Johns Hopkins Psychiatry Guide

Factitious Disorder

Daniel F. Ruthven, M.D.
Factitious Disorder is a topic covered in the Johns Hopkins Psychiatry Guide.

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DEFINITION

  • Factitious disorder is a behavioral disorder characterized by the intentional production/feigning of physical and/or psychological signs and/or symptoms in the absence of clear external rewards.
  • Factitious disorder is classified under the Somatic Symptom and Related Disorders section of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) [1].
  • When considering this diagnosis, it is important to have a firm understanding of somatization.
    • Somatization is the expression of mental phenomena as physical (somatic) symptoms.
    • There is a continuum of unconscious/non-volitional display of symptoms (patient unaware of the non-physiologic nature of symptoms) to conscious/volitional display (patient aware of the non-physiologic nature of symptoms).
    • Also important is the difference between primary gain (positive internal motivations) vs. secondary gain (positive external motivations).
      • Primary Gain Example: A patient feels guilty about not being able to perform a task, but if there is a medical condition justifying this inability, the guilt diminishes.
      • Secondary Gain Examples: A patient is allowed to miss work and gets financial compensation as the result of a medical condition.
      • Definite evidence of falsification of symptoms for primary gain is factitious disorder and for secondary gain is malingering.

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Last updated: October 17, 2014