100 - Factitious Disorders and Malingering

Abstract

Patients with factitious disorder and malingering present to the emergency department with symptoms that are simulated or intentionally produced. Somatization, factitious, and malingering disorders may be thought of on a continuum. Factitious disorders are characterized by symptoms or signs that are intentionally produced or feigned by the patient in the absence of apparent external incentives.1-2 There are two subtypes of factitious disorder: factitious disorder imposed on self (FDIS) and factitious disorder imposed on another (FDIA). FDIA commonly involves the biological mother and child. The mother frequently has a background in health care and comes from all socioeconomic groups.11-15 Malingering is the simulation of disease by the intentional production of false or grossly exaggerated physical or psychological symptoms, which are motivated by external incentives such as avoidance of work, obtaining financial compensation, or obtaining medications. While individuals with malingering are in control of their actions, individuals with factitious disorder cannot control their actions and their motivation is to achieve the “sick role.” The initial management of patients suspected of fabricating disease should include a caring, nonjudgmental attitude and a search for objective clinical evidence of treatable medical or psychiatric illness. FDIA constitutes a form of child (or elder) abuse, and appropriate action to protect the victim, including notification of state social service agencies, should take immediate priority.13,14 When evaluating these individuals, unnecessary tests, medications, and hospitalizations should be avoided in the absence of objective evidence of a medical or psychiatric disease, and patients should be referred for ongoing primary care.