Most of us go to great lengths to avoid getting sick. Illness takes such a toll on the mind and body that it’s hard to imagine why anyone would deliberately pretend to be unhealthy. But people with factitious disorder have a deep-seated need to be perceived as unwell. They visit multiple doctors, take handfuls of pills and even undergo unnecessary tests to fulfill their role as a sick person. Some individuals have gone so far as to harm themselves or have unneeded surgeries and other invasive procedures at the risk of their own lives.
Factitious disorder is usually accompanied by other mental health issues, such as depression, anxiety and addiction. Drug abuse is common in people with this disorder; individuals may become physically or psychologically dependent on prescription medications in their efforts to feign and illness. The deeply troubled people may drink or use drugs out of loneliness, fear, or unresolved feelings of anger or sadness.
Healing this mysterious, complicated condition requires a compassionate treatment team, especially when a Dual Diagnosis of drug abuse or alcoholism exists.
Recognizing Factitious Disorder
Factitious disorder is hard to recognize, even for seasoned medical professionals. People with this condition are emotionally invested in playing the role of a sick person, and they are often very good at feigning symptoms. The Cleveland Clinic emphasizes that in these cases, the decision to pretend to be ill is conscious and voluntary. Unlike hypochondriacs, who honestly believe that there is something wrong with their body or mind, people with factitious disorder are aware that they are not truly sick. Some may blow authentic symptoms out of proportion, while others make up their condition altogether.
How do you know when you’re dealing with someone who has this elusive disorder? It’s not always easy to tell that you’re being deceived, but the following clues may be warning signs:
- Vague symptoms that change frequently, especially after medical tests turn out negative
- A long but inconclusive medical record
- A pattern of visiting multiple medical facilities and having numerous tests without a clear diagnosis
- Unwillingness to let medical practitioners talk with family members or consult with other doctors
- Eagerness to take tests, be admitted to the hospital or have surgery
- A history of dishonest behavior, dating as far back as childhood
- Symptoms that mysteriously appear only in the presence of a doctor, nurse or other clinical professional
People with this condition may have extensive knowledge of the illness they’re feigning. According to the American Journal of Forensic Psychiatry, a large percentage of those who suffer from factitious disorder work in healthcare professions. Statistics from this journal indicate that over 50 percent of healthcare professionals with factitious disorder are nurses. The rest are medical technicians, nurses’ aides, doctors, administrators and medical secretaries. Easy access to medical facilities makes it easy to alter the results of tests or tamper with diagnostic equipment.
Factitious disorder can drive people to go to extremes to produce symptoms. They may go so far as to overdose on stimulant drugs to produce cardiac symptoms, inoculate themselves with dangerous microbes to create an infection, or arrange accidents to injure themselves. Symptoms such as delusional behavior, nausea and vomiting, seizures, fatigue and anxiety may be signs of drug abuse masquerading as another illness.
Types of Factitious Disorder+
Factitious disorders take several forms. According to the accepted definition of the condition in the psychiatric community, individuals fall into four categories, notes the Lagone Medical Center at New York University:
- Those who pretend to have a psychological illness, such as major depression or bipolar disorder
- Those who pretend to have a physical illness or injury, such as cancer or a broken limb
- Those who have both psychological and physical symptoms
- Those whose symptoms don’t meet the first three criteria, such as parents who project a factitious illness onto their children
Factitious disorder should not be confused with “malingering,” a common phenomenon in clinical settings. Malingerers pretend to be ill or injured in order to achieve some kind of gain, such as insurance money, prescription medications or paid time off work. With factitious disorder, the need to appear unhealthy arises from severe emotional disturbance. Factitious disorder often goes hand in hand with personality disorders, which interfere with a healthy sense of self and undermine relationships with others.
Munchausen syndrome and Munchausen syndrome by proxy are two severe forms of factitious disorder. People with Munchausen syndrome invent elaborate medical histories for themselves, traveling to different doctors and specialists in order to have their illness validated. An individual with Munchausen syndrome by proxy, on the other hand, projects serious health problems onto someone else in his or her life, often a child or a frail parent. In both forms of this disorder, efforts to seek medical help can result in harm to the patient through overtreatment and unnecessary medical procedures.
When factitious disorder is imposed on a child, the results can be deadly. Parents with factitious disorder have been known to starve, injure or drug young children in order to produce the illusion of disease. The National Institutes of Health calls Munchausen syndrome by proxy a form of child abuse, in which an adult seeks positive attention and admiration by willfully putting a child in grave danger.
Although there is no known cure for factitious disorders, treatment must involve protecting individuals and their loved ones from the harm caused by this condition.
Origins and Treatment
The dishonesty and manipulation of factitious disorder may be hard to comprehend, but the roots of the condition lie in a seriously troubled psyche. The desire to feign disease may come from a need for attention, a need to be cared for or a need to assume the role of an invalid with no personal accountability. The behaviors associated with the disorder often get worse under stress, suggesting that the disorder is a way of coping with anxiety. Major losses like a death in the family, a divorce or sudden unemployment can drive an emotionally disturbed person to seek support and concern by pretending to be ill.
For some adults, traumatic experiences in early childhood can lead to a factitious disorder later in life. Adults with this disorder may have been physically or emotionally abused as children. They may have received love or validation only when they were sick or injured. They may have grown up with a sibling or friend who received a lot of attention and concern as a result of a chronic illness.
Understanding the origins of factitious disorder requires great compassion and insight on the part of therapists and doctors.
Treatment is a multifaceted process, involving individual therapy to change the way you think about yourself and your health, along with family counseling for you and your loved ones. This condition often reflects a shaky sense of identity and a profoundly damaged sense of self-worth. Therapy must focus on rebuilding a stronger sense of self that is not based on weakness or disease.
Although there is no specific medication prescribed for Munchausen syndrome, anti-anxiety medication or antidepressants may be prescribed to treat co-occurring mood disorders or anxiety disorders.
Drugs and Factitious Disorder
Substance abuse is common among people with factitious disorder. Drugs may be used as a tool to produce symptoms (for instance, hallucinogenic drugs may be used to replicate the symptoms of psychosis). They may also be used as a way to cope with the emotional repercussions of dishonesty. People with factitious disorder know that their behavior is deceitful, but they are compelled to continue lying in order to satisfy deep needs for acceptance or nurturing.
Treating drug addiction without addressing its underlying causes won’t lead to a complete recovery. You need a program that is staffed by caring, compassionate professionals who understand the complexity of factitious disorder.
Finding True Health
Dual Diagnosis treatment is the answer for those who suffer from addiction and a psychological disorder. Unless substance abuse and mental health issues are treated at the same time, the destructive behaviors are likely to continue after treatment ends. A Dual Diagnosis treatment program offers a plan for long-term recovery, with an emphasis on restoring the health of your body and mind.
True health is within your reach when you seek help from a qualified treatment team. The professionals who staff Foundations Recovery Network treatment centers are uniquely qualified to treat both substance use disorders and complicated psychological conditions. If you or someone close to you is struggling with drug abuse and a mental health problem, we urge you to call our admissions coordinators to find out more about the best treatment options for your situation. With facilities in Southern California and Tennessee, we can provide innovative, fully integrated care that’s tailored to your needs. We are available 24 hours a day to help you find the answers that you’re looking for. Call now.
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.