Factitious disorders Flashcards
Factitious Disorder Imposed on Self
(Munchausen syndrome)
- Consciously simulated physical or psychological illness & need to assume a sick role for medical attention & emotional support without external incentive or reward (otherwise, it is likely malingering)
Risk Factors of Factitious Disorder Imposed on Self
- Females
- Unmarried individuals
- Healthcare workers (past or present)
- Past psychiatric history
- Recent family conflicts (examples abuse, divorse…)
Most Frequent Factitious
Psychiatric Symptoms/Illnesses:
- Prolonged Bereavement
- Depression
- Psychosis
- Suicidal ideation and behavior
Most Common Factitious disorder Symptoms/Diseases
- Abdominal pain, vomiting, or diarrhea
- Arthralgia
- Chest pain
- Coagulopathy
- Hematuria
- Hypercortisolism or hyperthyroidism
- Hypoglycemia
- Infections or skin wounds that do not heal
- Seizures or weakness
Factitious Disorder symptoms often accomplished by:
- Exaggerating/fabricating symptoms or medical history
- Exacerbating or inducing symptoms
- Aggravating genuine, existing illness by not adhering to medical recommendations
- Presenting benign physical findings as pathological
- Tampering with medical instruments, tests, or laboratory specimens
- Forging medical records
- Having an accomplice corroborate their story/history
Malingering
Falsification is done to obtain obvious external benefits
Treatment of Factitious Disorder Imposed on Self
- Only one provider overseeing patient management and making all other
providers aware of factitious diagnosis - Consult Psychiatry
- Diagnostic, therapeutic, and procedural interventions must have merit
- Don’t overlook true medical conditions and don’t stop regular evidence based
preventative medical care - Treat comorbid psychiatric disorders
- Cognitive-behavioral therapy (CBT) is often suggested
Factitious behavior can directly lead to death in up to ____
20%
Factitious Disorder Imposed on Another
(Munchausen by proxy)
Also knows as Medical child abuse. A form of abuse in which a caregiver
causes injury to a victim (usually a child) that leads to unnecessary and
potentially harmful medical care
Perpetrator Profile in Factitious Disorder Imposed on Another
- 95 % are female
- Often have history of factitious or somatoform disorders
- Often a history of traumatic childhoods (eg, deprivation and abuse)
- Past history of self-harm, alcohol or drug abuse, and criminal activity
Factitious Disorder Imposed on Another is accomplished by:
- Exaggerating of real symptoms or medical history
- Fabricating a false history/symptoms
- Simulating physical exam findings
- Intentionally inducing illness in their child (generally most serious)
Patient Presentation in Factitious Disorder Imposed on Another
- Recurrent, prolonged & unexplained illness(es) with atypical or inconsistent
findings and/or treatment failures - Inconsistencies in history, medical records from all past treating institutions
- Unusual illnesses or death of siblings
- Signs or symptoms only begin in the presence of the caregiver.
Definitive diagnostic test of Factitious Disorder Imposed on Another
Therapeutic separation of victim from perpetrator → Resolution of illness.
Definitive diagnostic test
* “Illness” resolves without additional care, or medical interventions
Factitious Disorder Imposed on Another treatment
- Take steps to safeguard victim by involving child protection agencies
- Stop any harmful interventions immediately
- Document observations about illness and actions of the perpetrator
- Multidisciplinary team to assess victim & treat any sequelae of factitious illness
- Provide family support
- Repair iatrogenic harm
Malingering
- Defined as deliberate deceptive behavior to simulate an illness to obtain
obvious external benefits including: - Financial support or money
- Medications (eg, opioids or benzodiazepines)
- Disability or time off work
- To obtain child custody
- To avoid criminal prosecution
