HISTORYThe condition was mentioned by Galen in the second century.
RICHARD ASHER The modern history of factitious disorder began in 1951 when Richard Asher described patients who seek hospital admission through feigned symptoms.Asher classified the profiles of most factitious patients into:-abdominal ("laparotomophilia migrans")-hemorrhagic ("hemorrhagica histrionica")-neurologic ("neurologica diabolica").
DISEASE LABELS:"hospital hoboes""hospital addicts""polysurgery addicts""professional patients,""pathomimes" ["hospital vagrants""partial suicide," (a compromise behavior designed unconsciously) to forestall total self-destruction )
DEFINITIONFactitious disorder refers to the psychiatric condition in which a patient deliberately produces or falsifies symptoms of illness for the sole purpose of assuming the sick role.According to one estimate, the unnecessary tests and waste of other medical resources caused by FD cost the United States $40 million per year.The name factitious comes from a Latin word that means "artificial" or "contrived."
GANSER SYNDROMEGanser syndrome is a rare dissociative disorder previously classified as a factitious disorder.It is characterized by nonsensical or wrong answers to questions or doing things incorrectly, other dissociative symptoms such as fugue, amnesia or conversion disorder, often with visual pseudohallucinations and a decreased state of consciousness.It is also sometimes called nonsense syndrome.The syndrome occurs mainly among prisoners and is characterized by feigned, wrong answers to the questions asked or doing incorrect things.
PSEUDOLOGIA FANTASTICAPseudologia fantastica, mythomania, or pathological lying are three of several terms applied by psychiatrists to the behavior of habitual or compulsive lying.It was first described in the medical literature in 1891 by Anton Delbrueck
MÜNCHHAUSEN SYNDROME Münchausen syndrome is a factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention or sympathy to themselves. There is discussion to reclassify them as somatoform disorder in the DSM-5 as it is unclear whether or not people are conscious of drawing attention to themselvesBaron Munchausen
CLASSIFICATION■With predominantly psychological signs and symptoms■With predominantly physical signs and symptoms■With combined physical and psychological signs and symptoms
CAUSESThe causes of factitious disorder, whether physical or psychiatric, are difficult to determine because these patients are often lost to follow-up when they sign out of the hospital.
PSYCHODYNAMIC EXPLANATIONSPatients with FD are trying to re-enact unresolved childhood issues with parents.They have underlying problems with masochism.They need to be the center of attention and feel important.They need to receive care and nurturance.They are bothered by feelings of vulnerability.Deceiving a physician allows them to feel superior to an authority figure.
RISK FACTORSThere are several known risk factors for factitious disorder, including:The presence of other mental or physical disorders in childhood that resulted in the patients getting considerable medical attention.A history of significant past relationships with doctors, or of grudges against them.Present diagnosis of borderline, narcissistic, or antisocial personality disorder.
PREDISPOSING FACTORSThe presence of other mental disorders or general medical conditions during childhood or adolescence that may have led to extensive medical treatment and hospitalization;Family disruption or emotional and/or physical abuse in childhood;A grudge against the medical profession; employment in a medically- related position;Presence of a severe personality disorder (Feldman, 2004).
DEMOGRAPHICS Some researchers have suggested that patients with factitious disorder often present in childhood with traumatic events, such as abuse and deprivation, as well as numerous hospitalizations; As adults, they lack support from relatives and friends (Szoke, 1999). Because they lack such support, it has been theorized that hospitalization is unconsciously used to recreate the desired parent- child bond that they lacked in reality (Kaplan, Sadock & Grebb, 1994).
UNSTABLE INTERPERSONAL RELATIONSHIPSThese patients often resemble persons with borderline personality in that they manifest identity disturbance, unstable interpersonal relationships and recurrent suicidal or self-mutilating behaviors; in addition, their deceitfulness, lack of remorse, reckless disregard for their own safety and repeated failure to sustain consistent work behavior resemble antisocial personality disorder (Szoke, 1999).It has also been theorized that Munchausen patients are motivated by a desire to be cared for, a need for attention, dependency, an ambivalence toward doctors or an existing personality disorder (HealthAtoZ, 2002).They may delight in outwitting the medical profession, whom they regard as highly trained (Feldman, 2004).
TREATMENTEffectiveness of different psychotherapeutic approaches is limited by the fact that few people diagnosed with FD remain in long-term treatment. In many cases, however, the factitious disorder improves or resolves if the individual receives appropriate therapy for a co-morbid psychiatric disorder. Ganser syndrome usually resolves completely with supportive psychotherapy .One approach that has proven helpful in confronting patients with an examiners suspicions is a supportive manner that focuses on the individuals emotional distress as the source of the illness rather than on the anger or righteous indignation of hospital staff. Although most individuals with FD refuse psychiatric treatment when it is offered, those who accept it appear to benefit most from supportive rather than insight-oriented therapy
TESTINGIn order to assess reports of pain, the McGill Pain Questionnaire (MPQ) and the Modified Somatic Perception Questionnaire (MSPQ) were compared (Larrabee, 2003). The study found that the MPQ was better than the MSPQ at detecting exaggerated pain symptoms; however, the author cautions that elevations in scores should not be used independently to detect malingering (Larrabee, 2003).A study of the Lees-Haley Fake Bad Scale and its ability to measure somatic malingering was utilized on 408 persons in a chronic pain group (among other groups) (Butcher, Arbisib, Atlisa & McNulty, 2003). The study found that the FBS is more likely to measure general maladjustment and somatic complaints, rather than malingering.
TREATMENTDoctors are advised not to merely dismiss patients who are presenting with nonorganic pain, as these patients are often very psychologically invested in their pain (Kiester & Duke, 1999).They should be confronted with their diagnosis without suggesting guilt or reproach (Merck Manual, 2006). They suggest giving patients a “ladder to climb out of their symptoms,” by explaining to them that they do not have a serious physical problem, and then directing them to therapies that can help them (Kiester & Duke, 1999).These therapies may include psychotherapy. Those found to be malingerers should be told outright that they cannot help them; this is useful in maintaining the integrity of the doctor, while not enabling the patient.It is suggested that examining doctors not assume that there are no physical problems co-occurring with a factitious disorder; they also suggest that the patient be kept in the hospital and placed in long-term treatment with a mental health professional, despite the small likelihood that the factitious disorder will be cured (Healthinmind, 2003).
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