Aetiology
No specific underlying cause has been identified for factitious disorder. It is likely to have a multi-factorial aetiology. In prototypical cases, there are no external motivators for engaging in factitious illness behaviour. Internal motivations may not be clear, either to the patient or to the physician. Proposed motivations include:[3]
The need to be the centre of attention
A longing to be cared for
Maladaptive response to loss or separation
Anger at physicians, or anger displaced onto physicians
Pleasure derived from deceiving others (duping delight).
Some researchers have suggested the possibility of an underlying cognitive dysfunction, and others have reported changes in neuroimaging.[7][8] However, the evidence is limited.
Pathophysiology
There is no known specific pathophysiology for factitious disorders.
Classification
DSM-5-TR subtypes of factitious disorder[1]
Factitious disorder imposed on self
Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.
The individual presents himself or herself to others as ill, impaired, or injured.
The deceptive behaviour is evident even in the absence of obvious external rewards.
The behaviour is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.
Factitious disorder imposed on another (previously factitious disorder by proxy)
Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception.
The individual presents another individual (victim) to others as ill, impaired, or injured.
The deceptive behaviour is evident even in the absence of obvious external rewards.
The behaviour is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.
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