attention that they required. Whereas in malingering symptoms are intentionally produced or exaggerated for clear external benefit like financial compensation, obtaining drugs, avoiding work and others. Thus, the central features of factitious disorder are intentional production of illness, deception about the illness, and the absence of an obvious external incentive. It can be difficult to identify because the person may provide convincing symptoms.

Theri are two main forms of factitious Disorder

1. Factitious disorder imposed on self
2. Factitious disorder imposed on others

Diagnostic Criteria (DSM-5-TR)

• Factitious Disorder Imposed on Self
  A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.
  B. The individual presents himself or herself to others as ill, impaired, or injured.
  C. The deceptive behavior is evident even in the absence of obvious external rewards.
  D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.
  Specify:
  Single episode
  Recurrent episodes (two or more events of falsification of illness and/or induction of injury)
• Factitious Disorder Imposed on Another (Previously Factitious Disorder by Proxy)
  A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception.
  B. The individual presents another individual (victim) to others as ill, impaired, or injured.
  C. The deceptive behavior is evident even in the absence of obvious external rewards.
  D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.
  Note: The perpetrator, not the victim, receives this diagnosis.
  Specify:
  Single episode
  Recurrent episodes (two or more events of falsification of illness and/or
  induction of injury)

Comorbidity

Comorbidity refers to the presence of two or more disorders or medical conditions in the same person at the same time. In psychology and psychopathology, it means that an individual has more than one mental disorder simultaneously. For example, a person with Major Depressive Disorder may also have Generalized Anxiety Disorder. In this case, depression and anxiety are comorbid conditions.

Case Study

Ramesh, a 32-year-old man, repeatedly visits different hospitals complaining of severe abdominal pain, vomiting, and weakness. Medical examinations do not identify a medical condition that explains his symptoms. Later, healthcare workers discover that he has been intentionally taking substances that make him sick and has altered some medical information to make his illness appear more serious. Even after doctors explain that there is no underlying disease, he continues to seek hospitalization and medical attention. He does not appear to be seeking money, avoiding employment, or obtaining medication for another purpose. His behavior may indicate factitious disorder imposed on self, because he is deliberately producing symptoms in order to assume the sick role.