Julie Miller's Mental Health Blog

Archive for the ‘"F" is for Factitious Disorder’ Category

An individual suffering from factitious disorder is utilizing the sick role to gain benefits such as nurturance, sympathy and/or attention.  This is not the same as malingering, in which an individual feigns illness of some kind to benefit financially or to avoid military service.

Ever called in sick to work because you didn’t want to get that unpleasant assignment from your boss?  Or what about telling the professor that you have the H1N1 flu, and could you take the test at a later date?  Of course, on the phone, you sniffle or cough just to improve the effect.  Anyone ever get out of an important work obligation by reporting that your mother is sick or died or that her father died, or her mother?  This would be malingering, not a factitious disorder, as the benefit is not simply to gain sympathy or nurturance, but indeed to escape a responsibility.

You may recall the TV series M*A*S*H, and Corporal Max Klinger feigning various psychological symptoms or bereavement issues in an effort to get out of the army (transvestitism, frequent deaths of mother, grandmother, aunt, father, brother, etc.).  Malingering.

The cost to the sufferer of a factitious disorder and their family and friends may be steep, including fear, resentment, anger, hurt and sadness.  Treatment includes psychotherapy for the individual with the factitious disorder, and family therapy to address the impact of the illness on the family.  The disorder tends to be chronic and difficult to treat, requiring acquisition of painful insight and family involvement.


“F” is not an easy letter in the DSM-IV.  When I came across factitious disorder, that seemed particularly relevant, given that I recently worked with a young man who clearly suffered from this diagnosis.  I could tell you the details of that case, but then I’d have to kill you.

The individual induces or simulates the illness or disease process, either in themselves or in the victim, and then presents for medical care (with the victim in the case of proxy).

The DSM-IV describes a factitious disorder as “physical or psychological symptoms that are intentionally produced or feigned in order to assume the sick role” (p. 471, DSM-IV).  For example, perhaps a man has a wound on his leg that he continues to re-injure (intentionally), keeping it from healing, so he can to to the emergency room and receive concerned attention and nurturing from the staff.

If it is factitious disorder by proxy, it is the deliberate production of physical or psychological symptoms in another person while that person is under the individual’s care.  Formally known as Munchhausen by Proxy, an example of factitious disorder by proxy is portrayed in the film, “Sixth Sense.”  A girl is slowly poisoned to death by her mother, and the mother receives benefit through the sympathy provided by friends and family in response to the child’s illness and death.

These behaviors seem outlandish to the vast majority of us, and yet the behaviors make sense for the person with the disorder.  It is a solution to a problem that is solved by assuming the sick role, or by assuming that role by proxy.  The  need for attention, sympathy or nurturing may have gone unmet as a child, and certain defenses may have been generated to allow the individual to take on the sick role to have these needs met, but he or she lacks insight into their behaviors.

Like many mental health issues, stress may trigger the behavior.  Threatened loss of a relationship may trigger a woman to create a physical illness (simulated or induced) to keep her partner with her (who can leave someone who has cancer?).  Loneliness, threat of overwhelming adult responsibilities, even job or family stress, legal or financial responsibilities might be alleviated (at least temporarily) by feigning of illness in oneself or another in order to receive sympathy or nurturance.