Factitious Disorder

What Causes Factitious Disorder?

The cause of FD is not yet known. It is likely triggered by a combination of factors, including biology and external environmental events. Some elements seem to put a person at increased risk for FD. Possible risk factors include:

• Childhood trauma or abuse
• Serious childhood illness
• Depression
• Low self-esteem
• Personality disorders
• Experience working in healthcare or a fascination with medical care

Is Factitious Disorder Hereditary?

There is no known inherited genetic cause of FD. However, some of the risk factors for the disorder can have an inherited component. For example, having a mental illness such as depression or anxiety increases FD risk, and those illnesses are more common in people with a family history.

How Is Factitious Disorder Detected?

Early detection of FD is challenging because a person with the disorder goes to great lengths to hide their deception. They may self-report symptoms, create actual symptoms through self-harm, or produce falsified medical records, making it hard for medical professionals to spot the deception.

Possible warning signs of FD include:

• Inconsistent medical history
• Inconsistent symptoms
• Unexplained relapses after treatment
• Symptoms that change after negative test results
• Symptoms that only occur when the person is alone
• Eagerness to undergo medical tests or procedures
• Fascination with or extensive knowledge of medical terminology
• Discouraging contact between healthcare providers and family members, friends, or previous providers
• Avoidance of psychological evaluation

How Is Factitious Disorder Diagnosed?

Diagnosis of FD begins by ruling out medical problems that may be causing symptoms. After these exams, if the doctor suspects that FD or another mental disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment.

Diagnostic steps may include:

• A physical exam. This exam aims to rule out physical conditions that could be causing the symptoms.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

After medical causes are ruled out, medical professionals can consider whether the patient meets the diagnostic criteria for FD. These criteria include:

• The person has engaged in identifiable deception regarding physical or psychological symptoms.
• The person presents themselves as ill, injured, or impaired.
• The deception continues even without external benefits (e.g., financial gain).
• Another mental disorder doesn’t better explain the behavior.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Factitious Disorder Treated?

There is no cure for FD, and no medications have proven effective at improving symptoms. Psychotherapy, usually cognitive behavioral therapy, is the most common course of treatment. In most cases, a person with FD will be unwilling to admit they have a problem or to participate in treatment for FD.

How Does Factitious Disorder Progress?

The long-term outlook for people with FD is typically poor. They are unlikely to seek or continue treatment. Some research has suggested that ongoing psychotherapy can improve symptoms, but it is rare for someone with FD to stick with a treatment program.

When a person with FD imposes their behavior on another person, that person is at serious risk of harm.

Long-term complications of FD can include:

• Self-harm caused by self-infliction of symptoms
• Complications from repeated and/or unnecessary medical procedures
• Depression or other mental disorders
• Social isolation
• Lack of healthy interpersonal relationships
• Work difficulties or unemployment
• Financial difficulties
• Legal difficulties
• Alcohol or substance abuse

How Is Factitious Disorder Prevented?

There is no known way to prevent FD.

Factitious Disorder Caregiver Tips

Many people with factitious disorder also suffer from other brain and mental health-related issues, a situation called co-morbidity. Here are a few of the disorders commonly associated with FD:

• Many people with FD also suffer from depression.
• Anxiety disorders are common in people with FD.
• People with FD are at risk of alcoholism or substance use disorders.
• Many people with FD have a co-morbid personality disorder such as borderline personality disorder.

Factitious Disorder Brain Science

Several studies have suggested that the brains of people with FD may differ from those without FD, at least in some cases. Study findings include:

• Some people with FD show deficits in judgment and organization despite having above-average intellectual and verbal skills. This combination of skills and deficits has led some researchers to suggest that these people might have impairment in their right cerebral hemisphere, a part of the brain that plays a role in emotion and body image.
• Other studies have found individual incidences of problems with the right hemithalamus, electrical brain activity, and mitochondrial disorders in people with FD.

Factitious Disorder Research

Title: Study of Dextromethorphan in OCD and Related Disorders

Stage: Not Yet Recruiting

Principal investigator: Peter J. van Roessel, MD PhD

Stanford University

Palo Alto, CA

This study aims to assess the tolerability and efficacy of dextromethorphan in combination with fluoxetine for symptom relief in OCD and related disorders.

Obsessive-compulsive disorder (OCD) and the related disorders body dysmorphic disorder (BDD), somatic symptom disorder (SSD), and illness anxiety disorder (IAD) are psychiatric conditions characterized by recurrent, intrusive thoughts, feelings or images (obsessions or preoccupations) and repetitive or ritualized behaviors or avoidance performed to relieve obsession or preoccupation-related anxiety. They are a significant cause of mental health-related disability and are inadequately served by available treatments.

This study tests whether an over-the-counter cough suppressant medicine, dextromethorphan, may offer symptom relief when combined with a low dose of fluoxetine, a standard prescription treatment for OCD and related disorders.

Title: Exposure Therapy vs. Standardized Education for Distress Related to Somatic Symptoms (SOMEX1)

Stage: Recruiting

Principal investigator: Erland Axelsson, PhD

Liljeholmen Academic Primary Care Clinic

Stockholm, Sweden 

The annual societal cost of medically unexplained symptoms in Sweden is approximately 40 billion SEK, i.e., similar to the annual cost of cancer. Prevalent chronic diseases like asthma and diabetes are also commonly associated with somatic symptoms that lead to significant distress and pervasive behavioral changes that result in functional impairment and place added strain on the health care system. Exposure-based treatment, where the patient willingly engages with stimuli that give rise to unwanted physical sensations or distress, has shown promise in reducing somatic symptom load and increasing quality of life in several conditions where patients commonly report substantial distress related to somatic symptoms, such as in asthma, musculoskeletal pain, and functional gastrointestinal syndromes. In routine care, however, access to such exposure-based treatment is limited. One reason is that there is no flexible exposure-based treatment protocol that can be easily tailored to suit a broad spectrum of patient groups who suffer from distress related to recurrent somatic symptoms. In a recent single group feasibility trial (N=33) at Karolinska Institutet, Sweden, the investigators found that such a tailored exposure-based treatment delivered in an online text-based format can be acceptable, with high treatment adherence, adequate treatment satisfaction, significant and lasting within-group improvement, and no serious adverse events. This is a randomized controlled trial (N=160). The investigators aim to test if the same tailored internet-delivered exposure-based treatment is more efficacious than a standardized education control for adult patients with clinically significant distress related to somatic symptoms in a primary care setting. The primary outcome is change in self-rated somatic symptom burden as modeled using linear mixed models fitted on weekly Patient Health Questionnaire 15 sum scores over the treatment period. Long-term efficacy is assessed up to one year after treatment, and cost-effectiveness is investigated based on the incremental cost-effectiveness ratio.

Title: Reappraisal Of Medical Assurance (ROMA): An Experimental Study in Patients With Functional Somatic Symptoms (ROMA)

Stage: Recruiting

Principal Investigator: Tobias Kube, PhD

University of Koblenz-Landau

Landau, Germany 

It is known from research on functional somatic symptoms that patients continue to worry about having a serious illness despite receiving medical reassurance and normal medical test results. However, the psychological mechanisms underlying this maintenance of concern are largely unknown. The planned study will therefore apply knowledge from depression research to this question: In the field of depression, there is sound evidence that people with depressive symptoms maintain negative expectations despite positive experiences to the contrary, and in previous work, it was shown that this is due to a cognitive re-appraisal of expectation-disconfirming experiences, referred to as cognitive immunization. The planned study seeks to investigate whether cognitive immunization is also a mechanism underlying sustained concerns about having a serious disease despite medical reassurance in patients with functional somatic symptoms. For this purpose, participants are presented with a vignette in which gastrointestinal complaints are reported; participants are instructed to imagine suffering from these symptoms and to go to a doctor to have their symptoms examined. Subsequently, participants watch a videotaped doctor’s report in which a family doctor discusses the results of several medical tests that have been carried out to exclude the possibility of some serious diseases, such as colon cancer. In this report, the doctor states clearly that, based on the test results, a serious disease is very unlikely. Afterward, participants of some experimental groups receive additional information on the accuracy of medical diagnostics, aimed at differentially varying the appraisal of the medical reassurance received.

The experimental conditions described above apply only to the sample of patients with functional somatic symptoms (inclusion and exclusion criteria see below). In addition, we will also recruit a clinical (patients with depression, n=30) and healthy control group (n=30). These control groups will not undergo the cognitive immunization manipulation but will only pass through the basic procedure of the experimental paradigm, that is, the same procedure as the control group from the sample of patients with functional somatic symptoms. These two control groups (healthy and clinical) are recruited to replicate previous findings showing that patients with somatic symptoms report increased probabilities of suffering from a serious disease compared to patients with depression and healthy control participants. Below, we will only present the inclusion and exclusion criteria of the sample with functional somatic symptoms.