From the Guidelines
Factitious disorder is a serious mental health condition characterized by the intentional creation or exaggeration of physical or psychological symptoms, without an obvious external benefit, and it significantly impairs psychosocial functioning. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, as discussed in the study by 1, factitious disorder is one of the seven distinct somatic symptom and related disorders, which also include somatic symptom disorder, illness anxiety disorder, and conversion disorder. The key distinction between factitious disorder and other somatic symptom disorders is the intentional production of symptoms, which is not driven by material gain but rather by psychological needs 1.
Key Characteristics
- Intentional creation or exaggeration of symptoms
- No obvious external benefit, such as financial gain
- Significant impairment in psychosocial functioning
- Differs from malingering, which is driven by external benefits
Diagnosis and Treatment
Diagnosing factitious disorder can be challenging due to the deceptive nature of the condition, as patients may have sophisticated medical knowledge and frequently change healthcare providers 1. Treatment primarily involves psychotherapy, with a focus on cognitive-behavioral therapy to address underlying emotional needs and develop healthier coping mechanisms. While there are no specific medications for factitious disorder itself, medications may be prescribed for co-occurring conditions like depression or anxiety. A compassionate, non-confrontational approach is recommended, as direct accusations can lead to denial and treatment abandonment.
Epidemiology and Impact
Somatic symptom and related disorders, including factitious disorder, are common and contribute significantly to healthcare usage and costs, with epidemiologic studies indicating that between 10% and 15% of adult primary care patients have one of these disorders 1. In children and adolescents, symptoms like recurrent abdominal pain and headaches are frequent, accounting for a significant portion of pediatric office visits. Recognizing and appropriately managing these conditions, including factitious disorder, is crucial for reducing healthcare costs and improving patient outcomes.
From the Research
Definition and Presentation of Factitious Disorder
- Factitious disorder is a psychiatric condition where patients intentionally produce symptoms to assume the sick role, resulting in multiple hospitalizations, unnecessary diagnostic workups, and invasive procedures 2.
- The disorder can present in various healthcare settings, with patients fabricating illness, injury, or impairment for psychological reasons, leading to the misapplication of medical resources 3.
- Patients with factitious disorder may exhibit a range of symptoms, including induced disease or injury, with induced skin injury being a common presentation 4.
Diagnostic Issues and Differential Diagnoses
- Differential diagnoses that should be ruled out include malingering, somatic symptom disorder, and anxiety disorders 2.
- Factitious disorder can be challenging to diagnose, and deriving systematic information about the illness is a major challenge 5.
- A systematic review of 455 cases in the professional literature found that patients with factitious disorder were most likely to present with endocrinological, cardiological, and dermatological problems 3.
Treatment and Management
- Confrontation and psychotherapy with a multidisciplinary team have been proposed as a form of treatment for factitious disorder 2.
- Dialectical behavior therapy (DBT) has been successfully employed in the treatment of a patient with factitious disorder, with the patient's own notations facilitating a concise planning of therapy and its successful progression 6.
- Counseling and psychotherapy were only offered to a small proportion of patients in one study, highlighting the need for better awareness and professional training in the identification and management of factitious disorder 4.
Epidemiology and Demographics
- Factitious disorder is a rare psychiatric condition that can affect patients of all age groups, with a male predominance observed in one study 4.
- A systematic review of 455 cases found that 66.2% of patients were female, with a mean age at presentation of 34.2 years, and a healthcare or laboratory profession being the most frequently reported occupation 3.
- Comorbid psychopathology, including depression and personality disorder, is common among patients with factitious disorder, with a current or past diagnosis of depression being more frequently reported than personality disorder 3.