Factitious Disorders (FD)

Factitious Disorders

Patients with Factitious Disorders knowingly fake symptoms, but do so for psychological reasons not for monetary or other discrete objectives as in the case of Malingering. They usually prefer the sick role and may move from hospital to hospital in order to receive care. They are usually loners with an early childhood background of trauma and deprivation. They are unable to establish close interpersonal relationships and generally have severe personality disorders. Unlike many malingerers, they follow through with medical procedures and are at risk for drug addiction and for the complications of multiple operations.

The DSM-IV recognizes the following 3 types of FD: (1) FD with predominantly psychological signs and symptoms, (2) FD with predominantly physical signs and symptoms, and (3) FD with combined psychological and physical signs and symptoms.

A fourth type, FD not otherwise specified, includes those disorders with factitious symptoms that do not meet the criteria for FD.

Prognosis of Factitious Disorders

Chronic FD appears to follow an unremitting course. Treatment may transiently ameliorate symptoms but does not appear to last. Patients with simple FD follow a more variable course. Some of those who seek treatment may be able to overcome their illness. In any event, simple FD appears to remit in the fourth decade of life.

The first probable cases of factitious disorder were reported in 1843 by Gavin (cited in Bhugra 1988). However, we could consider that Asher's article (Asher 1951), in which he introduced the term of Munchausen syndrome, is the origin of the ongoing medical interest in this specific pathology. It entered the DSM classification for the first time as factitious disorder in 1980 (Hiler and Spitzer 1978, American Psychiatric Association 1980).

Factitious disorder with psychological presentation was first reported by Gelenberg in 1977 (Gelenberg 1977). Since then it was considered a variant of the factitious disorder particular only in its expression. As a consequence, the same diagnostic criteria (i.e. intentional feigning of symptoms, motivation to assume the sick role and absence of external incentives), first designed for the factitious disorder with physical signs and symptoms, were used (American Psychiatric Association 1994). However, because of the specificity of the psychiatric diagnostic, i. e. that it entirely relies on statements made by the patient, the diagnostic criteria of factitious disorder with physical manifestations are difficult to use for factitious disorder with psychological symptoms.

Treatment of factitious disorders

The first goal of treatment is to modify the person's behavior and reduce his or her misuse or overuse of medical resources. In the case of factitious disorder by proxy, the main goal is to ensure the safety and protection of any real or potential victims. Once the initial goal is met, treatment aims to work out any underlying psychological issues that may be causing the person’s behavior.

The primary treatment for factitious disorders is psychotherapy (a type of counseling). Treatment likely will focus on changing the thinking and behavior of the individual with the disorder (cognitive-behavioral therapy). Family therapy also may be helpful in teaching family members not to reward or reinforce the behavior of the person with the disorder.

There are no medications to treat factitious disorders themselves. Medication may be used, however, to treat any related disorder—such as depression, anxiety or a personality disorder. The use of medications must be carefully monitored in people with factitious disorders due to the risk that the drugs may be used in a harmful way.

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