Factitious Disorder Ben Cassera Wake Forest University Department
Factitious Disorder Ben Cassera Wake Forest University Department of Counseling ABSTRACT Factitious disorder is an exaggeration or falsification of physiological or psychological symptoms with no clearly defined objective other than assuming the “sick role”. This disorder is rare and hard to verify, therefore the amount . of research regarding treatment or potential causes of the disorder are lacking. Relationship to Other Disorders Hysteria: – Similar to factitious disorder in that both involve symptoms that have no organic cause. – Both involve “deception. ” – Unlike factitious disorder the deception in cases of hysteria is unconscious or internal, producing symptoms beyond the patient’s control (Kanaan & Wessely, 2010). Malingering: • Like factitious disorder malingering involves a conscious deception regarding presented symptoms. • Unlike factitious disorder there is a tangible, external reward for presenting as sick. (ex. Worker’s comp, avoiding legal issues, etc. ) (Mc. Cullumsmith & Ford, 2011). DISCUSSION • The results of this study were both fascinating and aggrevating. • There is a lack of concrete research on this topic due to the rarity and difficulty of diagnosis. (Bass & Halligan, 2014) • Many clinicians, especially those in primarily physiological practices, are not trained in how to recognize or deal with people who are suspected of having this disorder (Bass & Halligan, 2014) INTRODUCTION Background: • The term ‘factitious disorder” was first used in 1838 however the disorder as it is conceptualized today did not begin to take shape until Richard Asher described a pattern of symptoms and behaviors in his article “Munchausen’s Syndrome” published in 1951 (Kanaan & Wessely, 2010). • Asher initially described this disorder in terms of three sub groupings: • Abdominal type: characterized by intense pain centered in the abdominal region. • Bleeding type: characterized by mysterious bleeding often in stool or urine samples • Neurological type: characterized by fainting, seizures, or any other neurological symptom for which there was no apparent cause (1955). • This disorder was formally introduced into the DSM-III as a mediating diagnosis to better fit patients who did not meet the criteria for hysteria or malingering((Mc. Cullumsmith & Ford, 2011) DSM-V Diagnostic Criteria: Factitious Disorder Imposed on Self 1. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception. 2. The individual presents himself or herself to others as ill, impaired, or injured. 3. The deceptive behavior is evident even in the absence of obvious external rewards. 4. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder. Factitious Disorder Imposed on Another (Previously Factitious Disorder by Proxy) 1. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception. 2. The individual presents another individual (victim) to others as ill, impaired, or injured. 3. The deceptive behavior is evident even in the absence of obvious external rewards. 4. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder. (American Psychiatric Association, 2013). RESEARCH POSTER PRESENTATION DESIGN © 2011 www. Poster. Presentations. com • Treatment of this disorder is poorly understood, there are relatively few examples within the literature and the clinicians do not seem to share a common approach. RESULTS Factitious Disorder Imposed on Another Factitious Disorder Imposed on Self Prevalence: • Prevalence of this disorder is hard to determine due to the deceptive nature of this disorder • Varying estimates of this disorder put somewhere between 1%(American Psychiatric Association, 2013) and 5%(Kanaan & Wessely 2010) of all hospital presentations as fictitious. Diagnosis: • Diagnosis is challenging and requires much more information than patient report and observation of behavior. • This is further complicated by the possibility of countertransference. The realization that a patient is feigning symptoms can make it difficult for the clinician to treat the patient with empathy (Pasic, Combs & Romm, 2009). • Diagnosis has been made slightly easier in recent times due to the digitization of medical records, making it easier to see patterns of hospital jumping behaviors. • • Vast majority of those diagnosed are woman while those victimized are usually children under the age of five (Shaw et al, 2008). The actual number of reported cases varies between. 4 to 2 per every 100000 children (Shaw et al, 2008). Diagnosis: • This is hard to diagnose as most sufferers portray themselves as the very model of a kind and concerned caretaker. • Another barrier to diagnosis is that children will often try very hard to shield their parent from any sort of accusation Shaw et al, 2008 ). RECOMMENDATIONS FOR FUTURE RESEARCH • Looking into potential causes of this disorder could yield some interesting information on this disorder. • There is some evidence that suggests a link between factitious disorder and borderline personality disorder, it would be interesting to investigate this further (Guthrie & Moghavemi, 2013). • The influence that technology has on this disorder, both in a patients ability to use the internet to facilitate the falsification of symptoms, and to portray themselves as sick to a wider audience, would be a very interesting area of study. REFERENCES Treatment: • Treatment of factitious disorder is a subject where research is severely lacking, there is no standard model of treatment for this disorder. • One common tactic that different clinicians have used when addressing this disorder is confrontation. However the method of confrontation is poorly described in the literature, though most decided to go for a non-punitive form (Eastwood & Bisson, 2008). • Modeling and Role Modeling theory (MRM) is another type of intervention that has been proposed as a potential treatment. This involves an attitude of acceptance and non-judgement to entice people with FD to engage with treatment. It is thought to facilitate the sufferers seeming need for attention, while also teaching them coping skills (Hagglund, 2008). American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5 th ed. ). Washington, DC: Author. Asher, R. (1955). Munchausen Syndrome. British Medical Journal, 2(4950), 1271. Bass, C. , & Halligan, P. (2014). Factitious disorders and malingering: Challenges for clinical assessment and management. The Lancet, 383(9926), 1422 -1432. doi: 10. 1016/S 01406736(13)62186 -8 Hagglund, L. A. (2009). Challenges in the treatment of factitious disorder: A case study. Archives of Psychiatric Nursing, 23(1), 58 -64. doi: 10. 1016/j. apnu. 2008. 03. 002 Guthrie, E. , & Moghavemi, A. (2013). Commentary on 'Recovery from chronic factitious disorders (Munchausen’s syndrome): A personal account' by Bass and Taylor, 2012. Personality and Mental Health, 7(1), 8688. doi: 10. 1002/pmh. 1225 Kanaan, R. A. , & Wessely, S. C. (2010). The origins of factitious disorder. History of the Human Sciences, 23(2), 68 -85. doi: 10. 1177/0952695109357128 Mc. Cullumsmith, C. B. , & Ford, C. V. (2011). Simulated illness: The factitious disorders and malingering. Psychiatric Clinics of North America, 34(3), 621 -641. doi: 10. 1016/j. psc. 2011. 05. 013 Pasic, J. , Combs, H. , & Romm, S. (2009). Factitious disorder in the emergency department. Primary Psychiatry, 16(1), 61 -66. Shaw, R. J. , Dayal, S. , Hartman, J. K. , & De. Maso, D. R. (2008). Factitious disorder by proxy: Pediatric condition falsification. Harvard Review of Psychiatry, 16(4), 215 -224. doi: 10. 1080/10673220802277870
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