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Factitious disorder

Synonym: Munchausen syndrome
German: Artifizielle Störung

1 Definition

A factitious disorder is a psychiatric condition in which patients fake or produce symptoms of illness.

2 Epidemiology

Factitious disorder has an incidence of about 0.5% with women being more frequently affected than men. Most often the disorder occurs at 35 years of age. About 1-5% of patients in general hospitals and approximately 3% in neurological hospitals are diagnosed with the condition.

3 Etiology

Most patients affected by factitious disorder had been subject to significant emotional burdens in their past. Frequently a patient's history contains reports of sexual abuse, growing up in an orphanage or an early death of a close relative.

4 Clinical significance

Fever of unknown etiology and impaired wound healing are the most frequent ailments that make patients with factitious disorder go and see a doctor.

Further reasons for a visit to the doctor can be pain, anemia, bleeding and injuries that might have been self-inflicted. Personality disorders often coincide with factitious disorder. Another possibility is puerilism, in which the patient imitates childish speech and movement.

Ganser syndrome is a disorder in which patients call themselves "insane", continuously produce wrong or nonsensical answers and deliberately talk nonsense.

If a mother feigns diseases in her child in order to gain (medical) attention, the condition is called Munchausen syndrome by proxy (MbP or MSbP).

Patients call also complain of pseudodementia and feign impaired memory or concentration.

5 Differential diagnosis

Factitious disorder has to be distinguished from purely simulating symptoms. In contrast to factitious disorder those patients have a specific reason for their behavior (e.g. desire for premature retirement).

Differential diagnosis should also exclude a masked depression and somatic symptom disorder. Patients with somatic symptom disorder do not feign symptoms but experience them as real.

Further psychiatric disorders that entail self harm (e.g. borderline personality disorder) should also be taken into consideration.

6 Diagnosis

The patient's history is fundamental but diagnosing the condition is still rather difficult. Repeated doctor appointments can be a sign of factitious disorder. According to ICD-10 the following criteria are associated with factitious disorder (F68.1):

  • Feigning or deliberately producing physical or psychological symptoms.
  • The suspicious activities are performed in secret and unobserved.
  • Presumed aim is to assume the role of a sick person and to receive the according treatment.

7 Therapy

Factitious disorder is treated with psychotherapy although only about one in three patients agrees to therapy. Six in ten patients deny faking their symptoms, making therapy impossible.

8 Prognosis

The prognosis is rather unfavorable due to many patients denying being affected by factitious disorder and refusing therapy.

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