Patients with
this disorder knowingly fake symptoms, but do so for psychological
reasons not for monetary or other discrete objectives as in the
case of Malingering. They usually
prefer the sick role and may move from hospital to hospital in
order to receive care. They are usually loners with an early childhood
background of trauma and deprivation. They are unable to establish
close interpersonal relationships and generally have severe personality
disorders. Unlike many malingerers,
they follow through with medical procedures and are at risk for
drug addiction and for the complications of multiple operations
In the more
severe form known as Münchhausen
syndrome, a series of successive hospitalizations becomes
a lifelong pattern. Factitious disorder is distinguished from
malingering where there is external
motivation for the symptom production, a patient with a factitious
disorder intentionally produces physical symptoms without external
incentives.
Associated
Features:
History
of Suicide Attempts and/or Depression
History of Multiple Medical Procedures
Adjustment Disorder
Substance
Abuse
Dysthymic Disorder
Somatoform Disorder
Borderline
Personality Disorder
Differential
Diagnosis:
Some disorders have similar symptoms. The clinician, therefore,
in his diagnostic attempt has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis
.Most important differential diagnoses are with:
Genuine
Psychiatric Pathology
Malingering
Somatoform Disorders.
Cause:
Little is
currently known about the etiology or psychopathology of factitious
disorders with physical or psychological symptoms. Besides the
difficulties involving the diagnosis, reluctance of those patients
to undergone psychological testing and heterogeneity in details
of cases published in literature are at the origin of this situation.
Many hypotheses have tried try to explain factitious
disorder. Some clinicians have remarked that patients with
factitious disorder often present traumatic events, particularly
abuse and deprivation and numerous hospitalizations in childhood
and as adults lack support from relatives and/or friends. Because
of that, they consider that hospitalization is unconsciously used
to recreate the desired parent-child bond they lacked in reality.
Other clinicians consider that factitious disorder allows patients
to feel in control as they never felt in childhood.
From a behavioral point of view factitious disorder is regarded
as a coping mechanism, learned and reinforced in childhood.
Treatment:
Essential and probably most difficult step is to secure an enduring
and stable patient-physician relationship. For achieving this
goal most clinicians advocate a non-confrontational strategy reframing
the factitious manifestation as a "cry for help".
An interesting approach is that of "contract conference".
In this approach the psychiatrist emphasize the need for the patient
to express him/herself in the common language of difficult relationships,
feelings and problems in living instead of the (factitious) language
of illness. After that patient and clinician can
focus their efforts on resolving those real problems.
Once a stable relationship installed the management of the disorder
must be oriented to avoid unnecessary hospitalizations and medical
acts.
An important goal of management of this condition is recognition
and adequate treatment of concurrent disorders (such as personality
disorders, depression, drug and/or alcohol abuse and dependence
etc.).
Counseling
and Psychotherapy [ See
Therapy Section ]:
Overall
the results of therapy are not encouraging therefore treatment
should be based on focusing on the management of the disorder
rather than on cure". Both analytical
and cognitive-behavioral approaches have been used to deal with
factitious disorder, with some benefit, in patients who accepted
to engage in such therapies.
Pharmacotherapy
[ See Psychopharmacology
Section ] :
Some
case reports focus on the use of pharmacological agents in the
treatment of factitious disorder. A good response have been reported
to antipsychotic drugs (Pimozide) other clinicians, because of
resemblance to OCDs and/or because the impulsive nature of the
disorder advocate the use of SSRIs.
