A Fundamental Guide To Factitious Disorder

Factitious disorder - previously known as Munchausen’s syndrome - is a troublesome mental illness recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The afflicted individual deceives others into believing they, or someone else, are ill by appearing sick, injuring themselves or others, or by purposely falling sick. It is not the same thing as telling a lie about being ill to stay home from work or to avoid other obligations. Individuals who have factitious disorder may know they are causing their symptoms, but they may not understand why or recognize the situation as a serious problem.

Types Of Factitious Disorder

There are two major types of factitious disorder: imposed on the self and imposed on another person. Factitious disorder imposed on the self-occurs when the individual in question fabricates or exaggerates symptoms they are personally experiencing, self-injures, and purposely gets themselves sick. Factitious disorder imposed on another person is often called factitious disorder by proxy, formerly known as Munchausen’s syndrome by proxy. 

Individuals with this type fabricate the symptoms on another person in their care, most commonly a mother harming her child to receive attention. Though this is the most common, fathers can be affected, as can individuals working with the elderly or individuals with disabilities, or even pet owners. With factitious disorder by proxy, the diagnosis is not given to the person with the physical symptoms, the victim, but rather the person who is causing them harm.

Symptoms Of Factitious Disorder

Some signs of factitious disorder will vary since different individuals with this condition will mimic the symptoms of various medical conditions. It is also important to note that it is quite difficult to detect symptoms of factitious disorder, as those who have this illness will go to significant lengths to hide their deception, making it difficult for others to realize what is happening. However, typical symptoms of factitious disorder include seeking treatment from multiple places and medical professionals, possibly under a fake name at some locations, and unwillingness to allow doctors to speak with family or other medical professionals. Other signs include frequent hospital stays and few visitors when hospitalized, and the individual exhibiting a reluctance to leave the hospital after treatment. They may also be excited to have risky surgeries or frequent tests or are argumentative with doctors and other hospital staff. 

Individuals with this condition may also possess a vast medical knowledge of medical terms, diseases, and treatments, be inconsistent or have suspiciously vague symptoms, and have numerous surgical scars or other indicators of many medical procedures. The condition(s) they claim to have may worsen for no apparent reason or have an unexpected response to standard treatments. Of course, in cases of factitious disorder by proxy, these symptoms would apply to how the individual inflicts the symptoms on another.

How Those With Factitious Disorder Fake Illnesses

Those who have factitious disorder will work to either exaggerate symptoms of minor illnesses and fabricate symptoms when no illness exists (e.g., fakes stomach pains). As previously discussed, some will also harm themselves deliberately to produce physical symptoms, such as interfering with wound healing, burning their body, and consume medications to produce symptoms. Beyond this, however, there are two other ways individuals with factitious disorder deceive others. 

They may provide false medical history to medical professionals, support groups, and even family and friends. For instance, they may claim to have been seriously ill in the past, such as with cancer, and they may even deliberately attempt to change their medical records to reflect this. Speaking of changing medical records, patients may also tamper with medical instruments and equipment or contaminate medical samples, such as their urine, to produce skewed results.

Causes Of Factitious Disorder

An exact cause of factitious disorder is not known, though research suggests psychological factors and extremely stressful experiences come into play. However, some of the factors that increase an individual’s risk of developing factitious disorder include having suffered a severe illness when growing up or experienced trauma in childhood, such as physical, sexual, or psychological abuse. These individuals may also have poor self-esteem, lost a loved one due to illness or abandonment, possess a heightened desire to be associated with doctors or hospitals, or may be employed in healthcare. Adults who have been previously ill and enjoyed the attention it brought may also be at an increased risk, as are those individuals who suffer from depression or personality disorders.

Potential Complications

Individuals with factitious disorder will continually put their life (or the life of another) at serious risk for doctors and others to see them as sick. Due to this, and since they may also have other mental illnesses, they face serious complications. These include significant injury or death from self-inflicted wounds or medical conditions, substance abuse, significant issues in their personal and professional relationships, as well as infections and other health issues from unnecessary procedures. In cases of factitious disorder by proxy, these complications, save for substance abuse and personal and professional relationship issues, apply to the victim of the individual who has factitious disorder.

Reaching A Diagnosis

Unfortunately, diagnosing factitious disorder is incredibly difficult, given those who have it are quite good at deception, and they may even have real medical conditions, even if they are self-inflicted. However, if a doctor does suspect their patient has factitious disorder, they will go through many processes to reach a final diagnosis. These processes include conducting a detailed interview, obtaining past medical records, speaking with other medical professionals who are treating the same patient, running only the required medical tests, and working with the patient’s family to obtain more information. If not already involved, doctors will often engage a psychiatrist or psychologist into this process, particularly when they cannot find a physical reason for their patient’s symptoms.

Professional Treatment Options

Factitious disorder is hard for doctors to treat, given their patients want to be sick and receive care for those illnesses, and not for the underlying condition causing them to do those things. Due to this, doctors and loved ones must tread carefully when trying to get someone treatment for factitious disorder. This may mean taking a softer approach and not directly accusing them of making things up. It also implies treatment for factitious disorder will shift on a case by case basis.

With this in mind, however, some of the typical treatment strategies for factitious disorder include having one primary doctor oversee and manage the individual’s treatment plan, including reducing visits to other medical professionals such as surgeons and specialists. In many instances, psychotherapy will play a role in treating factitious disorder to help the individual develop coping mechanisms instead of succumbing to the desire to be ill and inflicting pain. Psychotherapy will also address any other potential mental illnesses the patient may have, such as depression or personality disorders. Medication may also be required to treat these additional mental illnesses. In the most severe cases of factitious disorder, a hospital stay in the psychiatric ward may be necessary for the patient's safety and to kickstart treatment.

Lifestyle Treatment Options

Although it will be quite challenging to do, there are some lifestyle adjustments individuals with factitious disorder can make to help their treatment progress. This includes sticking to the treatment plan their doctor gives them, being honest with care providers about the urge to become ill or self-harm, maintaining just one primary doctor who manages all aspects of treatment and confiding with someone outside of the medical profession about the situation. Patients must also remember the very real risk of permanent injury and death if they continue engaging in this type of behavior.

In cases of factitious disorder by proxy, particularly when it is a parent/child relationship, it may be prudent to relinquish the primary caregiving role over the individual at risk while undergoing treatment. In the long run, though difficult to deal with, it will be well worth it.