Factitious Disorder
Overview
Factitious Disorder (FD) is a mental health condition wherein individuals deliberately fabricate or exaggerate symptoms of illness without obvious external incentives, such as financial gain or avoidance of duties. The primary motivation is to assume the “sick role” and receive medical attention. In India, as in many parts of the world, FD remains underdiagnosed, partly due to its deceptive nature and the limited awareness among healthcare professionals.
Key Facts
- Prevalence: A retrospective study conducted over a decade at a neuropsychiatric centre in Southern India identified only 8 cases of FD out of 81,176 patients, indicating a prevalence rate of approximately 0.985 per 10,000 patients.
- Global Comparison: Internationally, the prevalence of FD among psychiatric inpatients varies between 0.5% and 8%, suggesting that the disorder may be underreported or under recognized in India.
Symptoms and Patterns
Individuals with FD often present with:
- Inconsistent Medical Histories: Frequent hospital visits with varying complaints that don’t align with diagnostic findings.
- Eagerness for Procedures: A tendency to undergo multiple medical procedures or surgeries without clear medical indications.
- Symptoms Control: Ability to control symptoms, leading to discrepancies between reported symptoms and clinical observations.
- Extensive Medical Knowledge: Possession of medical terminology and knowledge, often due to prior healthcare experience.
Risk and Protective Factors
Risk Factors:
- Psychological Factors: A history of childhood trauma, neglect, or abuse may contribute to the development of FD.
- Personality Disorders: Traits associated with borderline or histrionic personality disorders are commonly observed in individuals with FD.
- Comorbidities: Depression is prevalent in approximately 30% of individuals with FD, further complicating diagnosis and treatment.
Protective Factors:
- Stable Support Systems: Strong family and social support can mitigate the risk of developing FD.
- Early Psychological Intervention: Timely mental health support for individuals exhibiting early signs of maladaptive behaviours can prevent the progression to FD.
Treatment and Care
Managing FD is challenging due to patients’ tendencies to deny their behaviours. Effective strategies include:
- Psychotherapy: Cognitive-behavioural therapy (CBT) aims to change the distorted thinking patterns and behaviours associated with FD.
- Medication: While no specific medications treat FD directly, antidepressants or anxiolytics may be prescribed to address underlying mood or anxiety disorders.
- Collaborative Care: A multidisciplinary approach involving psychiatrists, psychologists, and primary care physicians ensures comprehensive management.
Psychological and Psychosocial Interventions
- Behavioural Therapy: Focuses on identifying and modifying behaviours that reinforce the sick role.
- Family Therapy: Educates family members to avoid reinforcing the patient’s deceptive behaviours and provides support structures.
- Mindfulness and Stress Management: Techniques to help patients manage underlying stressors that may trigger FD behaviours.
Conclusion
Factitious Disorder poses significant diagnostic and therapeutic challenges, especially in settings where awareness is limited. In India, the apparent low prevalence may reflect underdiagnoses rather than true rarity. Enhancing awareness among healthcare professionals, coupled with culturally sensitive therapeutic interventions, is crucial for effective management and improved patient outcomes.
