FACTITIOUS DISORDER

Intentionally produce signs and symptoms of medical and mental disorder Misrepresent their histories and symptoms Objective: assume the role of a patient Compulsive quality; voluntary, deliberate and purposeful behavior

Epidemiology Prevalence in the general population is unknown Occur more frequent in hospital and health care workers Females > males

Etiology Psychosocial Factors:  History of childhood abuse or deprivation  Masochistic personality: seek out painful procedures  Identification: reunite with a relative in a magical way  Borderline PD: poor identity formation and disturbed self-image  Significant defense mechanisms: repression, identification, regression, symbolization

Biological Factors  Brain dysfunction: impaired information processing

Diagnosis and Clinical Features Diagnostic Criteria: 1.Intentional production or feigning of physical or psychological s/sxs 2.The motivation for the behavior is to assume the sick role 3.External incentives for the behavior is absent

Types: 1.FD with predominantly Psychological S/Sxs Depression, hallucinations, dissociative and conversion sxs, bizarre behavior 2.FD with predominantly Physical S/Sxs Munchausen Syndrome

3. FD with Combined Psychological and Physical S/Sxs 4. FD NOS FD by Proxy: a person intentionally produces physical signs or symptoms in another person who is under the first person’s care; to indirectly assume the sick role or to be relieved of the caretaking role

Differential Diagnosis 1.Somatoform Disorder 2.PD: antisocial PD, histrionic PD, borderline PD, schizotypal PD 3.Schizophrenia 4.Malingering 5.Substance abuse 6.Ganser’s syndrome

Course and Prognosis Onset: early adulthood May follow real illness, loss, rejection, or abandonment Long pattern of successive hospitalizations - knowledgeable about medications and hospitalization Incapacitating and often produce severe trauma or untowward reactions related to treatment Prognosis is poor

Treatment Focus on management rather than on cure Early recognition Educate the hospital staff members