Factitious Disorders

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Facticious means artificial or unnatural, a definition that could not be more appropriate. People who suffer from factitious disorder (FD) “are great con men or con women, although what they obtain through their conning most people would far rather not have”[1]. The earliest accounts of factitious disorders are recorded in the times of Galen, a Roman physician in the second century A.D. The term ‘factitious’ itself, is derived from a book, published in 1843 by Gavin, On Feigned and Factitious Diseases. Most aggressive study of the disorder began in 1950s, when an article published by a British psychiatrist, Richard Asher who initiated use of the term, Munchausen’s Syndrome[i], to describe a subtype of factitious disorder.The term factitious disorders (FD) refers to “any illness deliberately produced or falcified for the sole purpose of assuming the sick role.  Patients waste valuable time and resources with lenthy and unnecessary tests and procedures at a cost, according to one estimate, of  $40 million per year”(Elwyn, 2002 [online]) . Patients with FD often generate feelings of frustration and anger in the physician, because they violate the unwritten rules of being a patient: they do not provide a reasonable honest history, they do  hold the desire to recover and cooperate with treatment toward the end amd fially their symptoms do not result from an accident or injury. There are four main types of factitious disorder, according to the DXM-IV-TR: • Factitious disorder with mostly physical symptoms: Individuals claim to have symptoms related to a physical illness, such as symptoms of chest pain or stomach problems. • Factitious disorders with mostly psychological symptoms: patients mimic behavior that is typical of mental illness, for example schizophrenia. May appear confused, make absurd statements and report hallucinations. • Factitious disorder with both physical and psychological symptoms: patients produce symptoms of both, physical and mental illness. • Factitious disorder not otherwise specified: this type of disorder includes factitious disorder by proxy (also called Munchausen syndrom by proxy). People with this disorder produce symptoms of illness in another person under their care. It most often occurs in mothers, who intentionally harm their children in order to receive attention. some of the symptoms of FD are:

• The individual's history is vague and inconsistent; or the individual has a long medical record with many admissions at different hospitals. • The patient has an unusual knowledge of medical terminology or describes the illness as if they are reciting a textbook description of it. • The patient is employed in a medical or hospital-related occupation. • Pseudologia fantastica, a Latin phrase for "uncontrollable lying," is a condition in which the individual provides fantastic descriptions of events that never took place. • The patient visits emergency rooms at times such as holidays or late Friday afternoons when experienced staff are not usually present and obtaining old medical records is difficult. • The patient has few visitors even though he or she claims to be an important person. • The patient is unusually accepting of surgery or uncomfortable diagnostic procedures. • The patient's behavior is controlling, attention-seeking, hostile, or disruptive. • The symptoms are present only when the patient thinks he or she is being watched. • The patient is abusing substances, particularly prescription pain-killers or tranquilizers. • The course of the "illness" fluctuates, or complications develop with unusual speed. • The patient has multiple surgical scars, a so-called "gridiron abdomen," or evidence of self-inflicted wounds or injuries. Presentation

|Presentation |Current (n*=54) |Previous (n*=15) | |Depression |29**...
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