Factitious Disorder

Factitious Disorder
1. Adoption of physical or psychologogical symptoms (simulated or created)
2. Not motivated by material gain
  1. Motivated instead by desire to play the sick role
  2. Contrast with Malingering with secondary material gain
Munchausen Syndrome
1. Factitious Disorder characterized by habitual hospital presentations for apparent acute illness
2. Patient gives a false, dramatic, but somewhat plausible history
Munchausen Syndrome by Proxy
1. Parent fabricates childhood illness resulting in unnecessary medical evaluation and treatment
Malingering
1. Purposeful feigning of physical symptoms for material gain (e.g. Substance Abuse, worker's comp)

Patient intentionally falsifies physical or psychological signs and symptoms or induces injury or illness
Presents themselves to others as ill, impaired or injured
Deceptive behavior is not connected to external incentive or reward
Behavior not explained by other mental disorder

Common Presentations
1. Cardiovascular symptoms (e.g. Chest Pain, Dizziness, Shortness of Breath, Hypertension)
2. Endocrine symptoms (e.g. Hypoglycemia, Thyrotoxicosis, Cushing Syndrome)
3. Dermatologic symptoms (e.g. generalized skin lesions, or lesions localized to Breast, face, legs)
4. Unusual results (e.g. vey low Body Temperature) in an otherwise healthy appearing patient
Course
1. Protracted illness with episodes of spontaneous remission, or unexplainable worsening
2. When hospitalized, patients may suddenly worsen or develop new symptoms before intended discharge

Somatic Symptom Disorder
1. Unintentional perceived organic symptoms
2. Accepts painful or dangerous procedures
Malingering
1. Purposeful feigning of physical symptoms for material gain (e.g. Substance Abuse, worker's comp)
2. Avoids painful or dangerous procedures
Borderline Personality Disorder
1. Impulsive, self-created injury or illness (intended self harm)
2. Avoids painful or dangerous procedures
Histrionic Personality Disorder
1. Impulsive, simulated injury or illness (with grandiose or theatrical presentation)
2. Avoids painful or dangerous procedures
Illness Anxiety Disorder (Delusional Disorder, Hypochondriasis)
1. Preoccupation with either contracting or having a serious medical disorder
2. Accepts painful or dangerous procedures
Factitious Disorder
1. Adoption of physical or psychologogical symptoms (simulated or created) and not motivated by material gain
2. Seeks painful or dangerous procedures

Approach acute symptom presentations with the same thoroughness for all patients
1. Focus on stabilization of the acute condition and a search for underlying causes
2. Do not let suspicion for Factitious Disorder dissuade appropriate medical care for the given presentation
Factitious Disorder is typically identified after a recurrent pattern of presentations
1. Document in the medical record if suspicious of Factitious Disorder
2. Use non-judgemental terms (in contrast to lying, pretending, malignering)
3. Laboratory testing may be considered to support diagnosis (e.g. Insulin to C-Peptide ratio in Hypoglycemia)
Avoid confronting patients about Factitious Disorder during acute presentations
1. May worsen psychological stress and in some cases precipitate Suicidality
Mental Health referral
1. As with Somatic Symptom Disorder, refer Factitious Disorder to mental health