Factitious disorder

Background

• The falsification of medical or psychological signs and symptoms in oneself or others that are associated with the identified deception, absent of obvious external rewards
• Includes:
  • Munchausen syndrome
  • Psychogenic seizures
  • 20% of patients in epilepsy clinics
  • 3.5% of kidney stone patients

Clinical Features

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 behavior is evident even in the absence of obvious external rewards.
• The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Factitious Disorder Imposed on Another

• Falsification of physical or psychological signs or symptoms, or induction of injury or disease, on another, associated with identified deception.
• The individual presents another individual (victim) to others as ill, impaired, or injured.
• The deceptive behavior is evident even in the absence of obvious external rewards.
• The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Differential Diagnosis

• Somatic symptom disorder
• Malingering
• Conversion disorder
• Borderline personality disorder
• Medical condition or mental disorder not associated with intentional symptom falsification

Evaluation

• Difficult to diagnose, as often a diagnosis of exclusion. Refer to the patient's medical record for indication of repeated visits, recurrent testing, or multiple identities.

Management

• Close outpatient psychotherapy focused on establishing and maintaining a relationship with the patient.

Disposition

• Discharge