Factitious disorder

Background

The falsification of medical or psychological signs and symptoms in oneself or others that are associated with the identified deception, absent of obvious external rewards

Clinical Features

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.

Factitious Disorder Imposed on Another

• A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, on 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.

Differential Diagnosis

• Somatic symptom disorder
• Malingering
• Conversion disorder
• Borderline personality disorder
• Medical condition or mental disorder not associated with intentional symptom falsification

Evaluation

Difficult to diagnose, as often a diagnosis of exclusion. Refer to the patient's medical record for indication of repeated visits, recurrent testing, or multiple identities.

Management

Close outpatient psychotherapy focused on establishing and maintaining a relationship with the patient.

Disposition

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