From the Research
Factitious disorder is a serious mental health condition where individuals deliberately create, exaggerate, or induce physical or psychological symptoms to assume the sick role and receive medical attention, often driven by complex psychological needs rooted in childhood trauma or neglect, as noted in the most recent study 1.
Definition and Characteristics
Factitious disorder is characterized by the intentional production or feigning of physical or psychological symptoms, without any obvious external reward, as highlighted in 2 and 3. This behavior can lead to multiple hospitalizations, unnecessary diagnostic workups, and invasive procedures, resulting in potential harm to the patient.
Diagnosis and Differential Diagnosis
Differential diagnoses that should be ruled out include malingering, somatic symptom disorder, and anxiety disorders, as mentioned in 2. The diagnosis of factitious disorder can be challenging, and a comprehensive evaluation of the patient's history, behavior, and motivations is necessary.
Treatment and Management
Treatment typically involves a multidisciplinary approach, including psychiatric care with cognitive behavioral therapy (CBT) and sometimes selective serotonin reuptake inhibitors (SSRIs), as recommended in 4. Management should focus on establishing a consistent therapeutic relationship, rather than confronting the patient about deception, as emphasized in 3. Healthcare providers should maintain regular appointments, avoid unnecessary procedures, and coordinate care among all providers to prevent "doctor shopping."
Psychological Needs and Underlying Causes
The disorder stems from complex psychological needs, often rooted in childhood trauma or neglect, where medical attention provides emotional validation the person cannot otherwise obtain, as discussed in 1 and 5. Unlike malingering, patients with factitious disorder are not seeking external rewards like financial gain but are driven by psychological needs to adopt the sick role.
Prevalence of Depression and Risk Factors
Depression is highly prevalent in factitious disorder, affecting around 30% of the samples, as found in the systematic review 4. Risk factors for depression in factitious disorder include having suffered from childhood and adulthood traumatic experiences and having a history of psychosocial problems. Therefore, it is essential to screen for depression once a factitious disorder is diagnosed.