Materiały źródłowe

• #1 Factitious Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557547/

  The prevalence of factitious disorder in the general population is difficult to estimate and varies widely among different studies. Due to the secretive nature of this disorder, it is likely underdiagnosed; further, there is no defined threshold for the level of deception required to make a diagnosis. One study involving 241 German physicians in primary care and various subspecialty fields estimated factitious disorder prevalence at 1.3%. Another study analyzing 100 consecutive admissions to an inpatient psychiatric ward in New York found a diagnosis of factitious disorder in 6% of the study population. Factors that have been ascertained to increase the diathesis of this disease include female sex, employment in the healthcare field, and being unmarried. Most often, factitious disorder onsets in early adulthood or middle age.

• #2 Factitious Disorder | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21573

  The prevalence of factitious disorder in the general population is difficult to estimate and varies widely among different studies. Due to the secretive nature of this disorder, it is likely underdiagnosed; further, there is no defined threshold for the level of deception required to make a diagnosis. One study involving 241 German physicians in primary care and various subspecialty fields estimated factitious disorder prevalence at 1.3%. Another study analyzing 100 consecutive admissions to an inpatient psychiatric ward in New York found a diagnosis of factitious disorder in 6% of the study population. Factors that have been ascertained to increase the diathesis of this disease include female sex, employment in the healthcare field, and being unmarried. Most often, factitious disorder onsets in early adulthood or middle age.

• #3 Epidemiology and evolution of the diagnostic classification of factiti | PRBM

  https://www.dovepress.com/epidemiology-and-evolution-of-the-diagnostic-classification-of-factiti-peer-reviewed-fulltext-article-PRBM

  Factitious disorder (FD) is a psychiatric disorder in which sufferers intentionally fabricate physical or psychological symptoms in order to assume the role of a patient, without any obvious gain. […] The exact prevalence of the disorder is currently unknown but it has been estimated between 0.6% and 3% of referrals from general medicine to psychiatry and between 0.02% and 0.9% of cases reviewed in specialist clinics. […] The study showed that the patients did not meet Diagnostic and Statistical Manual of Mental Disorders-5 diagnostic criteria in 11.3% of cases. […] Early detection of FD is very important to limit harm to patients, and early management of FD may facilitate improved outcomes for patients with the disorder. […] Studies on FD demonstrate the huge impact of unnecessary investigations, treatments, and hospital admission on the health care system. Early detection of FD is necessary in order to limit wastage of health care resources and harm to patients.

• #4 A Systematic Review on Factitious Disorders: Psychopathology and Diagnostic Classification

  https://www.jneuropsychiatry.org/peer-review/a-systematic-review-on-factitious-disorders-psychopathology-and-diagnostic-classification-12370.html

  Factitious disorder (FD) is a psychiatric disorder in which sufferers intentionally fabricate physical or psychological symptoms in order to assume the role of the patient, without any obvious gain. The exact prevalence of the disorder is currently unknown but it has been estimated between 0.6% and 3 % of referrals from general medicine to psychiatry and between 0.02% and 0.9% of cases reviewed in specialist clinics. The study showed that patients did not meet DSM-5 diagnostic criteria in the 11.3% of cases. Early detection of factitious disorder is very important to limit harm to patients and early management of FD may facilitate improved outcomes for patients with the disorder. Studies on FD demonstrate the huge impact of unnecessary investigations, treatments and hospital admission on the healthcare system. The demographic profile of the sample shows a prevalence of female. This data support the hypothesis of several case reports that FD occur mainly in women. However other studies published in literature show a clear prevalence in male gender. All medical specialties may be interested in the management of factitious patients as evidenced by the clinical heterogeneity of the sample, but the study reveals a prevalence of psychiatry, emergency room and internal medicine departments. Among the factors leading to diagnosis of FD, the exclusion of other organic or psychiatric causes is the most represented. This is undoubtedly important both from a diagnostic point of view and because in patients with factitious disorders there may be physical or psychic comorbidity which are not diagnosed because of the nature of the disorder itself, which function as a confounding factor in the clinical presentation.

• #5

  https://link.springer.com/article/10.1007/s12024-020-00272-x

  Factitious disorders (FD) like Munchausen syndrome are well known to most physicians, yet the corresponding ICD-10 diagnosis F68.1 remains severely under-assigned and often misdiagnosed. […] The incidence of the diagnosis of FD in Germany and Norway showed similar assignment rates with 3.71 and 3.18 per 100,000, respectively. […] Systematic studies on the incidence of FD are relatively rare, with the major obstacle of obtaining a reliable and valid incidence being the nature of this disorder itself. […] The incidence of the diagnosis of FD in Germany and Norway showed similar assignment rates with 3.71 and 3.18 per 100,000, respectively. […] These results illustrate the difference between the estimations of the incidence of FD and the need for further studies.

• #6 Factitious Disorder: Detection, Diagnosis, and Forensic Implications

  https://www.psychiatrictimes.com/view/factitious-disorder-detection-diagnosis-and-forensic-implications

  Few phenomena in medicine are more confounding than the diagnoses involving deception: malingering, Munchausen syndrome, Munchausen by proxy (MBP), and factitious disorder. […] In some tertiary care settings sensitive to the issue of medical deception, the reported prevalence has been as high as 9.3% among patients with fever of unknown origin. […] In a prospective study on a psychiatric unit, the incidence was 6%. […] Still, the broader range of somatoform disorders, those mind-body disorders that occur at the intersection of disease and illness, are much more common.

• #7 Factitious Disorders in Everyday Clinical Practice (26.06.2020)

  https://di.aerzteblatt.de/int/archive/article/214473

  Little is known about the frequency of factitious disorders in their widely varying forms and degrees of severity. Current data from the central Norwegian patient registry showed a prevalence of only 0.0026%; however, careful review revealed that diagnoses were frequently incorrect and far too rarely made. A 1-year prevalence of around 1% (to 5%) is usually assumed in clinical populations. Numbers vary considerably depending on the survey method used and familiarity with the diagnosis, as well as on the specialty. The (suspected) diagnosis was made in 7.5% of pre-selected patients in a psychosomatic consultation liaison service. Systematic reviews of published case studies reported a high proportion of case reports in psychiatry (19%), accident and emergency departments (12%), neurology/neurosurgery (10%), infectiology and dermatology (9% each), endocrinology (13%), as well as cardiology and dermatology (10% each). Between 40 and 64% of cases remain suspected cases.

• #8 Münchhausen’s Syndrome: Symptoms and Treatment | Doctor

  https://patient.info/doctor/munchhausens-syndrome

  How common is Mnchhausen’s syndrome? (Epidemiology) […] Data from the central Norwegian patient registry showed a prevalence of only 0.0026%; however, careful review revealed that diagnoses were frequently incorrect and far too rarely made. […] A one-year prevalence of around 1-5%) is likely to be closer to reality in clinical populations. […] Systematic reviews of published case studies reported a high proportion of case reports in psychiatry (19%), accident and emergency departments (12%), neurology/neurosurgery (10%), infectious diseases and dermatology (9% each), and endocrinology (13%), as well as cardiology and dermatology (10% each). […] Patients are more commonly male. […] Most patients are white. Most cases reported in the literature are aged 30-50 years.

• #9 Factitious Disorders (300.19) – Abnormal Psychology

  https://fscj.pressbooks.pub/abnormalpsychology/chapter/factitious-disorders-300-19/

  FD often goes undetected therefore making it difficult to accurately determine how many people are afflicted. […] It has been shown that there is a much higher prevalence of physical factitious symptoms than psychological factitious symptoms. […] Only a few select studies have been done to show its prevalence. A large teaching hospital in Toronto reported that 10 of 1,288 patients referred to a consultation service had FD (0.8%). The National Institute for Allergy and Infectious Disease reported that 9.3% of patients referred for fevers of unknown origin had factitious disorder. A clinic in Australia found that 1.5% of infants brought in for serious illnesses by parents were cases of Munchausen syndrome by proxy.

• #10 Factitious Disorder/Münchausen Syndrome | 5-Minute Clinical Consult

  https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688583/0.2/Factitious_Disorder_M

  Incidence Estimates vary on the incidence of medical child abuse. In the United States, an estimated 200 new cases of serious abuse are expected to be uncovered yearly. […] Prevalence Factitious disorder with predominantly physical signs and symptoms: up to 5% of patient-physician encounters may be due to a factitious production of symptoms but hard to estimate due to the secretive nature of the disorder; identified as the probable cause of 39% of fevers of unknown origin in prospective studies. […] It is estimated that between 0.02% and 0.9% of all referrals to medical specialists may be cases of factitious disorder, rather than medical illnesses.

• #11 A descriptive, retrospective case series of patients with factitious disorder imposed on self | BMC Psychiatry | Full Text

  https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-021-03582-8

  Factitious disorder imposed on self (FDIS) is defined by the fifth edition of the Diagnostic and statistical manual of mental disorders (DSM) as falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception. […] Despite cases of factitious disorder imposed on self being documented in the literature for decades, it appears to remain an under-identified and under-diagnosed problem. […] FDIS can be encountered in all medical specialities. […] However, FDIS remains an under-identified and under-diagnosed problem. […] One of the largest systematic samples of FDIS patients dates back almost 20 years. […] The present study reinforces data in favour of a predominance of females among patients with factitious disorder imposed on self. […] The present study explored FDIS in a European hospital sample. It is likely that the frequency of FDIS was underestimated, due in part to differential diagnoses. […] In all events, our results reinforce the data in favour of a predominance of females among patients with FDIS.

• #12 Factitious Disorder – PsychDB

  https://www.psychdb.com/somatic/dsm-5/factitious

  The prevalence of factitious disorder is unknown, since the disorder involves deception; in hospital settings, it is estimated that up to 1% may meet criteria for factitious disorder. […] Factitious disorder is more common in women and healthcare workers. […] In factitious disorder imposed on another (FDIA, or Munchausen syndrome by proxy) almost all perpetrators are female, and more than 95% of perpetrators are the mother.

• #13 Factitious Disorders in Everyday Clinical Practice (26.06.2020)

  https://di.aerzteblatt.de/int/archive/article/214473

  Approximately 90% of patients feign sickness by fabricating symptoms in a self-harming manner. These factitious disorders in the narrower sense occur primarily in younger females. Likewise, across medical specialities and clinical presentations, patients with factitious disorders tend to be younger females. Merely in neurology and cardiology, as well as in investigations for HIV/sexual dysfunction, the proportion of males appears to be higher, while in dermatology this is the case for older patients. Only around 10% of cases correspond to the Mnchhausen subtype of evasive hospital hopper with a dramatic medical history. These cases are predominantly middle-aged males with dissocial personality traits. However, the term Mnchausens syndrome is proposed in some cases in the literature for severe, chronic fabrication of symptoms. In clinical routine, the term is often misleadingly used in an undifferentiated manner for the entire spectrum of factitious disorders.

• #14 Factitious Disorder | Neupsy Key

  https://neupsykey.com/factitious-disorder/

  Factitious disorder, also called Munchausens syndrome, refers to the condition in which patients consciously induce or feign illness in order to obtain a psychological benefit from being in the sick role. […] The nature of factitious disorder makes it difficult to determine how common it is within the general population. Patients attempt to conceal themselves, thereby artificially lowering the prevalence. The tendency of patients to present several times at different facilities, however, may artificially raise the prevalence. Most estimates of the prevalence of the disease rely on the number of factitious patients within a given inpatient population. Such attempts have generated estimates that 0.53% of medical and psychiatric inpatients suffer from factitious disorder. […] Reports in the literature show patients ranging from 8 to 85 years. Case series suggest that the majority of people with factitious disorder are women one case series found 78% of patients to be women while the majority of patients with the more severe Munchausens variant are men.

• #15 Factitious Disorders | Neupsy Key

  https://neupsykey.com/factitious-disorders/

  Factitious disorder is diagnosed in about 1 percent of patients who are seen in psychiatric consultation in general hospitals. […] Limited studies indicate that factitious disorder patients may comprise approximately 0.8 to 1.0 percent of psychiatric consultation patients. […] Good epidemiological data are lacking, however. […] Approximately two thirds of patients with Munchausens syndrome are male. […] Patients diagnosed with factitious disorders with physical signs and symptoms are mostly women, who outnumber men 3 to 1. […] Factitious physical disorders usually begin for patients in their 20s or 30s, although the literature contains cases ranging from 4 to 79 years of age. […] Factitious disorder by proxy (discussed separately later) is most commonly perpetrated by mothers against infants or young children. […] Rare or underrecognized, it accounts for less than 0.04 percent, or 1,000 of 3 million cases, of child abuse reported in the United States each year.

• #16 Factitious disorder imposed on another – Wikipedia

  https://en.wikipedia.org/wiki/Factitious_disorder_imposed_on_another

  FDIA is rare. Incidence rate estimates range from 1 to 28 per million children, although some assume that it may be much more common. One study in Italy found that 4 out of more than 700 children admitted to the hospital met the criteria (0.53%). In this study, stringent diagnostic criteria were used, which required at least one test outcome or event that could not possibly have occurred without deliberate intervention by the FDIA person. […] In one study, the average age of the affected individual at the time of diagnosis was four years old. Slightly over 50% were aged 24 months or younger, and 75% were under six years old. The average duration from onset of symptoms to diagnosis was 22 months. By the time of diagnosis, six percent of the affected persons were dead, mostly from apnea (a common result of smothering) or starvation, and seven percent had long-term or permanent injury. About half of the affected had siblings; 25% of the known siblings were dead, and 61% of siblings had symptoms similar to the affected or that were otherwise suspicious. The mother was the perpetrator in 76.5% of the cases, the father in 6.7%.

• #17 Factitious Disorder Imposed On Another – FindZebra

  https://www.findzebra.com/details/YGKYoDj-factitious-disorder-imposed-on-another?q=

  FDIA is rare. A study in Italy found that 4 out of more than 700 children admitted to the hospital met the criteria (0.53%). In this study, stringent diagnostic criteria were used, which required at least one test outcome or event that could not possibly have occurred without deliberate intervention by the FDIA person. […] One study showed that in 93 percent of FDIA cases, the abuser is the mother or another female guardian or caregiver. A psychodynamic model of this kind of maternal abuse exists. […] FDIA may be more prevalent in the parents of those with a learning difficulty or mental incapacity, and as such the apparent patient could, in fact, be an adult. […] Fathers and other male caregivers have been the perpetrators in only seven percent of the cases studied. When they are not actively involved in the abuse, the fathers or male guardians of FDIA victims are often described as being distant, emotionally disengaged, and powerless. […] Overall, male and female children are equally likely to be the victim of FDIA. In the few cases where the father is the perpetrator, however, the victim is three times more likely to be male.

• #18 Factitious disorder imposed on another – Wikipedia

  https://en.wikipedia.org/wiki/Factitious_disorder_imposed_on_another

  Studies have shown that over 90% of FDIA cases, the abuser is the mother or another female guardian or caregiver. A psychodynamic model of this kind of maternal abuse exists. Fathers and other male caregivers have been the perpetrators in seven percent of the cases studied. When they are not actively involved in the abuse, the fathers or male guardians of FDIA victims are often described as being distant, emotionally disengaged, and powerless. These men play a passive role in FDIA by being frequently absent from the home and rarely visiting the hospitalized child. Usually, they vehemently deny the possibility of abuse, even in the face of overwhelming evidence or their child’s pleas for help.

• #19 Factitious Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557547/

  Factitious disorder is an inherently secretive disorder, and thus, many patients go undiagnosed and untreated. These patients may present to nearly any specialty. Many physicians and other healthcare providers are unfamiliar with managing these patients and strategies for providing care. Healthcare providers must familiarize themselves with tools for identifying these patients to prevent unnecessary workups and risky procedures to initiate appropriate treatment.

• #20 Factitious Disorder | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21573

  The diagnosis of factitious disorder is most often based on DSM-5 criteria: Identified deception involves falsification of psychological or physical symptoms or induction of injury or disease. The individual presents themselves to others as ill, injured, or impaired. The deception is evident in the absence of external rewards. Another mental disorder does not better explain the behavior. Single or recurrent episodes should specify the behavior. […] Factitious disorder is an inherently secretive disorder, and thus, many patients go undiagnosed and untreated. These patients may present to nearly any specialty. Many physicians and other healthcare providers are unfamiliar with managing these patients and strategies for providing care. Healthcare providers must familiarize themselves with tools for identifying these patients to prevent unnecessary workups and risky procedures to initiate appropriate treatment.

• #21

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5729833/

  A systematic search for all case reports and case series of adult patients with factitious disorders (FD) in the databases MEDLINE, Scopus, and PsycINFO was conducted. The exact prevalence of the disorder is currently unknown but it has been estimated between 0.6% and 3% of referrals from general medicine to psychiatry and between 0.02% and 0.9% of cases reviewed in specialist clinics. […] The study showed that the patients did not meet Diagnostic and Statistical Manual of Mental Disorders-5 diagnostic criteria in 11.3% of cases. […] The diagnostic criteria for DSM-5 FD were met in 88.7% of cases. The reason for the remaining 11.3% of patients not meeting the criteria can be found in the reclassification that these conditions had in the modern edition of the manual some patients who first met the criteria of previous editions are now most likely included in another diagnostic category.

• #22 Epidemiology and evolution of the diagnostic classification of factiti | PRBM

  https://www.dovepress.com/epidemiology-and-evolution-of-the-diagnostic-classification-of-factiti-peer-reviewed-fulltext-article-PRBM

  The diagnostic criteria for DSM-5 FD were met in 88.7% of cases. The reason for the remaining 11.3% of patients not meeting the criteria can be found in the reclassification that these conditions had in the modern edition of the manual some patients who first met the criteria of previous editions are now most likely included in another diagnostic category.

• #23 Factitious Disorders in Everyday Clinical Practice (26.06.2020)

  https://di.aerzteblatt.de/int/archive/article/214473

  The scant prognostic data that are available indicate drastic differences in the degree of self-harm and the resulting degree of disability: approximately 10-30% of factitious acts appear to be isolated and harmless events; one sees mild disease courses and complete remissions. However, episodic or chronic courses with sometimes lasting disabilities appear to be more common. Mortality is likely to be increased: causes of death can include complications from (provoked) interventions or suicide, while approximately 14% of patients have suicidal thoughts. Failure to recognize feigning and symptom fabrication carries the risk of iatrogenic chronification and worsens the prognosis.

• #24 Factitious Disorder | Concise Medical Knowledge

  https://www.lecturio.com/concepts/factitious-disorders/

  The estimated prevalence is 5% in hospitalized patients. […] More common in men than women. […] Prevalence is higher in healthcare workers and those with higher intelligence. […] Many people with factitious disorders have underlying comorbid psychiatric disorders such as personality, mood, or substance use disorders.

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