Factitious disorder imposed on self

Essential (Required) Features:

• Feigning, falsifying, or intentionally inducing medical, psychological, or behavioural signs and symptoms or injury associated with identified deception. If a pre-existing disorder or disease is present, the individual intentionally aggravates existing symptoms or falsifies or induces additional symptoms.
• The individual seeks treatment or otherwise presents themselves as ill, injured, or impaired based on the feigned, falsified, or self-induced signs, symptoms, or injuries.
• The deceptive behaviour is not solely motivated by obvious external rewards or incentives (e.g., obtaining disability payments or evading criminal prosecution).
• The behaviour is not better accounted for by another mental disorder (e.g., Schizophrenia or Other Primary Psychotic Disorder).

Additional Clinical Features:

• Examples of behaviours involved in Factitious Disorder Imposed on Self include falsely reporting or simulating episodes of neurological or mental symptoms (e.g., seizures, hearing voices); manipulating laboratory tests to falsely indicate an abnormality (e.g., adding sugar to urine); falsifying past or current medical records to indicate an illness; ingesting a substance (e.g., warfarin) to produce an abnormal laboratory result or illness; and physically injuring or intentionally inducing illness in oneself (e.g., intentional exposure to infectious or toxic agents).
• The simulation of illness, injury, or impairment and the insistence and intensity of its presentation may be so convincing and persistent that repeated investigations or even surgeries are performed, sometimes at many different hospitals or clinics, in spite of repeated negative or inconclusive findings.
• The motivation for the behaviour is presumed to be psychological. Factitious Disorder Imposed on Self can be understood as a disorder of illness behaviour and adoption of the sick role. Seeking attention, especially from health care providers as a part of the sick role, often appears to be a motivation for the behaviour.
• There is evidence that Factitious Disorder Imposed on Self in adulthood may be associated with being the victim of Factitious Disorder Imposed on Another in childhood.

Boundary Normality (Threshold):

• Some individuals with medical conditions may exaggerate their symptoms in order to gain more attention from medical professionals, family members, or the community, or access to additional treatment. A diagnosis of Factitious Disorder Imposed on Self should only be considered if there is evidence that the person is feigning, falsifying, or intentionally inducing or aggravating the symptoms.

Course Features:

• The typical age at identification of individuals with Factitious Disorder Imposed on Self is 30 to 40 years, but at the time of first assessment it is often revealed that the disorder has been present without being detected for many years.
• There is some evidence that individuals with Factitious Disorder Imposed on Self typically progress from less to more extreme modes of medical deception, and from an episodic to a chronic pattern.
• Individuals with Factitious Disorder Imposed on Self often do not provide accurate histories or access to their past medical records. As a result, systematic data regarding the onset and development of their factitious illness behaviour and its long-term outcomes are extremely limited.

Developmental Presentations:

• Factitious Disorder Imposed on Self can occur in adolescents and has been identified in young children.
• Among children and adolescents, commonly reported falsified or induced conditions include fevers, ketoacidosis, rashes, and infections. Methods of fabrication may include false reporting of symptoms, self-bruising, ingestion of harmful substances, and self-injections.

Sex- and/or Gender-Related Features:

• A substantial majority of individuals identified with Factitious Disorder Imposed on Self are female.

Boundaries with Other Disorders and Conditions (Differential Diagnosis):

• Boundary with Bodily Distress Disorder and Hypochondriasis (Health Anxiety Disorder): Individuals with Bodily Distress Disorder or Hypochondriasis may exaggerate their symptoms at times to ensure that their care is prioritized or taken seriously, as a part of excessive attention and treatment seeking related to somatic symptoms. However, unlike Factitious Disorder Imposed on Self, there is no evidence that the person is feigning, falsifying, or intentionally inducing or aggravating the symptoms.
• Boundary with Dissociative Neurological Symptom Disorder: In Dissociative Neurological Symptom Disorder, symptoms (e.g., seizures, paralysis) are presented that are not consistent with neurological findings or other pathophysiology. In contrast to Factitious Disorder Imposed on Self, however, individuals with Dissociative Neurological Symptom Disorder do not feign, falsify or intentionally induce their symptoms.
• Boundary with Malingering: In Malingering, individuals also deceptively report, feign, or induce symptoms in order to falsify or exaggerate the severity of an illness. However, in Malingering, primary external incentives are considered to be motivating the behaviour. The most common external motives for malingering include evading criminal prosecution, obtaining psychoactive medications (e.g., opioids), avoiding military conscription or dangerous military duty, and attempting to obtain sickness or disability benefits or improvements in living conditions such as housing. Malingering is not considered a mental disorder and is classified in the chapter on Factors Influencing Health Status or Contact with Health Services. In Factitious Disorder Imposed on Self, the deceptive behaviour is not solely motivated by obvious external incentives.
• Boundary with other forms of self-injurious behaviour: Individuals who exhibit self-injurious behaviour, often in the context of another mental disorder, may intentionally provide false information to examiners regarding either the self-induced nature of the injuries or the presence of suicidal ideation or intent. The deception in these cases is typically intended to minimize rather than exaggerate the extent to which the individual is viewed as ill, injured, or impaired.