Chapter 9 - Managing factitious disorder and malingering

Summary

The cause of factitious disorder is a matter of speculation. Risk factors are thought to include histories of child abuse, childhood hospitalizations that may have been attempts to escape abusive and chaotic families and households, and parental rejection or over-reaction to illness. Patients with factitious disorder can self-induce illness in ways that result in severe disfigurement or death, often from unnecessary medical interventions. Presentations of factitious disorder and its most severe variant, often called Munchausen's syndrome, can range from completely fabricating a medical (or psychiatric) illness, to aggravating or exaggerating symptoms, to simulating an illness, such as by mimicking a generalized seizure episode or by inducing one. Most authors do not discuss treatment for malingering because it is not considered a mental illness. However, some authors emphasize the importance of letting the malingerer save face while giving up the sick role. Recovery, not confession, is often the most realistic goal.