Factitious Disorders
Definition
Factitious disorders are a group of mental disturbances in which patients intentionally act physically or mentally ill without obvious benefits. The name factitious comes from a Latin word that means artificial. These disorders are not malingering, which is defined as pretending illness when the "patient" has a clear motive, such as financial gain.
Description
Patients with factitious disorders produce or exaggerate the symptoms of a physical or mental illness by a variety of methods, including contaminating urine samples with blood, taking hallucinogens, injecting themselves with bacteria to produce infections, and other similar behaviors.
There are no reliable statistics on the frequency of factitious disorders, but they are more common in men than in women. The following conditions are sometimes classified as factitious disorders:
Munchausen syndrome
Munchausen syndrome refers to patients whose factitious symptoms are dramatized and exaggerated.
Many persons with Munchausen go so far as to undergo major surgery repeatedly, and, to avoid detection, at several locations. Many have been employed in hospitals or in health care professions. The syndrome's onset is in early adulthood.
Munchausen by proxy
Munchausen by proxy is the name given to factitious disorders in children produced by parents or other caregivers. The parent may falsify the child's medical history or tamper with laboratory tests in order to make the child appear sick. Occasionally, they may actually injure the child to assure that the child will be treated.
Ganser's syndrome
Ganser's syndrome is an unusual dissociative reaction to extreme stress in which the patient gives absurd or silly answers to simple questions. It has sometimes been labeled as psychiatric malingering, but is more often classified as a factitious disorder.
Causes and symptoms
No single explanation of factitious disorders covers all cases. These disorders are variously attributed to underlying personality disorders; child abuse; the wish to repeat a satisfying childhood relationship with a doctor; and the desire to deceive or test authority figures. Also, the wish to assume the role of patient and be cared for is involved. In many cases, the suffering of a major personal loss has been implicated.
The following are regarded as indications of a factitious disorder:
- dramatic but inconsistent medical history
- extensive knowledge of medicine and/or hospitals
- negative test results followed by further symptom development
- symptoms that occur only when the patient is not being observed
- few visitors
- arguments with hospital staff or similar acting-out behaviors
- eagerness to undergo operations and other procedures
When patients with factitious disorders are confronted, they usually deny that their symptoms are intentional. They may become angry and leave the hospital. In many cases they enter another hospital, which has led to the nickname "hospital hoboes."
