Factitious Disorders

Overview

What is factitious disorder?

Factitious disorder is a serious mental health disorder in which a person appears sick or produces physical or mental illness. People with factitious disorder deliberately produce symptoms of an illness for the purpose of receiving care and attention in a medical setting. The symptoms aren’t intended to get them practical benefits — the gain is believed to be mainly psychological.

Factitious disorder is considered a mental illness. It’s associated with severe emotional difficulties and patients’ likelihood of harming themselves by continuing to produce more symptoms, resulting in getting themselves unnecessary procedures and surgeries.

What are the types of factitious disorder?

Factitious disorders are of two types:

  • Factitious disorder imposed on self: This type includes the falsifying of psychological or physical signs or symptoms. An example of a psychological factitious disorder is mimicking behavior that is typical of a mental illness, such as schizophrenia. The person may appear confused, make absurd statements, and report hallucinations (the experience of sensing things that are not there; for example, hearing voices).
  • Factitious disorder imposed on another: People with this disorder produce or fabricate symptoms of illness in others under their care: children, elderly adults, disabled persons or pets. It most often occurs in mothers (although it can occur in fathers) who intentionally harm their children in order to receive attention. The diagnosis is not given to the victim, but rather to the perpetrator.

What are the warning signs of factitious disorder?

Possible warning signs of factitious disorder include:

  • Dramatic but inconsistent medical history.
  • Unclear symptoms that aren’t controllable, become more severe or change once treatment has begun.
  • Unpredictable relapses following improvement in the condition.
  • Extensive knowledge of hospitals and/or medical terminology, as well as the textbook descriptions of illness.
  • Presence of many surgical scars.
  • Appearance of new or additional symptoms following negative test results.
  • Presence of symptoms only when the patient is alone or not being observed.
  • Willingness or eagerness to have medical tests, operations or other procedures.
  • History of seeking treatment at many hospitals, clinics and doctors’ offices, possibly even in different cities.
  • Reluctance by the patient to allow healthcare professionals to meet with or talk to family members, friends and prior healthcare providers.
  • Refusal of psychiatric or psychological evaluation.
  • Forecasting negative medical outcomes despite no evidence.
  • The patient sabotaging discharge plans or suddenly becoming more ill as they’re about to be discharged from the hospital setting.

How common is factitious disorder?

No reliable statistics are available regarding the number of people in the United States who suffer from factitious disorder. Getting accurate statistics is difficult because patients don’t typically acknowledge their disorder. People with factitious disorders also tend to seek treatment at many different healthcare facilities, resulting in statistics that are misleading. It’s estimated that about 1% of those admitted to hospitals are believed to have factitious disorder, but this is likely under-reported.

Symptoms and Causes

What causes factitious disorder?

The exact cause of factitious disorder is not known, but researchers believe both biological and psychological factors play a role. Some theories suggest that a history of abuse or neglect as a child, or a history of frequent illnesses in themselves or family members that required hospitalization, may be factors in the development of the disorder.

Most patients with factitious disorder have histories of abuse, trauma, family dysfunction, social isolation, early chronic medical illness or professional experience in healthcare (training in nursing, health aid work, etc.).

What are the symptoms of factitious disorder?

People with factitious disorder may:

  • Lie about or mimic symptoms.
  • Hurt themselves to bring on symptoms.
  • Alter diagnostic tests (such as contaminating a urine sample or tampering with a wound to prevent healing).
  • Be willing to undergo painful or risky tests and operations in order to obtain the sympathy and special attention given to people who are truly medically ill.

Most people with this condition do not believe they have factitious disorder. They may not be entirely aware of why they are inducing their own illness. Many people with factitious disorder may also suffer from other mental disorders, particularly personality or identity disorders.

Diagnosis and Tests

How is factitious disorder diagnosed?

Due to the deceptive behaviors involved, diagnosing factitious disorder is difficult. Doctors must also rule out any possible physical and mental illnesses, and often use a variety of diagnostic tests and procedures before considering a diagnosis of factitious disorder.

If the healthcare provider finds no physical reason for the symptoms, he or she may refer the person to a psychiatrist or psychologist (mental health professionals who are specially trained to diagnose and treat mental illnesses). Psychiatrists and psychologists use thorough history, physical examinations, laboratory tests, imagery, and psychological testing to evaluate a person for physical and mental conditions.

The doctor bases a diagnosis on the exclusion of actual physical or mental illness, and observation of the patient’s attitude and behavior.

Management and Treatment

How is factitious disorder treated?

The first goal of treatment is to change the person’s behavior and reduce their misuse of medical resources. In the case of factitious disorder imposed on another, the main goal is to ensure the safety and protection of any real or potential victims.

Once the first goal is met, treatment aims to resolve any underlying psychological issues that may be causing the behavior.

The primary treatment for factitious disorder 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 help in teaching family members not to reward or reinforce the behavior of the person with the disorder.

There are no medications to actually treat factitious disorder. Medication may be used, however, to treat any related disorder, such as depression or anxiety.

What are the complications of factitious disorder?

People with factitious disorder are at risk for health problems associated with hurting themselves by causing symptoms. In addition, they may suffer health problems related to multiple tests, procedures, and treatments, and are at high risk for substance abuse and suicide attempts. A complication of factitious disorder imposed on another is the abuse and potential death of the victims.

Prevention

Can factitious disorder be prevented?

There is no known way to prevent factitious disorder. It may be helpful to start treatment in people as soon as they begin to have symptoms.

Outlook / Prognosis

What is the prognosis (outlook) for people with factitious disorder?

Some people with factitious disorder suffer one or two brief episodes of symptoms. In most cases, however, factitious disorder is a chronic, or long-term, condition that can be very difficult to treat. And unfortunately, due to their low self-awareness, many people with factitious disorder will not seek or follow treatment.

Last reviewed by a Cleveland Clinic medical professional on 12/03/2020.

References

  • Bass C, Halligan P. Lancet. 2014; 383:1422-1432. Accessed 1/4/2021.Factitious disorders and malingering: challenges for clinical assessment and management. (https://pubmed.ncbi.nlm.nih.gov/24612861/)
  • Elder WG, Bennett K. Chapter 55. In: South-Paul JE, Matheny SC, Lewis EL, eds. CURRENT Diagnosis & Treatment in Family Medicine. 3rd ed. New York: McGraw-Hill; 2011.
  • Carnahan KT, Jha A. [Updated 2020 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Accessed 1/4/2021.Factitious Disorder. (https://www.ncbi.nlm.nih.gov/books/NBK557547/)

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