William Carey University
The longing for attention, sympathy, nurturance and love can cause people to behave in destructive ways. These unfulfilled needs encourages some people to assume the sick role. When we are sick it seems that people come out of the woodwork to be supportive and helpful; we are praised as we fight to battle our illness, someone may bring us homemade chicken soup, doctors and nurses tend to us by giving us medical attention, we get sympathy cards and someone may sit with us so we always have company. The love our family and friends have for us is very apparent and the care given to us by our doctors and nurses are at their at their highest point. In some ways, it is nice to be sick, but most of us would rather be well since being sick is not a good feeling. Signs and Symptoms
Persons with Factitious Disorder will feign or produce illnesses in order to assume the sick role (American Psychiatric Association, 2000). Something that is factitious is not natural, it is something that is manufactured or contrived. The diagnostic criteria listed in the DSM-IV-TR (American Psychiatric Association, 2000) for Factitious Disorder are: A. Intentional production or feigning of physical or psychological signs or symptoms. B. The motivation for the behavior is to assume the sick role. C. External incentives for the behavior (such as economic gain, avoiding legal responsibility, or improving physical well-being, as in Malingering) are absent. (p.517) There are three subtypes which Factitious Disorder is coded by. Subtype 300.16 is predominantly psychological signs and symptoms, in these cases patients will feign a wide variety of mental problems or can feign one mental disorder, which usually has atypical symptomology since the patient’s feigned disorder must morph when he or she feels as though the doctor is beginning to uncover the fact that the illness is being faked (American Psychiatric Association, 2000). In these cases depression may lead into hallucinations which may then become paranoia and finally ending with schizophrenia, only for the patient to come back when different (and no doubt atypical) symptoms and signs arise. Subtype 300.19 is predominantly physical signs and symptoms of a medical nature, diarrhea, infection, rashes, high fever, bleeding, and many other problems can be produced or feigned by the patient (American Psychiatric Association, 2000). The combination of both physical and psychological signs and symptoms is also coded as 300.19 (American Psychiatric Association, 2000). It is unclear as to why there is a duplication of coding. Adding to coding confusion, 300.19 is also attributed to Factitious Disorder not otherwise specified; Factitious Disorder by proxy, which is when a caregiver feigns or produces illness in a person who they are caring to play the sick role vicariously, falls under this category (American Psychiatric Association, 2000). The terms Factitious Disorder by proxy and Munchausen by proxy are typically used interchangeably although the term Munchausen by proxy is never refereed to or identified in the DSM-IV-TR. A personal communication from Feldman to Lasher and Sheridan (2004) suggests that Munchausen by proxy (Factitious Disorder by proxy) should not have been included in the body of the DSM-IV-TR since it is not a psychological disorder, but rather a form of child abuse. Feldman goes on to communicate that: Appendix B diagnoses are terms and criteria sets still irrefutably under consideration by the American Psychiatric Association and not formalized mental disorder. …[Factitious Disorder by proxy] is NOT [sic] to be included when diagnosing a patient. …Placing [Factitious Disorder by proxy] on Axis II [i.e. including it in a formal mental health diagnosis] simply illustrates a total unfamiliarity with the conventions if the DSM to date. It makes a...