Materiały źródłowe

• #1 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. […] It is possible to identify some predisposing factors for the development of FD. The most significant factors include other mental disorders, general medical conditions that require treatment and hospitalization, especially in childhood or adolescence, deprivation stories (losses, family breakdowns), emotional and physical abuses in childhood. […] The study shows a preponderance of comorbidity with personality disorders (specifically borderline personality disorder) and depressive disorders. This outcome is not surprising since the correlation between FD and personality disorders is frequently described in literature.

• #1 Factitious Disorder – StatPearls – NCBI Bookshelf

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

  Factitious disorder is a condition in which a patient intentionally falsifies medical or psychiatric symptoms, which can be self-induced or fabricated. […] The etiology of factitious disorder is largely based on speculation. No high-quality, large-scale studies demonstrate consistent etiological factors; however, observations have been made based on case reports and small studies. Many experts consider factitious disorder to be largely developmental. The behaviors exhibited are thought to be maladaptive responses to life events, especially during childhood. […] There are several proposed mechanisms behind the behavior found in factitious disorder: Most obvious is the affection one may derive from the sick role, especially in those who sensed a lack of affection during childhood. […] Little is known about the pathophysiology of factitious disorder. One study of 5 individuals with a diagnosis of factitious disorder found that all had excellent intellectual and verbal skills, but neuropsychological testing revealed deficits in conceptual organization and judgment. Based on this, the authors hypothesized that factitious disorder may be related to certain patients’ dysfunction in the right cerebral hemisphere. […] Numerous isolated case reports exist documenting neuroimaging and other findings in patients with factitious disorders. These include hyperperfusion of the right hemithalamus, pathological EEG findings, and mitochondrial disorders.

• #1 Factitious Disorder: Symptoms, Causes & Treatment

  https://www.jagrutirehab.org/disorder/factitious-disorder.html

  Factitious disorder causes remain complex and multifaceted involving psychological, environmental, and biological factors. No cause has been singled out but the following elements contribute to the development of this condition: […] Some research findings indicate that the factitious disorder could be caused by abnormalities in areas of the brain that control emotions and impulse. […] Lack of meaningful relationships and loneliness can also be a compelling reason for people to resort to fabricating illnesses just to get some attention and sympathy as these encounters can temporarily counteract the effects of isolation. […] The misunderstanding of the Factitious Disorder has clouded many myths around it, creating a kind of stigma that obstructs its correct diagnosis and treatment. […] Factitious Disorder is distinct from malingering because in malingering, the person fabricates his or her symptoms to gain personal advantages, which cannot be determined from the onset.

• #1 Factitious disorder – Wikipedia

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

  A factitious disorder is a mental disorder in which a person, without a malingering motive, acts as if they have an illness by deliberately producing, feigning, or exaggerating symptoms, purely to attain (for themselves or for another) a patient’s role. […] What causes factitious disorder is not well understood, however there is a handful of possible motives that drive this pattern of behavior. […] Individuals may experience a heightened thrill from medical procedures, a desire for attention and care, or feelings of control or accomplishment when deceiving medical professionals. […] If an individual did not form a healthy attachment to a caregiver as a child, there is a possibility that the person may develop factitious disorder in order to fulfill the need of receiving care. […] Individuals diagnosed with this disorder are more likely to have a history of emotional or physical abuse, neglect, and/or turbulent childhoods.

• #1 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

  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. […] Statistical analysis have highlighted significant correlations between abuses and neglect in childhood with depressive spectrum disorders and substance abuse but also between substance abuse, BPD and depressive disorder in the female sex. In male gender there are significant correlations between substance abuse and BPD as well as between abuse and neglect in childhood and substance abuse and past experience of illness or long-term hospitalization.

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

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

  The etiology of factitious disorder is largely based on speculation. No high-quality, large-scale studies demonstrate consistent etiological factors; however, observations have been made based on case reports and small studies. Many experts consider factitious disorder to be largely developmental. The behaviors exhibited are thought to be maladaptive responses to life events, especially during childhood. […] There are several proposed mechanisms behind the behavior found in factitious disorder: Most obvious is the affection one may derive from the sick role, especially in those who sensed a lack of affection during childhood. […] Some experts have described factitious disorder as a type of behavioral addiction. Patients with factitious disorder have described an uncontrollable urge to maintain the sick role and, conversely, a desire to overcome their dependence.

• #1 Factitious Disorders (300.19) | Abnormal Psychology

  https://courses.lumenlearning.com/atd-herkimer-abnormalpsych/chapter/factitious-disorders-300-19/

  FD might be attempted to re-enact some unresolved parental issues, or to re-enact a particularly enjoyable hospital visit. […] It also might be a form of masochism. […] It could just be attention seeking behavior or a need for care and nurturance […] Its been speculated that FD may be an attempt to gain control over an authority figure such as a doctor. […] FD is often common amongst people who received extensive medical treatment as children for real physical disorders, experienced extreme family problems or abuse during childhood.

• #1 Factitious disorder: causes, symptoms, and treatments – The Diamond Rehab Thailand

  https://diamondrehabthailand.com/what-is-factitious-disorder/

  Brain abnormalities tend to contribute to the development of a factitious disorder. […] Trauma: Traumatic experiences in childhood pave the way for factitious disorder. Appearing sick on purpose serves as a coping mechanism for an individual who has been neglected or abused. […] Factitious disorder imposed on self, known as Munchausens syndrome, is the act of falsification of symptoms (physical or psychological) without an evident external incentive. […] People with factitious disorders imposed on themselves engage in potentially dangerous behaviors just to appear sick. For instance, they persuade a doctor to undergo a risky surgery. Others ingest substances or inject various chemicals into their bodies to induce injury or symptoms of certain health problems. […] Factitious disorder imposed on another, known as Munchausen syndrome by proxy, is when a person falsely claims the other individual is physically or psychologically sick. They cause injury to that person in order to deceive others.

• #1 Factitious Disorder Imposed on Self – Mental Health Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/mental-health-disorders/somatic-symptom-and-related-disorders/factitious-disorder-imposed-on-self

  The cause is unknown, but stress and a severe personality disorder may contribute. […] What causes factitious disorder imposed on self is unknown, but stress and a severe personality disorder, most often borderline personality disorder, may be involved. […] Faking an illness may be a way to increase or protect self-esteem by blaming social or work problems on their illness, by being associated with prestigious doctors and medical centers, or by appearing unique, heroic, or medically knowledgeable and sophisticated. […] Their deceits are conscious, but their motivation and quest for attention are largely unconscious. […] The diagnosis of factitious disorder imposed on self is made when all of the following are confirmed in a person who presents as sick, impaired, or injured: Doctors observe or discover evidence of exaggeration, faking, falsification, self-induced symptoms, or alterations in the medical history. […] The person has no obvious external incentives for faking or exaggerating symptoms. […] There are no clearly effective treatments.

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

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688583/all/Factitious_Disorder_M%C3%BCnchausen_Syndrome

  The psychological basis is thought to be an unresolved sense of deprivation from childhood that, in a time of stress in adulthood, leads to a false claim of medical illness in order to get care. In Mnchausen, this behavior is chronic. […] Personality predisposition and shaping may be factors, evident in the high degree of deceitfulness, seeming lack of remorse, disregard for safety, inability to manage work and interpersonal situations, and unwillingness to conform to social norms.

• #1 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

  The present study reinforces data in favour of a predominance of females among patients with factitious disorder imposed on self. This diagnosis is difficult and is based on a range of arguments. While induced cases can be of low severity, cases that are only feigned can lead to extreme medical interventions, such as intubation. The present study showed a predominance of female patients with FDIS (73.5%), in line with observations already made on this population in previously cited research. It is worth noting that this prevalence is in particular similar to that reported in Krahns study (72%). These results cast doubt on the previous assumption that the majority of patients are male, as specified in the DSM-IV criteria this stance was in fact abandoned in DSM-5. The frequency of a health-related occupation was 47.1% for patients with a known occupation in our study, compared to 68.3% for Reich, 67% for the recent work by Jimenez (49 cases), 57% for Yates, 50% for Carney and 44.1% for Krahn.

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

  https://2www.aerzteblatt.de/archiv/214473/Factitious-Disorders-in-Everyday-Clinical-Practice

  Due to their considerable heterogeneity on the one hand, and their blurred boundaries on the other, factitious disorders ought to be understood as a particularly severe manifestation on a broad spectrum of dysfunctional illness behavior. […] Approximately 90% of patients feign sickness by fabricating symptoms in a self-harming manner. […] However, the term Mnchausens syndrome is proposed in some cases in the literature for severe, chronic fabrication of symptoms. […] Clinical manifestations involve all organs and organ systems, are staged secretly and often with considerable skill, and range from inventing medical histories to inducing fatal diseases. […] Mental and behavioral disorders such as post-traumatic stress disorder or schizophrenia are also feigned. […] Individuals in medical (assistant) professions, or who fantasize thereof, appear to master this mimicry of the sick person particularly well, and 22-66% have medical qualifications.

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

  https://2www.aerzteblatt.de/archiv/214473/Factitious-Disorders-in-Everyday-Clinical-Practice

  Patients that have undergone early or frequent hospitalization or that have sick relatives potentially have a lower inhibition threshold, extensive knowledge, and specific skills with which to feign illness. […] 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. […] Failure to recognize feigning and symptom fabrication carries the risk of iatrogenic chronification and worsens the prognosis.

• #1 21.3 Factitious Disorder – Psychiatric-Mental Health Nursing | OpenStax

  https://openstax.org/books/psychiatric-mental-health/pages/21-3-factitious-disorder

  The symptoms of factitious disorder can vary depending on the individual and the specific presentation of the disorder. […] Individuals with factitious disorder often possess wide-ranging knowledge of medical conditions, procedures, and treatments. […] Maintaining a facade of illness and deception can negatively affect relationships with family, friends, and health-care providers. […] Factitious disorder is often associated with underlying psychological distress. […] A multidisciplinary approach is most effective when treating factitious disorder. […] It is crucial to address any underlying psychiatric conditions, such as personality disorders or trauma-related disorders, that may contribute to the development or maintenance of factitious disorder. […] Providing a supportive and nonjudgmental environment is also critical when treating factitious disorder.

• #1 Factitious Disorder: Navigating the Challenges of Deceptive Illnesses | CARLAT PUBLISHING

  https://www.thecarlatreport.com/articles/4978-factitious-disorder-navigating-the-challenges-of-deceptive-illnesses

  The medical team’s suspicions strengthen when Emily’s lab results show high insulin levels but low C-peptide levels, a combination that suggests she may be injecting herself with insulin. Normally, when the body produces insulin, it also produces C-peptide in equal amounts. So, when insulin levels are high but C-peptide is low, it’s a strong indication of exogenous insulin use. […] FD is a complex, often under-diagnosed condition that requires careful, empathetic handling. Patients often go to great lengths to induce or fabricate medical symptoms, putting themselves at risk of genuine harm. Engage patients in frank but nonjudgmental dialogue to best manage this condition.

• #1 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

  The two cases of severe haemodynamic failure were reminiscent of the reported cases of deaths resulting from self-induced infection among patients with FDIS. In fact, it has been suggested that the severity of FDIS should be based on whether the medical problem is falsely reported, feigned or induced. However, in the present study, a significant proportion of induced cases were self-inflicted skin lesions of low severity. Conversely, feigned presentations could have serious consequences: for example, a patient who feigned acute respiratory failure was intubated several times. […] The present results confirm that the diagnosis of FDIS is rarely accepted by patients, as none of them admits to trying to deceive others. The psychiatric management of FDIS must be a long-term process. However, it is poorly codified. No management technique has been shown to be superior to another. Usually, psychotherapy with individuals presenting FDIS includes the steps of acknowledging and gaining better understanding the problem, developing more effective coping skills, increasing empathy towards people negatively impacted by the falsifications (friends, family, professionals), taking responsibility for ones own recovery, and developing a helpful support system.

• #1 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

  The diagnostic criteria for DSM-5 factitious disorders were met in 88.7% of cases. The reason for the percentage of patients who do not meet the criteria (11.3%) 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.

• #1 Factitious Disorder vs. Malingering | Charlie Health

  https://www.charliehealth.com/post/factitious-disorder-vs-malingering

  In short, while both involve the fabrication of symptoms, the key difference between factitious disorder and malingering lies in the motivation behind these actions. Factitious disorder is driven by a psychological need to be seen as sick, whereas malingering is motivated by external benefits. […] The primary treatment for factitious disorder is psychotherapy, also known as talk therapy or counseling. This treatment focuses on changing the thinking and behavior of the patient. […] Psychotherapy helps people control stress, develop coping skills, and understand the motivations behind their actions. […] Because initiation and maintenance of treatment can be difficult due to the nature of this disorder, a compassionate, patient, and non-judgmental approach from healthcare providers is crucial. […] Early diagnosis and intervention can significantly improve the prognosis for factitious disorder.

• #2 Factitious Disorder Imposed on Self – Psychiatric Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/psychiatric-disorders/somatic-symptom-and-related-disorders/factitious-disorder-imposed-on-self

  Factitious disorder is falsification of physical or psychological symptoms without an obvious external incentive; the motivation for this behavior is to assume the sick role. […] The cause is unknown, although stress and a severe personality disorder, most often borderline personality disorder, are often implicated. […] Patients may have an early history of emotional and physical abuse. […] Patients appear to have problems with their identity as well as unstable relationships. […] The behavior must occur in the absence of obvious external incentives (eg, time off work, financial compensation for injury). […] Treatment of factitious disorder imposed on self is usually challenging, and there are no clearly effective treatments.

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

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

  The etiology of factitious disorder is largely based on speculation. No high-quality, large-scale studies demonstrate consistent etiological factors; however, observations have been made based on case reports and small studies. Many experts consider factitious disorder to be largely developmental. The behaviors exhibited are thought to be maladaptive responses to life events, especially during childhood. […] There are several proposed mechanisms behind the behavior found in factitious disorder: Most obvious is the affection one may derive from the sick role, especially in those who sensed a lack of affection during childhood. […] Some experts have described factitious disorder as a type of behavioral addiction. Patients with factitious disorder have described an uncontrollable urge to maintain the sick role and, conversely, a desire to overcome their dependence.

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

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

  Little is known about the pathophysiology of factitious disorder. One study of 5 individuals with a diagnosis of factitious disorder found that all had excellent intellectual and verbal skills, but neuropsychological testing revealed deficits in conceptual organization and judgment. Based on this, the authors hypothesized that factitious disorder may be related to certain patients’ dysfunction in the right cerebral hemisphere. […] Numerous isolated case reports exist documenting neuroimaging and other findings in patients with factitious disorders. These include hyperperfusion of the right hemithalamus, pathological EEG findings, and mitochondrial disorders.

• #2 Factitious disorder – Wikipedia

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

  Those with factitious disorder are also more likely to have experienced a severe illness in childhood, with the early exposure to healthcare being a major contributor to the onset of the disorder. […] There is a significant correlation found between the comorbidity of factitious disorder and personality disorders, specifically borderline personality disorder. […] Each particular case of factitious disorder presents itself differently and is derived from various etiologies. However, there is an overarching belief that patients experience the uncontrollable urge to maintain the sick-patient role, acting as a type of behavioral addiction.

• #2 Kevin William Grant—Registered Psychotherapist – Behind the Illness Facade: Understanding Factitious Disorder

  https://www.kevinwgrant.com/blog/item/behind-the-illness-facade-understanding-factitious-disorder

  The etiology of Factitious Disorder is multifaceted, with several theories proposed based on clinical observations, research studies, and case analyses. The exact cause of the disorder remains elusive, but a combination of biological, psychological, and sociocultural factors is believed to contribute. […] Many individuals with Factitious Disorder have a history of childhood trauma, neglect, or illness (Pankratz, 1986). Such early experiences might lead to a learned association between receiving medical attention and obtaining emotional care or comfort. […] Certain personality traits or disorders, especially borderline and dependent personality disorders, have been observed in individuals with Factitious Disorder (Yates Feldman, 2016). These underlying personality characteristics might predispose individuals to seek attention and care through the manifestation of illness. […] While extensive research in this area is lacking, some studies suggest neurobiological factors might be at play. Alterations in brain structure or function, particularly in areas associated with empathy, self-awareness, and impulse control, might contribute to the manifestation of Factitious Disorder (Bass Halligan, 2014).

• #2 Factitious Disorder: Symptoms, Causes, and Treatment

  https://psychcentral.com/health/factitious-disorder

  Research from 2016 found that several other factors may be associated with factitious disorder. First, it was discovered that about 40% of the people living with factitious disorder were depressed. […] Additionally, many had previously worked in a healthcare setting, and the average age of symptom onset was around age 34.

• #3 21.3 Factitious Disorder – Psychiatric-Mental Health Nursing | OpenStax

  https://openstax.org/books/psychiatric-mental-health/pages/21-3-factitious-disorder

  Adverse experiences during childhood, such as abuse, neglect, or significant disruptions in attachment, have been associated with an increased risk of developing factitious disorder. […] Individuals with factitious disorder often have a strong need for attention and validation. […] Certain personality traits may increase the susceptibility to developing factitious disorder. […] Individuals with factitious disorder engage in deceptive behaviors to fabricate or induce symptoms. […] Individuals with factitious disorder may establish a close relationship with health-care professionals, seeking their approval, validation, and attention. […] It is important to note that factitious disorder is different from malingering, where individuals feign symptoms for external incentives, such as financial compensation or avoiding legal responsibilities.

• #3 Factitious Disorder Imposed on Self – Psychiatric Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/psychiatric-disorders/somatic-symptom-and-related-disorders/factitious-disorder-imposed-on-self

  Factitious disorder is falsification of physical or psychological symptoms without an obvious external incentive; the motivation for this behavior is to assume the sick role. […] The cause is unknown, although stress and a severe personality disorder, most often borderline personality disorder, are often implicated. […] Patients may have an early history of emotional and physical abuse. […] Patients appear to have problems with their identity as well as unstable relationships. […] The behavior must occur in the absence of obvious external incentives (eg, time off work, financial compensation for injury). […] Treatment of factitious disorder imposed on self is usually challenging, and there are no clearly effective treatments.

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