Summary
Definition
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 behaviour.[1] The psychiatric nomenclature distinguishes factitious disorder from several related disorders by both the intentionality of the behaviour and its motivation. Symptoms produced without conscious intent are considered to be 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 to be malingering.
Distinguishing factitious disorder from related conditions can be a difficult task, particularly because they can sometimes co-exist in the same patient.[Figure caption and citation for the preceding image starts]: Distinguishing factitious disorder from related conditionsFrom the personal collection of Christopher P. Kogut, Virginia Commonwealth University, VA [Citation ends].
History and exam
Key diagnostic factors
- presence of risk 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 (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)
Diagnostic investigations
Investigations to consider
- cultures (e.g., blood or wound)
- serum C-peptide
- urine sulphonylureas
- urine electrolytes
- urine protein
- serum thyroglobulin
Treatment algorithm
Contributors
Authors
James L. Levenson, MD
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.
Acknowledgements
Prof Levenson would like to gratefully acknowledge Prof Christopher P. Kogut, a previous contributor to this topic.
Disclosures
CPK declares that he has no competing interests.
Peer reviewers
Tanveer Padder,
Consulting Psychiatrist
Padder Health Services
Laurel
MD
Disclosures
TP declares that he has no competing interests.
Marc Feldman,
Clinical Professor of Psychiatry
University of Alabama
Tuscaloosa
AL
Disclosures
MF receives royalties for two books on the subjects covered in this topic (Routledge publishing and American Psychiatric Publishing). He is also an author of references cited in this topic.
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