Random Psychology Disorder (somewhat) Explained #3 (Factitious Disorder)

Random psychology disorder (somewhat) explained #3 (Factitious Disorder)

Diagnostic Criteria

Factitious Disorder Imposed on Self

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.

B. The individual presents himself or herself to others as ill, impaired, or injured.

C. The deceptive behavior is evident even in the absence of obvious external rewards.

D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Factitious Disorder Imposed on Another (Previously Factitious Disorder by Proxy)

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception.

B. The individual presents another individual (victim) to other as ill, impaired, or injured.

C. The deceptive behavior is evident even in the absence of external rewards.

D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Note: The perpetrator, not the victim, receives the diagnosis.

Diagnostic Features

The essential feature of factitious disorder is the falsification of medical or psychological signs and symptoms in the individual or others that are associated with the identified deception.

Individuals with factitious disorder can also seek treatment for themselves or another following induction of injury or disease.

The diagnosis requires demonstrating that the individual is taking surreptitious actions to misrepresent, simulate, or cause signs or symptoms of illness or injury even in the absence of obvious external rewards.

The diagnosis of factitious disorder emphasizes the objective identification of falsification of signs and symptoms of illness and not the individual motivations of the falsifier.

Methods of illness falsification can include exaggeration, fabrication, simulation, and induction.

While a preexisting medical condition may be present, the deceptive behavior or induction of injury associated with deception causes others to view such individuals (or, in the case of factitious disorder imposed on another, the victim) as more ill or impaired, and this can lead to excessive clinical intervention.

Individuals with factitious disorder might, for example, report feelings of depression and suicidal thoughts or behavior following the death of a spouse despite the death not being true or the individual's not having a spouse; deceptively report episodes of neurological symptoms (e.g., seizures, dizziness, or blacking out); manipulate a laboratory test (e.g., by adding blood to urine) to falsely indicate an abnormality; falsify medical records to indicate an illness; ingest a substance (e.g., insulin or warfarin) to induce an abnormal laboratory result or illness; or physically injure themselves or induce illness in themselves or another (e.g., by injecting fecal material to produce an abscess or to induce sepsis).

Although individuals with factitious disorder most often present to health care professionals for treatment of their factitious symptoms, some individuals with factitious disorder choose to mislead community members in person or online about illness or injury without necessarily engaging health care professionals.

Associated Features

Individuals with factitious disorder imposed on self or factitious disorder imposed on another are at risk for experiencing great psychological distress or functional impairment by causing harm to themselves and others.

Family, friends, faith leaders, and health care professionals are also often adversely affected by their behavior (e.g., devoted time, attention, and resources to provide medical care and emotional support to the falsifier).

Individuals with factitious disorder imposed on another sometimes falsely allege the presence of educational deficits or disabilities in their children for which they demand special attention, often at considerable inconvenience to education professionals.

Whereas some aspects of factitious disorders might represent criminal behavior (e.g., factitious disorder imposed on another, in which the parent's actions represent abuse and maltreatment of a child), such criminal behavior and mental illness are not mutually exclusive.

Moreover, such behaviors, including the induction of injury or disease, are associated with deception.

Differential Diagnosis

Deception to avoid legal liability. Caregivers who lie about abuse injuries in dependents solely to protect themselves from liability are not diagnosed with factitious disorder imposed on another because protection from liability is an external reward (Criterion C, the deceptive behavior is evident even in the absence of obvious external rewards).

Such caregivers who, upon observation, analysis of medical records, and/or interviews with others, are found to lie more extensively than needed for immediate self-protection are diagnosed with factitious disorder imposed on another.

Somatic symptom and related disorders. In somatic symptom disorder and the care-seeking type of illness anxiety disorder, there may be excessive attention and treatment seeking for perceived medical concerns, but there is no evidence that the individual is providing false information or behaving deceptively.

Malingering. Malingering is differentiated from factitious disorder by the intentional reporting of symptoms for personal gain (e.g., money, time off work).

In contrast, the diagnosis of factitious disorder requires that the illness falsification is not fully accounted for by external rewards.

Factitious disorder and malingering are not mutually exclusive, however.

The motives in any single case might be multiple and shifting depending on the circumstances and reactions of others.

Functional neurological symptom disorder (conversion disorder). Functional neurological symptom disorder is characterized by neurological symptoms that are inconsistent with neurological pathophysiology.

Factitious disorder with neurological symptoms is distinguished from functional neurological symptom disorder by evidence of deceptive falsification of symptoms.

Borderline personality disorder. Deliberate physical self-harm in the absence of suicidal intent can also occur in association with other mental disorders such as borderline personality disorder.

Factitious disorder requires that the induction of injury occur in association with deception.

Medical condition or mental disorder not associated with intentional symptom falsifitcation. Presentation of signs and symptoms of illness that do not conform to an identifiable medical condition or mental disorder increases the likelihood of the presence of a factitious disorder.

However, the diagnosis of factitious disorder does not exclude the presence of a true medical condition or mental disorder, as comorbid illness often occurs in the individual along with factitious disorder.

For example, individuals who might manipulate blood sugar levels to produce symptoms may also have diabetes.

Random Psychology Disorder (somewhat) Explained #3 (Factitious Disorder)

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