psychiatric disorders
Factitious Disorder Imposed on Self
Introduction
Factitious disorder is falsification of physical or psychologic symptoms without an obvious external incentive; the motivation for this behavior is to assume the sick role. Symptoms can be acute, dramatic, and convincing. Patients often wander from one physician or hospital to another for treatment. The cause is unknown, although stress and a severe personality disorder, most often borderline personality disorder, are often implicated. Diagnosis is clinical. There are no clearly effective treatments. (See also Overview of Somatization .) Factitious disorder imposed on self was previously called Munchausen syndrome, particularly when manifestations were dramatic and severe. Factitious Disorder Imposed on Another person may also occur. These patients initially and sometimes chronically become the responsibility of medical or surgical clinics. Nevertheless, the disorder is a psychiatric issue, is more complex than simple dishonest simulation of symptoms, and is associated with severe emotional difficulties. Patients may have prominent Borderline Personality Disorder (BPD) features and are usually intelligent and resourceful. They know how to simulate disease and are sophisticated regarding medical practices. They differ from malingerers because, although their deceits and simulations are conscious and volitional, there are no obvious external incentives (eg, economic gain, time off from work) for their behavior. It is unclear what they gain beyond medical attention for their suffering, and their motivations and quest for attention are largely unconscious and obscure. Patients may have an early history of emotional and physical abuse. Patients may also have experienced a severe illness during childhood or had a seriously ill relative. Patients appear to have problems with their identity as well as unstable relationships. Feigning illness may be a way to increase or protect self-esteem by blaming failures on their illness, by being associated with prestigious physicians and medical centers, and/or by appearing unique, heroic, or medically knowledgeable and sophisticated. 