Factitious disorders are uncommon disorders in which the patient intentionally fabricates physical or psychological symptoms primarily for the purpose of deceiving healthcare providers and/or others.
Patients are motivated primarily by a desire to assume the sick role rather than by the hope to achieve external rewards.
Munchausen syndrome is an extreme form.
Factitious disorder imposed on another (previously factitious disorder by proxy) describes the clinical scenario wherein the patient feigns or induces signs or symptoms of illness in another person who is under the patient's care, when there are no clear external incentives. It is a potentially lethal form of abuse, as patients may inadvertently induce coma or death by giving medications to simulate disease.
Systematic evidence for directing treatment is lacking.
Factitious disorder is a syndrome in which signs and/or symptoms of disease are intentionally feigned, exaggerated, or self-induced by a patient when there is no clear principal external incentive for the behavior. 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 somatic symptom disorder. Symptoms intentionally feigned or created for some external reward, such as getting out of jail or obtaining unneeded pain medication, are considered malingering.
Distinguishing factitious disorder from related conditions can be a difficult task, particularly because they can sometimes co-exist in the same patient.
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
- female sex (factitious disorder)
- medically related employment (factitious disorder)
- cluster B personality characteristics (factitious disorder)
- male sex (Munchausen subtype)
- single marital status (Munchausen subtype)
- age 40 to 50 years (Munchausen subtype)
- antisocial personality traits (Munchausen subtype)
1st investigations to order
- clinical history and exam
Investigations to consider
- cultures (e.g., blood or wound)
- serum C-peptide
- urine sulfonylureas
- urine electrolytes
- urine protein
- serum thyroglobulin
suspected factitious disorder
- Somatic symptom and related disorders
- Organic disease
- Assessment and management of adults and children in cases of fabricated or induced illness
- Munchausen by proxy: clinical and case management guidance
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