Factitious Disorders With Predominantly Physical Signs and Symptoms

Clinical Findings
Physical factitious disorders can take many forms, limited only by human imagination. Individuals have been known to create signs or symptoms of virtually every disease entity. Patients with factitious disorder have created abnormalities such as hypokalemia, anemia, hyperamylasuria, and hypoglycemia. Conditions including acquired immunodeficiency syndrome (AIDS), bleeding disorders, cancer, limb edema/reflex sympathetic dystrophy, shoulder-hand syndrome, and skin conditions have been feigned. Individuals with factitious disorders are generally considered to produce signs and symptoms on three possible levels: 1) fictitious history (e.g., a patient claims to have migraine headaches when in fact he or she has no headache), 2) simulation of disease (e.g., adding drops of blood to a urine specimen to simulate hematuria), or 3) actual creation of a pathophysiological state (e.g., injecting bacteria to create an infection).

The identification and appropriate treatment of factitious disorders are particularly important because these patients can consume vast quantities of expensive services. Clearly these patients are a major financial strain on the health care system.

The best known variant of factitious disorder is Munchausen syndrome. In this condition, the individual pursues an unceasing lifestyle of patienthood. The individual wanders geographically and has sociopathic tendencies (e.g., lying, impostorship). Asher (1951) was the first to label these patients as having Munchausen syndrome because they often told incredible stories (pseudologia fantastica) with dramatic symptoms reminiscent of the Baron von Munchausen children's stories. It is important to note, however, that most factitious disorder patients do not fit the criteria for Munchausen syndrome. P. Reich and Gottfried (1983) and Kapfhammer et al. (1998) reported that up to 90% of factitious disorder patients do not have the Munchausen syndrome variant. This 90% have stable homes, families, and jobs. This differentiation is important because Munchausen syndrome patients are refractory to psychiatric interventions to which other factitious disorder patients may readily respond. With Munchausen syndrome patients, the main intervention is to try to avoid the potential harm of invasive medical procedures and the tremendous expenses incurred. Goldstein (1998) emphasized the importance of differentiating between factitious disorders in patients having reactions to acute stressors and chronic patterns of behavior.