Description

• A disorder in which the patient fakes signs or symptoms without tangible personal benefit other than to experience the sick role
• Referred to as factitious disorder in the DSM-5
• The nature of the disorder resists rigorous study and prevalence is unknown but possible risk factors include:
  • Males
  • Unmarried
  • Age in the thirties/forties
  • Personality disorder
  • A history of sadistic and rejecting parents
  • A history of chronic childhood illness
  • A history of employment in the medical field

Etiology

• Factitious disorder:
  • DSM-5 diagnostic criteria:
    • Intentional production of physical or psychological signs associated with deception
    • Patients presents as ill, impaired, or injured
    • Absence of external incentives
    • The behavior is not better explained by another mental disorder
• Onset is usually early adulthood often after hospitalization for a mental disorder or medical condition
• Clinical clusters:
  • Self-induced infection
  • Simulated specific illnesses with no actual disorder
  • Chronic wounds
  • Self-medication

• Munchausen by proxy (Factitious Disorder Imposed on Another):
  • The patient's illness is caused by the caregiver, not the patient
  • The motivation for the caregiver's behavior is to assume the sick role by proxy
  • The caregiver inflicts injury or induces illness in their charge, usually a child
  • Commonly parents (mostly mothers)
• May simulate injury and disease in a number of ways:
  • Inflicts injury
  • Induces Illness
  • Fabricates symptoms
  • Exaggerates symptoms of the child's illness causing overaggressive medical interventions
• The perpetrator usually refuses to acknowledge the deception
• Cessation of the symptoms when the patient and caregiver are separated