Valerie Rice | February 19, 2021
I heard the most interesting thing the other day. I was scrolling through tik tok,as one is wont to do, and heard “Some people just pretend to have mental illness for attention!”in an angry tone. Well, because I simply canNOT keep my little mouth shut, I decided to mention that faking mental illness is, in itself, mental illness. It is! I think this is a lovely time to mention that we are not okay with getting angry at someone for being mentally ill so please click here to learn more about the stigma surrounding mental health.
WHAT IS FACTITIOUS DISORDER?
I am so very glad you asked. We used to call this Munchausen’s Syndrome or, if the person created the illness in someone else, Munchausen’s by proxy. With the new revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), it has been revised and renamed Factitious Disorder. This is when a person fakes an illness, physical or mental, in order to achieve the role of patient. The main diagnostic criteria are
- Intentionally creating, exaggerating, or falsifying symptoms of an illness.
- The person presents themself as sick to others.
- The person persists in doing so without any external reward.
- There is no other mental illness to explain the symptoms.
You have probably seen a movie based on this disorder, or more likely factitious disorder in another, as Hollywood simply adores demonizing individuals with mental illness. Hulu just came out with their new horror-thriller Run. Have you seen the movie The Act? That one was based on a true story. Stephen King gave a nod to this disorder in IT when Eddie’s mother convinces him he has asthma and The Sixth Sense was all about solving the murder of a little girl at the hands of her caregiver. My point is that we are far more aware of this disorder than we realize, we just tend to see it as the subject of horror movies and not an everyday occurrence.
HOW DANGEROUS IS IT? REALLY?
This disorder is rare, and symptoms can range from mild to severe. While we do not have exact data given the difficulty in diagnosing these people and their reluctance to accept treatment, we do know that the more severe the case the more likely the person is to be diagnosed. Remember those diagnostic criteria we discussed? Number 4 is a major point and the one that gives us the most trouble. Factitious disorder is incredibly difficult to distinguish from other disorders such as malingering as dissociative disorders (Hausteiner-Wiehle & Hungerer,2020). The most important distinguishing characteristic, and the one that is least often apparent, is motivation (Martin & Schroeder, 2015). This is why it is believed that many cases, including fatal ones, are never diagnosed. Diagnosis is key to intervention, which is essential to preventing the worst damage that results from this disorder. The largest danger is, of course, death. Factitious disorder is an illness that can be lethal to the individual or the proxy, and it is nothing to take lightly or brush off as a cry or attention.
While people suffering with this disorder are often characterized as monsters, they are not in control of their behavior and do not themselves understand why they continue to behave as they do. Like any other terminal illness, we need to take this disorder seriously and provide as much support to the individual as possible while they receive treatment.
WHAT IS THE TREATMENT THEN?
Unfortunately, we do not have a standard treatment. Part of the problem is that the person has to admit to having a factitious disorder and, even when presented evidence of their disorder, they tend to deny it and stop treatment. Treatment also means that they will no longer be sick, which is a role they are actively seeking, and that is in direct opposition of their goals. The best thing to do is to approach the person in a supportive way and make it clear that they need help, providing them the patient role they desire. Psychotherapy is the current treatment and it is used to teach coping skills and stress management. How does this work for factitious disorder?
Well… honestly, since we don’t know what causes it, this treatment is a shot in the dark. But it is our best shot. A good counselor or therapist will skip the categorical thinking and try to find the meaning behind the behavior. Making yourself or someone else sick doesn’t make sense to those of us who are not experiencing this disorder. It doesn’t even make sense to the ones who are. This is where the “outside the box” therapists shine. Toss out the beloved CBT and DBT or any other technique that can be neatly categorized. This requires the rabbit hole of person centered, old fashioned, talk.. Existential wanderings? Bring ‘em on. Hours of seemingly useless and unrelated conversation? Excellent! We are looking for the invisible motivational thread that ties together this tapestry of illness and despair before it’s too late. Hospitalization may be required to prevent imminent harm, and that is something that would be hard to determine without a solid rapport built on humanistic principles.
I realize I used a whole lot of words to explain that we know very little, but what we do know is that we shouldn’t give up. I have a tendency to see people as fascinating creatures with amazing potential. Despite the difficulties we face in diagnosis and treatment, it is always worth the time and effort. Mental illness of any sort is not to be brushed off, and accusing someone of “attention seeking” is both childish and dangerous. We ALL seek attention, with almost very social interaction. That is simply human nature and not a weakness or flaw. Maladaptive or dangerous behavior, on the other hand, should be addressed with compassion. Hopefully we can make this world a better place together. Until next time Be Well!
Hausteiner-Wiehle C, Hungerer S: Factitious disorders in everyday clinical practice. Dtsch Arztebl Int 2020; 117: 452–9. DOI: 10.3238/arztebl.2020.0452
Martin, P. K., & Schroeder, R. W. (2015). Challenges in Assessing and Managing Malingering, Factitious Disorder, and Related Somatic Disorders. Psychiatric Times, 32(10), 1–4.