This is the 2007 version. Click here for the 2017 chapter 12 table of contents.

Factitious Disorders

Mental health professionals sometimes encounter fraud and deception by patients. One section on axis 1 of DSM-IV is devoted to such disorders.

What are factitious disorders?

Factitious disorders are fake or voluntary, aimed at achieving the patient role. Such patients are frequently hostile, demanding treatment. They show no obvious anxiety and can switch their symptoms on or off at will. This category is one of the hardest to diagnose because the patients are masters at deception (Spitzer, Forman and Nee, 1979).

What is Munchausen syndrome?

Patients with Munchausen syndrome seek to gain admission to hospitals. One famous example, Stewart McIlroy, managed 207 admissions in 68 hospitals, costing the British taxpayers several million pounds through charges to the national health insurance system. Frequently such people have an expert knowledge of medical symptoms, including those that are most useful for gaining immediate admission to a hospital.

What widely reported case brought Munchausen syndrome by proxy to public attention?

Munchausen syndrome by proxy is a variety of Munchausen syndrome that is "acted out" through another person. The syndrome was highlighted in the United States media in 1996 when a mother in Florida, whose child suffered from a long string of medical problems, was found to be causing the problems deliberately. Authorities charged that she had even injected fecal matter into the daughter's intravenous tubing. Apparently the motivation was the public attention that the woman and her daughter received. For example, the woman was able to obtain a photograph of herself and her wheelchair-bound daughter standing next to the President's wife during a hospital fund-raiser.

While previous versions of the Diagnostic and Statistical Manual of Mental Disorders listed Munchausen syndrome and Munchausen syndrome by proxy as formal diagnostic categories, DSM-IV adopted a more colorless terminology. Munchausen syndrome is now called factitious disorder with predominantly physical signs and symptoms, while Munchausen syndrome by proxy is called factitious disorder by proxy.

What is the difference between malingering and factitious disorders?

Malingering occurs when a person acts sick for ulterior motives such as collecting insurance money or escaping from a bad situation at home or school. Unlike factitious disorders, malingering is not an addiction to the patient role. It is described under factitious disorders in DSM-IV but is not treated as a diagnostic category because it requires legal rather than clinical attention.

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