Psychiatry CDMObjective 6

Objectives

• Describe factitious disorder.• Factitious disorder by proxy.• Differentiate factitious disorder from malingering.• Enumerate other unspecific somatoform disorders.

Factitious Disorder• Factitious disorder is a serious mental disorder in which someone

fakes illness.• Symptoms can range from mild (slight exaggeration of symptoms) to

severe (previously called Munchausen syndrome).

• Causes ?Attention and emotional care, no other intentions.The biological basis are unknown. However, people with this disorder may have experienced a severe illness when they were young or may have been emotionally or physically abused.

• Comorbidity: Many people diagnosed with factitious disorder have comorbid psychiatric problems.

Diagnosis

• Diagnosing factitious disorder is often extremely difficult. People with factitious disorder are experts at faking many different diseases and conditions. And often they do have real and even life-threatening medical conditions, even though these conditions may be self-inflicted.

Signs and symptoms • The person's medical history doesn't make sense• No believable reason exists for the presence of an illness or injury• The illness does not follow the usual course• Frequent hospitalizations• There is a lack of healing for no apparent reason, despite appropriate treatment• Extensive knowledge of medical terms and diseases• Eagerness to have frequent testing or risky operations• Seeking treatment from many different doctors or hospitals, which may include

using a fake name.• There are contradictory or inconsistent symptoms or lab test results• Arguing with hospital staff• Frequent requests for pain relievers or other medications.• The person is caught in the act of lying or causing injury.

Factitious disorder by proxy (FDIA)•AKA factitious disorder imposed on another

•Individuals with this disorder produce or fabricate symptoms of illness in another under their care: children, elderly adults, disabled persons, or pets.

•In this mental illness a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick.

•It is considered as a form of abuse by the American Professional Society of Children Abuse.

•Uncommon, very difficult to diagnose.

Factitious disorder vs Malingering• Secondary gain which may include financial

compensation, avoiding school, work or military service; obtaining drugs; getting lighter criminal sentences.. Etc

• Malingering is not considered a mental illness.

• often is associated with an antisocial personality disorder and histrionic personality disorder.

Other somatoform disorders

• Briquet's syndrome• Pain disorder• Body dysmorphic disorder • Undifferentiated somatoform disorder

References • Kaplan & Sadock's clinical psychiatry, 3rd edition.• Emedicine.com