Factitious disorder is the damaging need for attention.
You might not recognize the term Factitious Disorder when you hear it, but you're probably much more familiar with it than you think. Factitious disorder used to be called Munchausen Syndrome and is a mental disorder in which an individual repeatedly and deliberately acts as if they have a physical or mental illness when they're not really sick. It's considered a mental illness because it's associated with severe emotional difficulties.
"Factitious disorder is a polite way of saying a patient is making up symptoms with intent," said Stuart Spitalnic, MD. "You don't treat it, you discover it."
People with factitious disorder intentionally create or exaggerate symptoms of an illness in several ways: they may lie about or pretend to have certain symptoms, hurt themselves to bring on the symptoms, or change diagnostic tests (like contaminating a urine sample).
Those with factitious disorder have a strong need to be seen as sick or injured but do it for attention, not for financial gain (such as collecting insurance money), food or shelter, or to avoid criminal prosecution or other responsibilities. Faking it for profit is a condition known as malingering.
There are four types of factitious disorder: Factitious disorder with predominately psychological signs and symptoms, Factitious disorder with predominately physical signs and symptoms, Factitious disorder with combined psychological and physical signs and symptoms, and lastly, Factitious disorder not otherwise specified (Munchausen by proxy).
Factitious disorder by proxy, or Munchausen by proxy, is when an individual creates or fabricates symptoms of illness in another person under their care (usually their child) to receive attention. In the movie Sixth Sense, one of the big reveals was that a woman was deliberately poisoning her daughter — not to kill her, but to gain the sympathy that's given to a mother of a sick child. Factitious disorder by proxy is now often seen in TV shows and movies.
Factitious disorder is considered a mental illness because it's linked to serious emotional difficulties, and many patients also suffer from mental disorders (especially personality disorders), and have poor coping skills and problems forming healthy relationships.
Here are 11 signs of factitious disorder with mostly physical symptoms:
- Dramatic but inconsistent medical history
- Symptoms that aren't clear or controllable, and ones that worsen or change once treatment has begun
- Predictable relapses that follow an improvement in the condition
- Extensive knowledge of hospitals and/or medical terminology, as well as the textbook descriptions of illnesses
- Presence of many surgical scars
- An appearance of new or additional symptoms following negative test results
- Symptoms that only appear when patient is with others or being observed
- Enthusiastic willingness to have medical tests, surgeries, or other procedures
- History of seeking treatment at various hospitals, clinics and doctor's offices, possibly even in different cities or states
- Patient doesn't want doctors to meet or talk with family, friends, or to consult with prior doctors
- Problems with identity and self-esteem
Former emergency services psychiatric clinician, and current attorney and author, Susan J. Elliott, J.D., M. Ed, explained what happens when a factitious disorder sufferer's behavior begins to escalate.
"Because they exaggerate to some degree, they may run into issues 'proving' that something is wrong. In the beginning, they are taken seriously but soon begin to find they are dismissed early by doctors and medical staff after going for numerous tests and exams that reveal nothing. They usually graduate to 'cloaked' self-harm — they do things that result in actual harm and may even undergo unnecessary surgeries and medical treatments in an effort to 'prove' there is something wrong," she said.
Although some sufferers from factitious disorder may fabricate symptoms of mental illness, they are often unwilling to seek treatment for the condition itself, which makes treating people very challenging and the outlook for recovery not good.
There's also the problem of diagnosing someone with this disorder and then having actual illnesses not taken seriously.
"The problem for psychiatric clinicians is similar to that of medical staff ... if you 'saddle' someone with this disorder, you run the risk of real medical issues being overlooked in the future," said Elliott. "No one wants to be in that position. But they need help, and that also is difficult."
People with factitious disorder are at risk for health problems (or even death) associated with hurting themselves or causing symptoms. In addition, they may suffer from reactions or health problems related to having multiple tests, procedures, and treatments. And they're at high risk for substance abuse and attempts at suicide.
As there are no specific medications to treat this disorder, some medications for related conditions, such as depression or anxiety, may be prescribed, but must be carefully monitored. Psychotherapy is generally the best treatment for people with factitious disorder.
"I would begin by focusing on the attention that the therapy is going to give the client," Elliott said. "Munchausen involves a need for attention and helping them see that engaging in therapy (meaning really being involved in their own progress) gives them the attention of someone who truly cares (a listening, empathetic therapist). I would also suggest a support group where they can be listened to by others."