Hyacinth C.

Manood, MD, FPPA

A condition in which patient fake illness to
the point of inflicting painful, deforming, or
even life-threatening injury on themselves or
those under their care with the primary goal
of gaining the emotional care and attention
that comes with playing the role of the
patient

Approximately 0.8 to 1.0 percent of

psychiatry consultation patients
 Intentional
production or feigning of physical
or psychological signs or symptoms.

Themotivation for the behavior is to assume

the sick role.

External
incentives for the behavior (such as
economic gain, avoiding legal responsibility,
or improving physical well-being, as in
malingering) are absent.
 Withpredominantly psychological signs
and symptoms

With
predominantly physical signs and
symptoms (Munchausen Syndrome)

Withcombined psychological and physical

signs and symptoms
 Factitious Disorder Not Otherwise Specified

Factitious disorder by proxy - a person

intentionally produces physical signs or symptoms
in another person who is under the first person's
care.
! for the caretaker to indirectly assume the sick role;
! to be relieved of the caretaking role by having the
child hospitalized
 Munchausen syndrome
a syndrome in which patients embellish their
personal history, chronically fabricate symptoms
to gain hospital admission, and move from
hospital to hospital.
Approx. 2/3 are male
white, middle-aged, unemployed, unmarried,
and without significant social or family
attachments
essential feature of patients with the disorder is
their ability to present physical symptoms so well
that they can gain admission to, and stay in, a
hospital
 Factitious
disorders with psychological signs
and symptoms
are mostly women who outnumber men 3 to 1.
usually 20 to 40 years of age with a history of
employment or education in nursing or a health
care occupation
 Factitious disorder by proxy

most commonly perpetrated by mothers against

infants or young children
less than 0.04 percent
 The symptoms and pattern of illness are
extremely unusual, or inexplicable
physiologically.
Repeated hospitalizations and workups by
numerous caregivers fail to reveal a
conclusive diagnosis or cause.
Physiological parameters are consistent with
induced illness; e.g., apnea monitor tracings
disclose massive muscle artifact prior to
respiratory arrest, suggesting that the child
has been struggling against an obstruction to
the airways.
 The patient fails to respond to appropriate
treatments.
The vitality of the patient is inconsistent
with the laboratory findings.
The signs and symptoms abate when the
mother has not had access to the child.
The mother is the only witness to the onset
of signs and symptoms
Unexplained illnesses have occurred in the
mother or her other children.
 The mother has had medical or nursing
education, or exposure to models of the
illnesses afflicting the child (e.g., a parent
with sleep apnea).
The mother welcomes even invasive and
painful tests.
The mother grows anxious if the child
improves.
Maternal lying is proved.
Medical observations yield information that is
inconsistent with parental reports.
 many of the patients suffered childhood
abuse or deprivation, resulting in frequent
hospitalizations during early development

inpatient stay may have been regarded as an

escape from a traumatic home situation, and the
patient may have found a series of caretakers to
be loving and caring.
 The usual history reveals that the patient
perceives one or both parents as rejecting
figures who are unable to form close
relationships.

The facsimile of genuine illness, therefore, is

used to recreate the desired positive parent -
child bond
 basic
conflict of needing and seeking
acceptance and love while expecting that
they will not be forthcoming

patient
transforms the physicians and staff
members into rejecting parents.

seekout painful procedures, such as surgical

operations and invasive diagnostic tests, may
have a masochistic personality makeup in
which pain serves as punishment for past sins,
imagined or real
 Patientswho feign psychiatric illness may
have had a relative who was hospitalized
with the illness they are simulating.

Through identification, patients hope to

reunite with the relative in a magical way.

nogenetic patterns have been established,

and electroencephalographic (EEG) studies
noted no specific abnormalities in patients
with factitious disorders
 Somatoform Disorders

voluntary production of factitious symptoms

the extreme course of multiple hospitalizations
seeming willingness of patients with a
factitious disorder to undergo an extraordinary
number of mutilating procedures
 Personality Disorders
Antisocial PD
Histrionic PD
Borderline PD
Schizophrenia
Malingering
Substance Abuse
Gansers Syndrome
 begin in early adulthood
onset of the disorder or of discrete episodes
of seeking treatment may follow real illness,
loss, rejection, or abandonment
long pattern of successive hospitalizations
patient becomes knowledgeable about
medicine and hospitals
prognosis in most cases is poor
a few of them probably die as a result of
needless medication, instrumentation, or
surgery
3 Major Goals of Treatment:

To reduce the risk of morbidity and mortality

to address the underlying emotional needs or
psychiatric diagnosis underlying factitious illness
behavior
to be mindful of legal and ethical issues