Factitious Disorder

The DSM-5 gives the following criteria for a diagnosis of factitious disorder:

Factitious Disorder Imposed on Self

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.

B. The individual presents himself or herself to others as ill, impaired, or injured.

C. The deceptive behavior is evident even in the absence of obvious external rewards.

D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Specify:

Single episode

Recurrent episodes (two or more events of falsification of illness and/or induction of injury)

Factitious Disorder Imposed on Another

(Previously Factitious Disorder by Proxy)

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception.

B. The individual presents another individual (victim) to others as ill, impaired, or injured.

C. The deceptive behavior is evident even in the absence of obvious external rewards.

D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Note: The perpetrator, not the victim, receives this diagnosis.

Specify:

Single episode

Recurrent episodes (two or more events of falsification of illness and/or induction of injury

Criterion A addresses that factitious disorder features the falsification or deliberate creation of physical or mental health symptoms either in oneself or in another with the intention of deception. If symptoms really exist, this diagnosis still applies if the symptoms are deliberately exaggerated to make the individual feigning them or being forced to feign them appear more ill or impaired than they really are.

Criterion B specifies that the supposed or induced symptom, injury, or illness is not kept private but is instead presented to others, possibly including health professionals, by the one behind the deception.

Criterion C ensures that factitious disorder is not confused with malingering. Factitious disorder is a mental illness while malingering is driven by an external reward (such as disability benefits or time off from work).

Criterion D excludes symptoms that are due to other mental disorders.

The individual behind the deception is the individual diagnosed. If the deception is imposed on another, the one who is forced to feign symptoms or the one who has injuries or illnesses induced is a victim. Factitious disorder imposed on another constitutes abuse.

Factitious disorder can cause real physical, mental, and emotional harm to the individual behind the deception, to the individual having symptoms imposed on them, and to family, friends, and health care professionals who attempt to care for or support the individual(s). It is estimated that 1% of individuals in hospital settings have factitious disorder, though the role of deception helps to obscure the true statistic (American Psychiatric Association, 2013).¹ In tertiary care settings, such as specialized treatment for cancer, the rate may be as high as 9% (Madrid, 2012).² Regarding psychiatric health, factitious disorders are thought to account for 0.5% of psychiatric hospital admissions, 6.4% of psychotic disorders in individuals who are inpatient, and 2-10% of dissociative disorders in individuals who are inpatient (Welburn et. al, 2003).³ Intermittent and recurrent episodes are more common than single or unrelenting episodes. The disorder often begins in young adulthood after a hospitalization of either the individual behind the deception or of the dependent that symptoms are being imposed on (American Psychiatric Association, 2013).¹

Factitious disorder should be distinguished from lies made to hide abuse, somatic symptom disorder, malingering, conversion disorder, borderline personality disorder or unassociated self harm, and actual medical or mental disorders that are responsible for the symptoms witnessed. Again, however, it should be noted that an individual can have the symptoms reported but also be deceptively exaggerating these symptoms or sometimes inducing them (American Psychiatric Association, 2013).¹

¹ American Psychiatric Association. (2013). Somatic Symptom and Related Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). http://dx.doi.org/10.1176/appi.books.9780890425596.dsm09

² Madrid, C. (2012, November 21). The lying disease: Why would someone want to fake a serious illness on the internet? Retrieved May 24, 2015 from http://www.thestranger.com/seattle/the-lying-disease/Content?oid=15337239

³ Welburn, K. R., Fraser, G. A., Jordan, S. A., Cameron, C., Webb, L. M., & Raine, D. (2003). Discriminating dissociative identity disorder from schizophrenia and feigned dissociation on psychological tests and structured Interview. Journal of Trauma & Dissociation, 4(2), 109-130. doi:10.1300/j229v04n02_07