Patients with factitious disorders repeatedly present with symptoms that have no organic basis. According to the DSM-IV (Diagnostical and Statistical Manual of Mental Disorders) diagnostic criteria, the motivation for the behavior is to assume the sick role. External incentives for the behavior should be absent for the correct diagnosis.[1,6] Since most patients have been employed in the health care professions, they generally have a somewhat reasonable medical history, but discrepancies are detectable upon careful evaluation.

Causes

The exact cause of factitious disorders is not known, but researchers are looking at the roles of biological and psychological factors in the development of these disorders. Some theories suggest that a history of abuse or neglect as a child, or a history of frequent illnesses that required hospitalization might be factors in the development of the disorder.

Men have been shown to be more vulnerable to stressors across all ages and types of stressors, for unknown reasons. A poorly developed ego is also a factor that could make one more vulnerable to this disorder, whether it is caused by cerebral impairment or upbringing. Those damaged by repeated trauma also are at greater risk, even if that trauma is in the distant past.

Symptoms

The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of Somatization Disorder, and is not better accounted for by another mental disorder.

Patients may become extremely dependent. They increasingly demand help and emotional support and may become enraged when they feel their needs are not met. They are sometimes considered exhibitionistic and seductive.

Dramatic but inconsistent medical history unclear symptoms that are not controllable and that become more severe or change once treatment has begun. Patients usually spend many hours a day thinking about their perceived defect. Most check themselves often in mirrors, others avoid mirrors, and still others alternate between the 2 behaviors. Most try to camouflage their imagined defect—eg, by growing a beard to hide perceived scars or by wearing a hat to cover slightly thinning hair.

Treatment The primary treatment for factitious disorders is psychotherapy (a type of counseling). Treatment likely will focus on changing the thinking and behavior of the individual with the disorder (cognitive-behavioral therapy). Family therapy also may be helpful in teaching family members not to reward or reinforce the behavior of the person with the disorder.

There are no medications to treat factitious disorders themselves. Medication may be used, however, to treat any related disorder—such as depression, anxiety or a personality disorder. The use of medications must be carefully monitored in people with factitious disorders due to the risk that the drugs may be used in a harmful way.

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