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. Motives in factitious disorder may include seeking attention or affection from the sick role, coping with stress, or gaining enjoyment from stumping healthcare workers.[1]
• Factitious disorder can be imposed on oneself or another ("Factitious Disorder Imposed on Another," previously Munchausen Syndrome by Proxy).
• Factitious disorder is classified under the Somatic Symptom and Related Disorders section of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Text Revision (DSM-5-TR).[2]
  • Other diagnoses under this section include somatic symptom disorder, functional neurological disorder (conversion disorder), and illness anxiety disorder.
• 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 feigns illness to reduce distress about not being able to perform a task or achieve a goal.
    • Secondary gain example: A patient feigns illness to avoid work or receive disability compensation for a medical condition.
    • Definite evidence of falsification of symptoms for primary gain is factitious disorder, while definitive evidence of falsification of symptoms for secondary gain is malingering.