health

1. Definition .
   
2. What Is Factitious Disorder?
3. What Characterizes People Who Have Factitious Disorders?
4. How Do Doctors Diagnose and Treat Factitious Disorder?
5. Can Factitious Disorder Be Prevented?

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Factitious disorder is a psychiatric condition in which an individual
deliberately produces or falsifies symptoms of an illness for the sole purpose
of assuming the role of a patient. Individuals with factitious disorder want
to be under medical care, perhaps to obtain attention, care, or nurture.
Generally this disorder signifies a very serious unmet psychological need or
psychological trauma.

Anjali’s Story

Anjali needed extra hours of volunteering at the hospital to fulfill her high
school community service obligation. For some reason, this year there
was less demand for the volunteers than in previous years. Therefore, she
found herself serving at a third hospital in as many months when most
students could expect to stay at one hospital the entire year. In many
ways the hospitals were similar, but every difference in this new hospital
reminded her that she wanted a “home” site. While she was thinking this,
she felt relieved to see a familiar face. She saw someone she knew being
pushed in a wheelchair by a nurse. Deanna had been a patient at Anjali’s
first hospital.
One night when Anjali was on duty, Deanna wanted someone to talk
to, and Anjali spent some time with her. Deanna told her all about her
illness. It was a strange one that the doctors did not understand. The day
that Deanna was released, Anjali overheard some nurses commenting that
her illness was not so serious and that she would be all right.
Now, Anjali was wondering why Deanna was back in the hospital.
“Hi, Deanna!” she called out, but Deanna did not respond. “Do you
remember me?”
Deanna looked a bit shocked to recognize Anjali, but muttered “Oh,
hello.”
“Are you all right?” Anjali asked.
“Yes,” said Deanna. “I just had a relapse.”
The nurse pushing Deanna’s wheelchair had a quizzical smile.
“Relapse? You mean you have had this before? You should have told
the ER doctor.”
“Oh, well, that time was not as bad as this time,” Deanna replied
After the nurse settled Deanna in her hospital room, Anjali asked the
nurse. “Is she all right?”
“Yes,” said the nurse. “She thinks she has some form of exotic infection.
The doctor thinks she has Munchausen syndrome.” Anjali had to look up
the term. She found it is the most common factitious disorder.

Factitious disorder is when a person seeks medical treatment for a falsified
condition. The person with a factitious disorder visits the doctor persistently
complaining of different symptoms of illnesses. The doctor can find
no physical or mental condition associated with the symptoms. There
is no external reward for faking an illness such as collecting workman’s
compensation or escaping some stressful situation. The main motivation
appears to be the desire to be treated as a sick person.
Underlying motives distinguish factitious disorder from malingering.
Someone who is malingering is seeking immediate external reward by faking
a sickness. The motivation may include absence from work, avoidance of
responsibility, receiving financial compensation, or obtaining prescription
drugs. The main focus in handling malingering has been on how to detect
the malingerer. The goal has been to prevent unfair worker’s compensation,
escape from military service, and unnecessary medical expenses.
Factitious disorder is also distinguished from conversion disorder.
With conversion disorder, afflicted persons actually believe they have the
physical symptoms. Patients may actually appear to have the symptoms,
but the cause is psychological, not physical, relating to internal conflict or
external stressors. Conversion disorder may be the result of dissociation,
characterized by a disconnection between past and present, lack of identity,
no immediate sensations, and loss of control of the body. Dissociation is
caused by trauma, extreme problems, or harmful relationships.
Factitious disorder is the name for any self-induced disease. The symptoms
are voluntarily controlled. There is a conscious awareness on the part of the
deceiver. There is evidence of internal compulsion. The person appears to be
unable to control the urge to adopt the symptoms. Additionally, the person
seems to maintain the illness because of psychological stressors. The person
with factitious disorder needs help from a mental health professional because
the feigned illness can do considerable, even irreparable damage to the health
of the afflicted person. The three most common types of factitious disorder
are Munchausen syndrome, Munchausen by proxy, and Gansen syndrome.
Factitious disorder is a continuum based on the seriousness of the
symptoms and the intensity with which the afflicted person is looking
for medical attention. However, nowhere on this continuum is there any
observable extrinsic incentive for the behavior. It is important to note that
people afflicted with factitious disorder have the goal of being sick; they
want to be sick even when there is no one around to impress.
Depending on the persistence, strength, and danger of the deceit,
individual cases of the syndrome may be considered mild to severe. If the
symptoms and the portrayal of the afflicted do not change their life much,
then the disorder is considered mild. However, if the afflicted people
are persistent to the point of enduring very painful symptoms, financial
difficulties, and lifestyle disruptions, then the disorder is considered
severe. On the severe end of the continuum is Munchausen syndrome
named in 1951 by British doctor Richard Asher based on the popular
perception of Baron Freiherr von Münchhausen, who exaggerated his
exploits in the Russian-Turkish war. Munchausen syndrome involves
reporting the symptoms of physical illnesses. Another less common
disorder is Gansen syndrome, which involves reporting the symptoms of
psychological illnesses.

Munchausen syndrome Munchausen syndrome is the most common
factitious disorder. The symptoms reported are from physical maladies.
These symptoms may be naturally occurring, but they are exaggerated
or made worse by the afflicted. However, the symptoms may also be selfinflicted.
The afflicted is willing to receive treatments for the feigned
physical ailments but is usually resistant to treatment for the psychological
disorder.

Gansen syndrome Gansen syndrome is the factitious disorder
in which symptoms of psychological disorders such as dementia
or schizophrenia are mimicked. Gansen syndrome is very rare and has
mostly been reported in prison populations. One of the characteristics of
Gansen syndrome is the response of “approximate answers.” The patient
gives logically ridiculous answers to simple questions but responds with
a number to a question requiring a number answer or with a color to a
question requiring a color answer. It is listed in the Diagnostic and Statistical
Manual of Mental Disorders, fourth edition (DSM-IV) as a dissociative
disorder; however, it is so rare that the true cause, whether dissociative or
factitious, may not be known.

Munchausen by proxy Munchausen by proxy was named in 1977 by
British pediatrician Roy Meadows, who is credited with its discovery. It is
a form of caregiver abuse of children or dependent others. Munchausen by
proxy most often occurs in a mother seeking medical treatment for a child
with a feigned illness. In this case, the mother has the disorder and tries to
receive attention for being the mother of a sick child. Although the mother
faking illness in her child is the most common scenario, Munchausen by
proxy could affect a father faking illness in his child or any individual in the
position of caregiver who seeks medical help for the person in their care when
the illness is feigned. In any scenario, Munchausen by proxy is purposeful,
abusive behavior toward the individual receiving care by the caregiver. The
only cause for it is the mental disturbance of the perpetrator.
The characteristics include the parent constantly seeking medical
attention for the child, always presenting the child to the doctors as
weak and sickly, vulnerable to a number of ailments. The parent with
this disorder will allow the child to go through any number of physical
examinations, even the most intrusive and uncomfortable. If the parent
gets hold of the laboratory reports, the parent will tend to reach separate
judgments from them. If the doctor tells the parent that there is nothing
wrong with the child, the parent will not accept the doctor’s conclusion.
The typical behavior of the parent in receiving the doctor’s conclusion
is to selectively hear the doctor’s report, focusing on the small phrases
that could support the parent’s contention that the child is seriously ill.
Otherwise, the parent might argue with the doctor, find another doctor,
or not acknowledge hearing anything that the doctor said. Always the
parent acts like a responsible, caring parent.
As with the other factitious disorders, there is no extrinsic incentive
for this pretense to either the afflicted caregiver or the person in his or her
care. Also, as with the other factitious disorders, Munchausen by proxy
can range in the degree of severity. On the mild end, a mother may be
only exaggerating symptoms that currently naturally exist in the child.
On the severe end, a parent may be actually causing the child to be sick
or injured. This may be done by giving the child something toxic to eat
or by ignoring the treatment prescribed by the doctor.
The motivations for Munchausen by proxy vary. While the most common
motivations are pathological, there are cases in which the mother is
extremely stressed by her responsibilities, and her deceit is her way of making
a desperate plea for help. When this is the motivation, she is relieved
to be discovered, and therapy involves education in the areas in which she
feels most vulnerable. There are also parents who are micromanagers of
their children’s health. These individuals might try to second-guess the
doctor’s advice, seek out the opinions of other doctors, and meticulously
monitor the child’s progress. While this behavior may be extreme and
obstructive to the child’s therapeutic relationship with the doctor, it is not
factitious or pathological.
There are two general pathological motivations for this behavior. The
first is an obsession with obtaining medical treatment, which is commonly
referred to as a “doctor addiction”. The perpetrator is more likely to
exaggerate an existing illness than to actually bring on some malady in
the child.
The second pathological motivation is more common and more
dangerous. The parent is trying to gain a sense of power by deceiving the
doctors who are perceived as highly trained and intelligent. The parent
also finds a sense of esteem in the role of a parent of a sick child. These
parents are more likely to actively induce sickness in their children. This
is the most serious level of Munchausen by proxy. When a physician in
good faith suspects a case of Munchhausen by proxy towards a child,
the doctor is obligated to contact child protection authorities, since
the health of that child may be in danger. This behavior of the parent
may be life-threatening to the child. However, such accusations are
hard to prove and require constant monitoring. When the perpetrator
of Munchausen by proxy is found out, psychological interventions have
limited success.

It is difficult to develop a typical profile for someone with a factitious disorder
because the reported cases are so few. An early study of Munchausen syndrome
found more women than men tended to have the disorder. The afflicted was
usually a young woman with poor psychosocial development. For most of
her life, she had been dependent on her mother, but her dependency needs
remained unfulfilled. She tended to have very little emotional support from
her father and her verbal skills were poor. This pattern implies that she is
looking to fulfill unmet needs but does not have the social skills necessary
to seek them in direct, adaptive manners. Gansen syndrome mostly afflicts
men, but this finding may be based on the prison context of most studies.
Most of those afflicted with Munchausen by proxy are young mothers.

Factitious disorders are very difficult to diagnose and treat. Because of
the persistent deceit on the part of the afflicted, it is not easy for the
doctor to determine what the problem actually is. The doctor must first
rule out the possibility that the symptoms are real. If a factitious disorder
is suspected, the doctor must determine how well the patient is familiar
with the disease being faked. The patient may know the symptoms but
not their proper order. If the patient then reports something unusual,
such as the symptoms appearing in the wrong sequence, then the doctor
may be cued that the patient does not really have the illness.
A complete diagnosis should involve a careful reading of the medical
records for any inconsistencies or abnormalities. The doctor should also
interview friends and family. Because the factitious disorder patient is
not trying to get well, there should be some system of monitoring the
patient’s compliance with treatment.
Treatment is not easy because the causes of these disorders usually
signify deep psychological problems, likely an underlying personality disorder.
The mental health professional offering therapy has to be careful at
first to develop a supportive relationship with the afflicted. There should
be no early confrontation regarding the patient’s lies except in a crisis
situation. Therapy can follow a conventional pattern after the rapport has
been established. However, the therapist has to be constantly aware that
the patient has a weak ego and low self esteem.

As of 2009, there were no preventative measures. In most mental health
issues, the person’s family should be able to notice behavioral irregularities
and provide the necessary support. However, if early studies of
Munchausen syndrome are correct, afflicted individuals often do not
have family support. Gansen syndrome did not appear to be preventable
either.