Physical Signs and Symptoms of Factitious Disorder
Why someone would feign being ill, without obvious gain, is mysterious, yet episodes of patients feigning illness are not uncommon within the hospital setting.
In factitious disorder, people intentionally produce symptoms to assume the role of a patient. Most of the symptoms are physical, but some people produce psychological symptoms as well.
Patients with factitious disorder may have physical symptoms, psychological symptoms, or a mixture of the two. They often present with signs and symptoms of illnesses that suggest rare medical conditions in order to interest physicians sufficiently to be admitted.
They make up symptoms—for example, reporting acute pain. Some will take extraordinary measures to make themselves ill. They may injure themselves, take damaging medications, or inject themselves with toxins.
It is estimated that 1 in 10 patients with factitious disorder have the most severe form, which is popularly known as Munchausen syndrome. Munchausen syndromeOpens in new window is characterized by multiple hospitalizations with repeated invasive testing and surgical procedures.
The symptoms of patients with factitious disorder with predominantly physical signs and symptoms are suggestive of a physical disorder that is intentionally produced. Simulation of almost every medical illness is possible, only limited by the patient’s imagination, medical sophistication, and daring.
Impressive physical signs can be fabricated. For instance, restricting blood flow with a ligature can produce significant edemaOpens in new window. Falsified physical signs and symptoms are often supported by false histories and reported test results.
Additionally, in a pattern akin to self-harm, medical signs can be induced through surreptitious means, such as inducing actual illness by infecting one’s wounds, ingesting chemicals or other substances, or by aggravating existing medical conditions.
Frequently seen factitious conditions include bleeding caused by the ingestion of anticoagulant medication, endocrine abnormalities caused by the ingestion of thyroid hormone, abscessesOpens in new window caused by subcutaneous injection of saliva or feces, hyperthermiaOpens in new window caused by manipulating the thermometer, and voluntary limb dislocation.
In one of the most severe examples of factitious disorder reported, a woman named Miss Scott describd being hospitalized at more than 600 hospitals and having 42 operations, nearly all of which were not needed (Grady, 1999).
Some days she would leave one hospital and be admitted to a different hospital by nightfall. One doctor who examined the scars on her abdomen reported that “she looked as if she had lost a duel with Zorro.” When asked about her treatment seeking, she reported, “To begin with, it was just something I did when I needed someone to care about me. Then it became something I had to do. It was as if something took me over. I just had to be in the hospital. I had to.”
She had grown up as an abused, lonely child, and one of her early positive memories was the care she received from a nurse after having her appendix removed.
After that experience, she once walked into her local hospital feigning a stomachache, hoping that someone would care about her experience. She spent several days there appreciating the attention that she received.
Over the course of the next year, she began to seek care at a series of different hospitals. Soon she was spending all her time hitchhiking from town to town, trying to get into the hospital (Grady, 1999, p.D5). For Miss Scot, being a patient became her chief way of gaining support and nurturance.
Certain behavioral features are associated with patients with factious disorder. Pathological lying about various aspects of history and background sometimes occurs. Patients may claim to be related rich, famous, and powerful individuals.
The hospital staff treated one patient royally after he led them to believe that he was a prince from a central African country. Another patient claimed he was related to the senator of an adjoining state. These patients may wander from city to city, state to state, or country to country in search of treatment for their symptoms. In addition, patients with factitious disorder may complain of new physical problems related to different organ systems as soon as one set of symptoms is under control.
Because of the nature of their illness, many patients with factitious disorder do, in fact, need treatment for genuine physical illnesses. For example, a patient who surreptitiously injected fecal material into his skin did have genuine infections, fevers, and septicemia that were life-threatening and required medical intervention in the form of intravenous antibiotics. However, until the factitious etiology of the symptoms is uncovered, treatment is problematic.
The major differential diagnosis for factitious disorder with predominantly psychological symptom is a true mental disorder. This diagnosis is even more difficult to establish with certainty than is factititious disorder with physical symptom because, in most cases, no confirmatory laboratory or imaging findings exist.
In majority of instances, physicians use their experience and intuition to determine whether patients have intentionally produced symptoms in an attempt to cope with stressors that they cannot communicate well to their physicians.