Factitious Disorders and Malingering Introduction

Factitious disorders are those illnesses that are consciously created by an individual. They represent the willful production of signs and symptoms of disease. Usually the patient’s primary goal is to receive medical, surgical, or psychiatric care to satisfy some psychological need. These patients are often of great interest to physicians because their behavior typically involves getting physicians and nurses to participate in their psychological disorder. The DSM-IV (American Psychiatric Association 1994) criteria for factitious disorder are given in

Table 62-1.

Factitious disorders may be best considered a form of abnormal illness-affirming behavior. Individuals with this behavior either create or amplify clinical signs or symptoms to appear more ill than the level of biomedical disease would indicate. In contrast to self-mutilating patients, who usually admit to producing their injury and do not aim their behaviors at obtaining medical care, factitious disorder patients typically conceal the origin of their disorder and specifically seek care. In contrast to malingering patients, factitious disorder patients produce illness primarily to achieve a psychological benefit; external incentives play only a secondary role.

The factitious illness that is produced can be either physical or psychological in nature. In this chapter, I discuss the nature of and treatment strategies for both types of factitious disorder. I also discuss the treatment of Munchausen syndrome by proxy (MSP), in which one person creates signs or symptoms of illness in another person. Finally, I discuss the identification and management of malingering. I begin with the factitious physical disorders because they have been the best studied.