Diagnosing Factitious Disorder

EPC 695B Advanced Behavior Disorders

The presence of the following factors may raise the possibility that the illness is factitious:

  • Dramatic or atypical presentation
  • Vague and inconsistent details, although possibly plausible on the surface
  • Long medical record with multiple admissions at various hospitals in different cities
  • Knowledge of textbook descriptions of illness
  • Circumstances that do not conform to an identifiable medical or mental disorder
  • An unusual grasp of medical terminology
  • Employment in a medically related field
  • Pseudologia fantastica i.e., uncontrollable lying characterized by a fantastic description of false events in their lives)
  • Arrival in the emergency department during times when obtaining old medical records is hampered or when experienced staff are less likely to be present (e.g., holidays, late Friday afternoons)

Other clues that may arise during the course of treatment include the following:

  • A patient who has few visitors despite giving a history of holding an important or prestigious job or a history that casts the patient in a heroic role
  • Calmly accepting the discomfort and risk of diagnostic procedures (La belle indifference) or the discomfort and risk of surgery
  • Symptoms or behaviors only present when the patient is being observed
  • Controlling, hostile, angry, disruptive, or attention-seeking behavior duringhospitalization
  • Fluctuating clinical course, including rapid development of complications or a new pathology if the initial workup findings prove negative
  • Giving approximate answers to questions (e.g., a horse has 3 legs; 7 X 6 = 41), usually occurring in FD with predominantly psychological signs and symptoms

Physical clues may be present:

  • Suspicion of FD is raised when the patient has multiple surgical scars, indicating the chronic form of FD,
  • Or, with evidence of self-induced physical signs.

Mental Status Examination:

  • Patients with FD may vary in their presentation.
  • No findings have been shown to be predictive of FD
  • The following findings are possible:
  • Appearance may include physical findings described above.
  • Attitude may range from cooperative with assessment and treatment to evasive and vague regarding details.
  • Mood and affect may be brighter than what would be expected given the patient's medical condition.
  • Perceptual abnormalities, such as hallucinations and disturbances of thought process or thought content, and suicidality and/or homicidality may be present with FD with predominantly psychological signs and symptoms.
  • Patients having FD with predominantly physical signs and symptoms usually do not confess to thoughts of harming themselves or others, even when they have actually harmed themselves by deliberately inducing physical illness.
  • Cognitive functioning may be aberrant if the patient presents with Ganser syndrome.