Summary
Definition
Factitious disorder is a syndrome in which signs and/or symptoms of disease are intentionally feigned or exaggerated by a patient when there is no clear external incentive for the behavior.
[1]
The psychiatric nomenclature distinguishes factitious disorder from several related disorders by both the intentionality of the behavior and its motivation. Symptoms produced without conscious intent are considered a somatoform disorder. Symptoms intentionally feigned or created for some external reward, such as getting out of jail or obtaining unneeded pain medication, are considered malingering.
[Figure caption and citation for the preceding image starts]:
Distinguishing factitious disorder from related conditions
From the personal collection of Christopher P. Kogut, Virginia Commonwealth University, VA
[Citation ends].
History and exam
Key diagnostic factors
- history of unexplained complaints or inconsistency over time
- unusual presentation relative to demographics
Other diagnostic factors
- symptoms more exaggerated while aware of being observed
- presentation for care at many different hospitals
- eyewitness evidence of the patient manipulating findings
- dramatic history of travel and acute illness (Munchausen subtype)
- multiple abdominal scars (Munchausen subtype)
- medications or medical paraphernalia found in an unusual location in a patient's room
Risk factors
- female sex (common-variety factitious disorder)
- medically related employment (common-variety factitious disorder)
- cluster B personality characteristics (common-variety factitious disorder)
- male sex (Munchausen subtype)
- single marital status (Munchausen subtype)
- age 40 to 50 years (Munchausen subtype)
- antisocial personality traits (Munchausen subtype)
Diagnostic investigations
Investigations to consider
- cultures (e.g., blood or wound)
- serum C-peptide
- urine sulfonylureas
- urine electrolytes
- urine protein
- serum thyroglobulin
Treatment algorithm
Contributors
Authors VIEW ALL
Assistant Professor
Department of Psychiatry
Virginia Commonwealth University
Richmond
VA
Disclosures
CPK declares that he has no competing interests.
Professor of Psychiatry
Internal Medicine and Surgery
Vice-Chair
Department of Psychiatry
Chair
Division of Consultation/Liaison Psychiatry
Virginia Commonwealth University
Richmond
VA
Disclosures
JLL is the author of a reference cited in this topic.
Peer reviewers VIEW ALL
Professor
Department of Psychiatry
University of New Mexico School of Medicine
Albuquerque
NM
Disclosures
JY is an author of a reference cited in this topic.
Consultant Psychiatrist
The London Medical Centre
London
UK
Disclosures
AR declares that she has no competing interests.
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