Factitious Disorders

"Factitious" literally means "contrived," and the meaning could hardly be more apt. People with factitious disorder are great con men or con women, although what they obtain through their conning most people would far rather not have. They fake either mental disorders or physical disorders - two specific types of factitious disorder - or a mixture of the two, which qualifies them for the third classification, Facititious Disorder With Combined Psychological and Physical Signs and Symptoms. Finally, there is the usual "Not Otherwise Specified" category, which includes people who concoct symptoms in others, typically children, so that the concocter can assume the sick role by proxy.

People with Factitious Disorder (FD) are not pretending to be sick in order to gain benefits external to the disorder, for example, to get insurance money. Thus they differ from malingerers, who are dishonest but do not have a mental disorder. People with FD are such expert liars that the syndrome has been called "Munchausen syndrome" in honor of a German baron who was a famous liar. In this respect FD patients share characteristics with people who have Antisocial Personality Disorder.

People with FD are willing and eager to pay for their symptoms by having unnecessary tests, treatments, and operations. They may become expert in producing the symptoms of disorders, expert enough in many cases to con physicians and surgeons into treating them or operating on them for nonexistent maladies, or mental health professionals into treating them for imaginary disorders. The person with FD thus appears to the outsider to share characteristics with masochists, in that they arrange to cause pain to themselves. Maxmen and Ward¹ report that one person with FD had over 420 documented hospitalizations. Further, they note that the state of Washington saved $100,000 per patient per year by installing a tracking system that identified patients with FD and prevented them from being repeatedly admitted to hospitals for treatment.

Patients with FD vehemently deny that they are faking symptoms, and they do not seek, or willingly accept, treatment from mental health professionals. Nevertheless, Maxmen and Ward¹  warn examiners not to assume that there are no physical problems co-occurring with the FD. Also, they suggest that the patients be kept in the hospital and placed in long-term treatment with a mental health professional, despite the small likelihood that the FD will be cured. If a child is being victimized by a parent who concocts symptoms for the child, the child should be protected through admission to the hospital.  In these cases, the diagnosis given to the parent is Munchausen Syndrome by Proxy, a type of child abuse.

Read a book on the subject:

Patient or Pretender:  Inside the Strange World of Factitious Disorders by Marc D. Feldman, Charles V. Ford

Go to an excellent web site to learn more about FD and Munchausen Syndrome by Proxy.

                                                                                                                                Last updated  12/19/03