Factitious disorder: Wikis

  

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Factitious disorder
Classification and external resources
ICD-10 F68.1
ICD-9 300.16
MeSH D005162

Factitious disorders are conditions in which a person acts as if he or she has an illness by deliberately producing, feigning, or exaggerating symptoms. Factitious disorder by proxy is a condition in which a person deliberately produces, feigns, or exaggerates symptoms in a person who is in their care. Münchausen syndrome is an outdated term for Factitious disorder. People with this condition may produce symptoms by contaminating urine samples, taking hallucinogens, injecting themselves with bacteria to produce infections, and other such similar behaviour. People with this condition might be motivated to perpetrate factitious disorders either as a patient or by proxy as a caregiver to gain any variety of benefits including attention, nurturance, sympathy, and leniency that are unobtainable any other way. The condition is only diagnosed in the absence of any other mental disorders.[1] Somatoform disorders are characterised by multiple somatic complaints.[2]

Contents

Motives

The motives of the patient can vary: for a patient with factitious disorder, the primary aim is to obtain sympathy, nurturance, and attention accompanying the sick role.[1] This is in contrast to malingering, in which the patient wishes to obtain external gains such as disability payments or to avoid an unpleasant situation, such as military duty. Factitious disorder and malingering cannot be diagnosed in the same patient, and the diagnosis of factitious disorder depends on the absence of any other psychiatric disorder.[1] While they are both listed in the DSM-IV-TR, factitious disorder is considered a mental disorder, while malingering is not.[3]

Differential diagnosis

Factitious disorders should be distinguished from somatoform disorders, in which the patient is truly experiencing the symptoms and has no intention to deceive. These disorders include body dysmorphic disorder, conversion disorder, somatization disorder, and pain disorder. In these conditions the patient believes he or she has a particular medical disorder and, like the Factitious disorder patient, may seek contact from multiple physicians, emergency departments, and hospitals.

Criteria

Criteria for diagnosis includes intentionally fabricating (or faking) to produce physical or psychological signs of symptoms and the absence of any other mental disorder. Motivation for their behaviour must be to assume the 'sick role', and they do not act sick for personal gain as in the case of malingering sentiments. When the individual applies this pretended sickness to a dependent, for example a child, it is often referred to as 'factitious disorder by proxy.'

Munchausen syndrome

Munchausen syndrome, or Factitious disorder, has specified symptoms. Factitious disorder symptoms may seem exaggerated; individuals undergo major surgery repeatedly, and they 'hospital jump' or migrate in order to avoid detection.

Munchausen by proxy

The word 'proxy' means 'substitute'. Munchausen by proxy is the involuntary use of another individual to play the patient role. For example, false symptoms are produced in children by the caregivers or parents (almost always mothers), to produce the appearance of illness, or they may give misleading medical histories about their children. The parent may falsify the child's medical history or tamper with laboratory tests in order to make the child appear sick. Occasionally, in Munchausen by proxy, the caregiver will actually injure the child to ensure that the child will be treated. Such parents enjoy the attention that they receive from having a sick child.

Ganser syndrome

Ganser syndrome is a separate factitious disorder. It is a reaction to extreme stress[citation needed] or an organic condition; the patient suffers from approximation or giving absurd answers to simple questions. The syndrome can sometimes be diagnosed as merely malingering; however, it is more often defined as a Factitious disorder. Symptoms include a clouding of consciousness, somatic conversion symptoms, confusion, stress, loss of personal identity, echolalia, and echopraxia. Individuals also give approximate answers to simple questions such as, "How many legs on a cat?" "Three"; "What's the day after Wednesday?" "Friday"; and so on. The disorder is extraordinarily rare with less than 100 recorded cases. While individuals of all backgrounds have been reported with the disorder, there is a higher inclination towards males (75% or more). The average age of those with Ganser syndrome is 32 and it stretches from ages 15–62 years old.

Causes of factitious disorder

There are many possible causes for this disorder. One such possibility is an underlying personality disorder. Individuals with FD may be trying to repeat a satisfying childhood relationship with a doctor. Perhaps also the individual has a desire to deceive or test authority figures. The underlying desire to resume the role of a patient and to be cared for can also be considered an underlying personality disorder. Abuse in childhood is also another probable cause for the disorder. A background of neglect and abandonment may contribute to the development of FD. These individuals may be trying to reenact unresolved issues with their parents. A history of frequent illnesses may also contribute to the development of this disorder. Perhaps the individual afflicted with FD is accustomed to actually being sick, and thus returns to their previous state in order to recapture what was once considered to be the 'norm.' Another cause is a history of close contact with someone (a friend or family member) who had a severe or chronic condition. The patient found themselves subconsciously envious of the attention said relation received, and felt that they themselves faded into the background. Thus medical attention makes them feel glamorous and special.

Treatment

No true psychiatric medications are prescribed for factitious disorder. However, selective serotonin reuptake inhibitors (SSRIs) can help manage underlying problems. Medicines used to treat mood disorders such as SSRIs can be used to treat FD, as a mood disorder may be the underlying cause of FD. Some authors (such as Prior and Gordon 1997) also report good responses to antipsychotic drugs such as Pimozide. Family therapy can also prove to be of assistance. In such therapy, families are helped to better understand patients (the individual in their family with FD) and their need for attention. In this therapeutic setting, the family is urged not to condone or reward the FD individual's behavior. This form of treatment can be unsuccessful if the family is uncooperative or displays signs of denial and/or antisocial disorder. Psychotherapy is another method used to treat the disorder. These sessions should focus on the psychiatrist establishing and maintaining a relationship with the patient. Such a relationship may help to contain symptoms of FD. Monitoring is also a form that may be implicated for the FD patient's own good. Video cameras, etc. are not illegal to use in such monitoring in any country or jurisdiction of the world where people can read Wikipedia, for in many cases, FD (especially proxy) can prove to be very detrimental to an individual's health if they are, in fact, causing true physiological illnesses. Even faked illnesses/injuries can be dangerous and might be monitored for fear that unnecessary surgery may subsequently be performed.

Treatment of Munchausen by proxy

Treatment for FD proxy is not so subtle. Physicians, upon suspecting the disorder, should notify authorities immediately. Authorities will then initiate steps for immediate protection of the proxy (i.e. victim). Criminal charges may be deemed necessary. Many times, help may be sought for the caregiver with Munchausen by proxy as well as the affected target. Careful monitoring of the family for an extended period of time is often a necessary precaution. This is to prevent translocation and to prevent the insinuation of a possible upheaval of the detrimental disorder.

Prognosis

Some experience only a few outbreaks of the disorder. However, in most cases, the disorder is chronic, and factitious disorder is a long-term condition that is difficult to treat. There are relatively few positive outcomes for this disorder; in fact, treatment provided a poorer percentage of positive outcomes than did treatment of individuals with obvious psychotic symptoms such as schizophrenics. In addition, many individuals with factitious disorder do not present for treatment, often insisting their symptoms are genuine. Some degree of recovery, however, is possible. Age seems to help the disorder greatly. There are many possible explanations for this occurrence, although none are currently considered definitive. Some say perhaps it is because the FD individual has mastered the art of feigning sickness over so many years of practice that the disorder can no longer be discerned. Another hypothesis is that many times an FD individual will be put in a home or experience health issues that are not self-induced or feigned. Thus, in this way, the problem with obtaining the 'patient' status is resolved because symptoms arise without any effort on the part of the individual.

See also

References

  1. ^ a b c Elwyn, Todd S. "Factitious Disorder: eMedicine Psychiatry". emedicine.medscape.com. http://emedicine.medscape.com/article/291304-overview. Retrieved 2009-09-14. 
  2. ^ Somatoform Disorders
  3. ^ Bienenfeld, David, MD (July 2008). "Malingering". http://emedicine.medscape.com/article/293206-overview. Retrieved 2009-11-14. 
  • American Psychiatric Association (1997). DSM-IV Somatoform Disorders. APA. pp. 445–450. 
  • Eisendrath, Stuart J. (Feb 1984). Factitious illness: a clarification. Psychosomatics. pp. 25(2):110–3, 116–7. http://psy.psychiatryonline.org/cgi/external_ref?access_num=6701283&link_type=MED. 
  • Feldman, Marc D.; Charles V. Ford, Toni Reinhold (1993). Patient or Pretender: Inside the Strange World of Factitious Disorders. John Wiley & Sons Inc. ISBN 0-471-58080-5. 
  • Feldman, Marc D. (editor); Eisendrath, Stuart J. (editor) (August 1996). The Spectrum of Factitious Disorders (Clinical Practice, 40). American Psychiatric Publishing; 1st ed edition. p. 229. ISBN 0-88048-909-X. 
  • Feldman, Marc D. (2004). Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering and Factitious Disorder. Brunner-Routledge. p. 288. ISBN -415-94934-3. 

External links








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