19.10 Factitious Disorder
Introduction
19.10.1 Factitious disorder refers to the intentional physical self injury or the production of physical signs of disease or the feigning of physical or psychological symptoms, with the apparent aim of being diagnosed as ill.
19.10.2 This disorder is not the same as malingering [see paragraph 19.11] in that its primary aim is not to bring external rewards such as avoidance of duties or fraudulent financial gain, but to obtain medical attention. People with factitious disorder often have very disturbed personalities.
19.10.3 Some common features seen in people with factitious disorder are skin lesions which are produced by self-injury (this is sometimes called dermatitis artefacta) or their presenting with an apparent high body temperature (pyrexia) produced by various means, such as rubbing the bulb of a clinical thermometer to produce frictional heat or dipping the thermometer in a hot drink when unobserved. Some people with this disorder may deliberately aggravate an existing physical disorder, for example by preventing the healing of the ulcers which sometimes occur due to varicose veins in the legs.
19.10.4 Munchausen syndrome is a rare but extreme form of the disorder in which the affected individual will give a plausible account of an illness with feigned symptoms and signs. These may include psychiatric symptoms. These people often present themselves at a series of different hospitals using different names.
19.10.5 Munchausen syndrome by proxy is used to describe a condition in which an adult with a personality disorder, in charge of a child, gives a false account of symptoms in the child and may fake physical signs of illness in the child.
19.10.6 Care Needs and Mobility Considerations
Although there is no evidence that financial gain is involved in people with factitious disorder, and though some affected people may also have abnormal personalities [see paragraph 19.8], there is nevertheless a conscious and deliberate intention to simulate illness. There is no specific treatment and though supportive counselling may be offered, many people affected by this disorder refuse treatment. Counselling cannot be considered as attention to bodily functions since it focuses on ways in which the affected person may come to terms with and cope with their own difficulties. Care needs and mobility requirements should not arise in people with factitious disorders in the absence of co-existing illnesses and disabilities which are not the product of conscious intentions to deceive.
By its very nature and the conclusions which necessarily follow it, a diagnosis of factitious disorder must be confirmed by seeking a comprehensive report from a consultant psychiatrist. In all cases where this disorder is mentioned advice should be sought from a Medical Services doctor for assistance in framing questions to put to the psychiatrist and in interpreting the subsequent report.