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Variations on a Factitious Theme

This paper addresses three problems. The first is the differentiation between malingering and factitious disorders. In the former, conscious elements are said to predominate, while in the latter, unconscious factors are primary. That notion is questioned here. Second, the determination of the truth of memories is especially controversial in cases of reported childhood abuse. This paper argues that numbers of such patients may have a mixture of Munchausen-like symptoms together with childhood trauma and adult dissociative symptoms. Such patients may present their therapists with “false truths” and “true falsehoods.” Third, there is a puzzle in the cases of patients who assert histories of severe childhood abuse and subsequently retract those stories. Rather than seeing them as helpless foils of therapists who “implant” falsehoods, or as individuals who are merely attempting to profit from turning against a therapist who had helped them, this paper argues that such patients may be enacting a pathological “victim” role with therapist and attorney alike, in a “legal Munchausen syndrome.”