Malingering and Factitious Disorder

Factitious disorders are those conditions in which individuals actively create signs or symptoms of physical or psychological disease states.' Although there are numerous reports of factitious psychological disorders, there is controversy about the legitimacy of the diagnosis This paper will limit its focus to factitious physical disorders and how they may enter the legal system in civil litigation. Although most psychiatrists are familiar with factitious disorders from their medical training, many attorneys and judges have had not any exposure to such cases. As these cases appear to be developing more frequently in legal and other non-medical settings,' it is important for these non-psychiatrists to become aware of the factitious disorders in order to deal with cases appropriately. Considerable education may be necessary to inform legal staff about factitious disorders because the entity is so counter intuitive-no one expects an apparently reasonable person to actively create a...

Factitious disorder is the term used to describe a pattern of behavior centered on the exaggeration or outright falsifications of one’s own health problems or the health problems of others. Some people with this disorder fake or exaggerate physical problems; others fake or exaggerate psychological problems or a combination of physical and psychological problems. Factitious disorder differs from a pattern of falsified or exaggerated behavior called malingering. While malingerers make their claims out of a motivation for personal gain, people with factitious disorder have no such motivation.

Factitious Disorder Basics

People with factitious disorder do several things that are unexpected for patients who present themselves for medical treatment, or for individuals seeking treatment for others in their care. First, they commonly exaggerate or lie about problems in their medical histories or the histories of others. They also present their doctors with symptoms that don’t legitimately ....

Practice Essentials

Factitious disorder imposed on another (formerly factitious disorder by proxy) has as its cardinal characteristic the production or feigning of physical or psychological symptoms in another person, usually a child or adult under the care of the person with the disorder. It is currently understood as including the condition commonly known as Munchausen syndrome by proxy (MSBP). Signs and symptoms

Common presentations of factitious disorder imposed on another (including MSBP) include the following:

•Bleeding •Seizures •Recurrent apparent life-threatening events •Poisoning •Apnea •Central nervous system (CNS) depression •Diarrhea and vomiting •Fever, either feigned (via falsification of chart records) or actual •Rash •Hypoglycemia •Hyperglycemia •Hematuria or guaiac-positive stools •Multiple infections with varied and often unusual organisms

Warning signs that raise the possibility of this disorder include the following:

Unexplainable, persistent, or recurrent illnesses Discrepancies among the history, clinical findings, and child’s general health