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Factitious Disorder
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Also known as Munchausen Syndrome

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.

 


DSM Code

300.19 Factitious Disorder Not Otherwise Specified

F68.1 Factitious Disorder

Disorder Sheets

Mind (UK)
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London E15 4BQ
Tel : +442085192122
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Recommended Book

Munchausen's Syndrome by Proxy: Current Issues in Assessment, Treatment and Research - Click Here to View

 

Factitious Disorder Also known as Munchausen Syndrome

Misc Information

 

Factitious Disorder's