A factitious disorder ts characterized by symptoms that are manufactured” by the patient.The factitious disorder is a condition in which the patient, consciously and deliberately acts as if he has a physical or mental illness when really nothing happens.Patients with this disorder create and exaggerate the symptoms of a disease in different ways.
According to DSM-III. the symptoms of a factitious disorder are under voluntary control Control, motives, and awareness can only be inferred, but symptoms can be considered “voluntary” if caused by the patient’s action, even when the patient seems to have little control over self-destructive impulses In contrast, there is little indication that somatoform or “conversion” patients cause their own symptoms in a deliberate way.
Factitious psychological disorders include many patients who seek repeated psychiatric hospitalization by feigning hallucinations, delusions, and suicidal or violent ideation. They may describe memory loss, posttraumatic stress, bereavement, pananuety. or general inability to cope with simple stresses On mental status examination they may give near misses (Ganser syndrome), endorse any suggested symptom, or be negativistic.
Patients with medical factitious disorders may have simulated, self-iflicted, or self-maintained symptoms. For example, a patient may have “fever” caused by manipulating a thermometer, however, a fever may be secondary to self-injection of a harmful substance, or an existing fever may be nuinuined by surreptitiously rejecting prescribed medication.
Patients with chronic factitious illness, sometimes called the Munchausen syndrome, travel from hospital to hospital presenting a medical emergency (generally with pain and bleeding), and provide a convoluted but believable history They cannot easily be ignored because they may have senous medical problems or iatrogenic illnesses Many of these patients use medical terminology with ease, are substance abuserv and may have a pnson record Although the Munchausen syndrome is associated with grandiosity and a flair for the dramatic, many patients with factitious disorders are quiet and passive—almost model patients The proper diagnosis is most likely obtained when the clinician considers the Larger context of the illness Interviewing people who know the patient is essential Factitious disorders flourish where the patient has multiple care providers, none of whom are aware of the patient s social and medical history.
Factitious disorders are associated with personality disorders Frequently there are developmental and psychodynamic issues such as parental loss or rejection and exposure to chronic illness and institutionalization A remarkable number of these patients are trained in paramedical professions Brain dysfunction, particularly of the nght hemisphere, has been implicated as one of the contributing factors, particularly in those patients with fantastic stones, variable histories, or unusual explanations for symptoms. Careful assessment is important because there is frequently a complex interaction between a genuine medical problem and simulation or sick-role behavior.
How To Recognize The Fictitious Disorder.
These are the possible signs that can represent an alarm bell for the presence of a fictitious disorder:
- The person says he has had a number of illnesses in the past, but he has no documentation available to prove it. It does not have the results of the analyzes, hospital certificates, etc.
- The person has several scars that testify to an abnormal number of surgical interventions.
- “New symptoms” appear regularly when no person is diagnosed with the disease.
- The person has periodic relapses every time he begins to heal.
- The person complains that he has some symptoms that he can not show because they only take place “when I am alone”.
- A past history of numerous interventions, hospitalizations, medical visits even in different cities.
- The hospitalized patient receives few or no visits from family members or acquaintances.
Causes of fictitious disorders
Scholars tend to agree that people with these disorders have had a childhood characterized by major episodes of neglect and neglect, in which they have experienced stories of important and frequent illnesses. The person may have been particularly ill during childhood or having witnessed the illness of a family member. The condition of illness in these stories is often associated with long or frequent periods of hospitalization.
Fictitious disorders: symptoms
There are two types of symptoms :
- the fictitious disorder with predominant physical signs and symptoms, which is the most frequent;
- the fictitious disorder with predominant psychological signs and symptoms or Ganser’s syndrome.
Common characteristics of people affected by these disorders are the poor sense of reality, manipulative attitudes, aggression, arrogance and social isolation.
How are fictitious disorders treated?
The first objective for the treatment of fictitious Disorders consists is treating put self-destructive behavior of the person. In the case protective measures must be put in place for the victim through legal action.
Once the first goal is reached, it is necessary to cover the psychological difficulties of these people. A psychotherapeutic path is indicated, even if these people are not motivated to collaborate with the therapeutic process. A therapeutic path, requires the person’s awareness of the disease and its motivation to come out of it.
A Psychotherapy is often used for these type of people. It changes the beliefs about the fact.These people also must acquire the ability to enter into intimacy with others as a person, and not as a patient . They must understand how, when and why they have developed their convictions.For the treatment of Fictitious Disorders, Cognitive Behavioral Therapy can be an effective treatment only when patient is willing to recognize the cause of his illness.