Factitious Disorder

Author: Anna Chou

Editor: Prachi Patel, Helia Mansouri Dana

Scientific Review: Ozair Ali 

Overview

Factitious disorder, also referred to as Munchausen syndrome, is a grievous mental illness that entails repeatedly falsifying psychiatric or medical symptoms that may be fabricated or self-induced (Carnahan & Jha, 2021). 

This includes patients falsifying health statuses of those around them and in particular of their children as well (Carnahan & Jha, 2021). 

Epidemiology

Individuals with this disorder are motivated to falsify their symptoms due to the attention received, stress mechanism, or simply the enjoyment of fooling healthcare professionals (Carnahan & Jha, 2021).

Due to the secretive nature of this disorder and diagnostic uncertainties, determining the epidemiology is difficult (Carnahan & Jha, 2021). Nonetheless, a few studies have highlighted their epidemiological findings. 

The onset of factitious disorder is believed to be in early or middle adulthood (Carnahan & Jha, 2021) with a mean age of 25 years for both sexes (Jafferany et al., 2018). It was reported that factitious disorder is more common in females with a diagnosis found in 72% of females in the study population conducted by Jafferany et al. (2018). 

The prevalence rates of the disorder vary with one study finding a diagnosis in 6% of their study population (Carnahan & Jha, 2021) whereas another study found the disorder prevalent in less than 1% of patients in clinical settings (Weber et al., 2021). Additionally, it was found that the incidence of factitious disorder was 6.8 per 10,000 cases (Weber et al., 2021). 

Etiology

Models have been produced to better understand factitious disorders, mainly with a focus on psychodynamics and trauma psychology (Yates & Feldman, 2016). 

The psychodynamics approach is characterized by addiction, narcissism, a derivation in pleasure from pain, as well as poor coping methods to traumatic experiences (Yates & Feldman, 2016). 

According to Carnahan and Jha (2021), a history of childhood illness was found in 60% of the study population revealing childhood trauma as a risk factor. 

Childhood trauma may include experiencing the death of someone who was close to the individual, abandonment, and abuse (Weber et al., 2021). In addition, a strong relationship was observed between personality disorders and factitious disorders (Carnahan & Jha, 2021). 

Carnahan and Jha (2021) describe factitious disorder where patients have an urge to adopt the sick role, a type of behavioural addiction. 

 

Symptoms

Individuals with factitious disorder may present with a variety of symptoms that may range from very mild to very severe as they would falsify their symptoms by self-inducing or fabricating them (Carnahan & Jha, 2021).

 It is important to note that while the symptoms may align with factitious disorder, to some degree, they are asynchronous with common forms of self-harm in regular clinical care (Yates & Feldman, 2016). 

Main common symptoms of the condition include:

  • Artificial skin disease 
  • Induction of fever 
  • Self-induction of various conditions such as anaemia, hypoglycaemia, hyperthyroidism, cardiac disease symptoms, abdominal pain, and vaginal bleeding  (Yates & Feldman, 2016)
  • Falsifying conditions such as seizures, headaches, and kidney stones (Jafferany et al., 2018)

Risk factors

Some of the most common risk factors associated with factitious disorder are mainly attributed to circumstances involving self-damaging behaviour – overuse of unnecessary medication, and physical methods of self-manipulation that require acute medical attention (Yates & Feldman, 2016). 

Females, being married, and employment in healthcare are common factors observed in factitious disorder (Carnahan & Jha, 2021; Weber et al., 2021). In addition, those with childhood trauma are at risk for developing factitious disorder (Weber et al., 2021). 

Diagnosis

Clinical Features

Clinical features of patients with factitious disorder may vary greatly as symptoms are falsified (Carnahan & Jha, 2021). As a result, a thorough history and physical exam are critical for these patients to determine if symptoms have a true physiological cause  (Jafferany et al., 2018). 

The criteria for DSM-5 look for deception, aggravation, deliberate pretending of illness, and a lack of incentive for such behaviour (Jafferany et al., 2018). 

While the DSM-5 is used to diagnose factitious disorder, there are some individuals who argue that the DSM does not account for deception as basic human nature (Carnahan & Jha, 2021). 

Therefore, the diagnosis of factitious disorder is complicated as the threshold after which behaviour is considered pathological is unclear (Carnahan & Jha, 2021). Several indications may reveal the individual has factitious disorder. These indications include:

  • Several hospital visits within a short amount of time
  • Visits to several nearby hospitals
  • Inconsistent test results to the symptoms indicated by the patient
  • Eagerness to undergo medical procedures
  • Refusal for healthcare professionals to access previous medical records (Weber et al., 2021; Carnahan & Jha, 2021)

Pathological Features

Research on pathological features in individuals with factitious disorder is limited. However, dysfunction in the right cerebral hemisphere may be indicated within this population as some neurophysiological deficits were found in organization and judgement (Carnahan & Jha, 2021). 

Treatment Protocol

Treatment of factitious disorder can be difficult, requiring the collaboration of professionals from various health disciplines such as a psychiatrist, general practitioner, social worker, therapist, and more (Jafferany et al., 2018). 

Pharmacological methods are not used to treat factitious disorder, rather, psychological methods are tried to communicate with those suffering from the condition (Jafferany et al., 2018). The only effective treatment for factitious disorder is psychotherapy, although some patients may refuse treatment (Carnahan & Jha, 2021; Weber et al., 2021). 

Psychoeducation, as an early intervention is recommended as it provides information on the disorder, symptoms, and treatment outcomes to prevent a repetition of the behaviour (Jafferany et al., 2018).

Confrontation is often used to alert patients of their behaviour, although often met with hostility. According to Jafferany et al. (2018), patients may change their physician or hospital to prevent getting treated for factitious disorder. 

Non-confrontational techniques are thought to have an advantage over confrontational techniques, as they make the situation less embarrassing for the patient (Jafferany et al., 2018). “Face-saving” can be used as it prevents humiliation for the patient by informing them that their symptoms may not be reactive to medication (Jafferany et al., 2018).

Treatments may also be directed towards secondary reasons. If a patient has comorbid psychiatric conditions (e.g. depression), then that condition would need to be treated using the appropriate course of treatment (Carnahan & Jha, 2021). In some cases, cognitive behavioural therapy (CBT) may also be used to address childhood trauma that may progress this disorder (Weber et al., 2021). 

 

Articles on Misdiagnosis

Carnahan, K. T., & Jha, A. (2021). Factitious Disorder. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK557547/

Jafferany, M., Khalid, Z., McDonald, K. A., & Shelley, A. J. (2018). Psychological Aspects of Factitious Disorder. The Primary Care Companion for CNS Disorders, 20(1). doi: 10.4088/PCC.17nr02229 

 

References 

Carnahan, K. T., & Jha, A. (2021). Factitious Disorder. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK557547/.

Jafferany, M., Khalid, Z., McDonald, K. A., & Shelley, A. J. (2018). Psychological Aspects of Factitious Disorder. The Primary Care Companion for CNS Disorders, 20(1). doi: 10.4088/PCC.17nr02229

Weber, B., Gokarakonda, S. B., & Doyle, M. Q. (2021). Munchausen Syndrome. StatPearls PublishingRetrieved from https://www.ncbi.nlm.nih.gov/books/NBK518999/

Yates, G. P., & Feldman, M. D. (2016). Factitious disorder: A systematic review of 455 cases in the professional literature. General Hospital Psychiatry, 41, 20-28. doi: 10.1016/j.genhosppsych.2016.05.002

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