factitious-disorder-imposed-on-self-with-predominantly-physical-signs-and-symptoms

f68-12

Factitious disorder imposed on self, with predominantly physical signs and symptoms

Factitious disorder imposed on self is a mental health condition characterized by the intentional production or feigning of physical or psychological symptoms. Individuals with this disorder may present with a variety of physical signs and symptoms t

Overview

Factitious disorder imposed on self, with predominantly physical signs and symptoms (ICD-10: F68.12), is a complex psychiatric condition characterized by the intentional fabrication or self-induction of physical symptoms to assume the role of a patient. This disorder is distinct from malingering, where the motivation is primarily external, such as financial gain or avoidance of responsibilities. In factitious disorder, the motivation is internal, and individuals often seek to fulfill emotional needs through the act of deception. The prevalence of factitious disorder is difficult to determine precisely due to its clandestine nature, yet estimates suggest that it affects between 0.5% and 2% of hospitalized patients. Its incidence appears higher in settings such as surgical wards and among patients with complex, chronic medical conditions. The impact on the healthcare system is significant; it often leads to unnecessary and invasive diagnostic procedures, prolonged hospital stays, and increased healthcare costs alongside the emotional toll on medical professionals who may feel manipulated or frustrated. The disorder can manifest in various ways, such as feigning symptoms of disease (like chest pain or neurological deficits), seeking multiple consultations, and presenting with inconsistent medical histories. These behaviors not only complicate clinical management but can also lead to serious adverse outcomes, including iatrogenic harm due to unnecessary treatments or surgeries. The stigma attached to mental health disorders further complicates the situation, making it crucial for healthcare providers to approach such cases with compassion and understanding, while also maintaining a critical eye toward the medical facts presented.

Causes

The etiology of factitious disorder is multifaceted, often involving psychological, social, and biological factors. Many individuals with this disorder have a history of significant emotional distress, trauma, or psychiatric illness. The biological underpinnings may involve neurobiological abnormalities, as evidenced by studies suggesting alterations in brain structures associated with emotional regulation. Some patients have underlying personality disorders, particularly those within the cluster B spectrum, which may predispose them to this behavior. Additionally, environmental factors, such as a history of childhood illness or a caregiver who was overly involved in a patient's medical care, can cultivate a perception that illness equates to love and attention. Pathophysiologically, the act of inducing symptoms can be understood through the lens of maladaptive coping mechanisms—whereby the individual uses the role of a patient to manage stress or gain emotional support. This behavior may fulfill unmet psychological needs, providing a temporary escape from reality, leading to a cycle of illness and attention-seeking. Understanding these underlying mechanisms is crucial for clinicians as they approach treatment and management.

Related ICD Codes

Helpful links for mental health billing and documentation

f65-1

Transvestic fetishism

f68-13

Factitious disorder imposed on self, with combined psychological and physical signs and symptoms

f68-11

Factitious disorder imposed on self, with predominantly psychological signs and symptoms

f68-8

Other specified disorders of adult personality and behavior

f68-10

Factitious disorder imposed on self, unspecified

f68-1

Factitious disorder imposed on self

Diagnosis

The diagnostic approach to factitious disorder imposed on self is challenging and requires a thorough clinical evaluation. The primary tool for diagnosis is the DSM-5 criteria, which include the intentional production or feigning of physical or psychological symptoms, the motivation being to assume the sick role, and the absence of external rewards. Clinicians must conduct a detailed patient history and physical examination, paying close attention to inconsistencies or contradictions in the patient's medical narrative. Differential diagnoses include somatic symptom disorder, malingering, and other psychiatric disorders such as borderline personality disorder. Comprehensive diagnostic testing may be appropriate when there are signs of illness, but caution is necessary to avoid unnecessary procedures. Clinicians may also utilize psychiatric screening tools and structured interviews to ascertain the patient's psychological state. The decision-making process must balance the need for patient safety with the recognition of the underlying psychological condition, employing a compassionate approach to communicate concerns without alienating the patient.

Prevention

Preventive strategies for factitious disorder involve both primary and secondary prevention approaches. Primary prevention encompasses community-based initiatives that promote mental health awareness, resilience, and coping mechanisms. Programs designed to educate the public on the signs of emotional distress and the importance of seeking help can reduce stigma and encourage early intervention. Secondary prevention focuses on at-risk populations, particularly children and adolescents with histories of trauma or chronic illness. Mental health screenings in pediatric and adult healthcare settings can identify individuals who may benefit from psychological support before developing more severe maladaptive behaviors. Lifestyle modifications, such as increased social support, stress management techniques, and access to mental health resources, are crucial in mitigating risk factors associated with the disorder. Continuous education and training for healthcare professionals about factitious disorder can enhance early recognition, leading to timely intervention and prevention of unnecessary medical procedures.

Related CPT Codes

96116 - Neurocognitive assessment, including a structured interview
90791 - Psychiatric diagnostic evaluation
99213 - Established patient office visit, Level 3
96136 - Psychological testing, interpretation, and report
90834 - Psychotherapy, 45 minutes with patient

Prognosis

The prognosis for individuals with factitious disorder imposed on self can be variable, influenced by several prognostic factors, including the severity of the disorder, the individual's psychological resilience, and their engagement in treatment. While some patients may achieve significant improvement and symptom resolution with appropriate intervention, others may experience chronic, relapsing patterns that complicate their recovery. Long-term considerations often include the ongoing need for psychological support, as the underlying emotional issues may persist. The potential for iatrogenic complications remains a concern, particularly if patients undergo unnecessary medical interventions based on fabricated symptoms. Quality of life impacts can be profound, affecting interpersonal relationships, occupational functioning, and overall well-being. Efforts to enhance recovery potential should focus on a supportive therapeutic framework that fosters self-awareness and emotional health, aiming to break the cycle of illness behavior. Encouraging positive coping strategies and resilience may facilitate better long-term outcomes, though the chronic nature of some cases may require ongoing management.

Risk Factors

Risk factors for developing factitious disorder are diverse, and both modifiable and non-modifiable elements play a role. Non-modifiable risk factors include demographic variables such as age (more common in young adults), gender (more frequent in females), and a personal or family history of psychiatric disorders or chronic illness. Those with a history of trauma or abuse often show a higher prevalence of factitious disorder, particularly if they have been exposed to environments where illness was a means of receiving care or attention. Modifiable risk factors encompass social isolation, lack of support systems, and previous medical trauma, which can increase the likelihood of adopting maladaptive coping strategies. Screening for these risk factors can be achieved through comprehensive psychiatric evaluations that explore the patient's psychosocial history and emotional well-being. Prevention opportunities rest primarily in addressing these underlying risk factors through community and mental health interventions aimed at fostering resilience and coping strategies in at-risk populations, particularly those who have experienced significant life stressors.

Symptoms

Patients with factitious disorder imposed on self present with a wide array of physical symptoms, which may vary significantly between individuals. Common symptoms can include feigned neurological deficits, fabricated pain syndromes, gastrointestinal disturbances, and even signs of infection or malignancy. An initial presentation may often lead to a cascade of medical interventions, including imaging studies, blood tests, and surgical explorations, all aimed at identifying an underlying condition that does not exist. A classic example is a patient who presents with recurrent abdominal pain and multiple emergency room visits. Upon extensive evaluation, no organic cause is identified, yet the patient insists on surgical intervention, leading to unnecessary laparotomies. Early signs of the disorder may include a dramatic medical history that is consistently inconsistent, an eagerness for medical attention, and a pattern of frequent hospitalizations. Clinicians may notice that patients frequently change physicians and often have a deep knowledge of medical terminology and practices. Variations in presentation can occur across demographic populations; for instance, certain studies suggest that individuals with a history of trauma or abuse may exhibit more severe manifestations of the disorder. The severity can range from mild symptom exaggerations to severe life-threatening presentations, making clinical awareness critical.

Treatment

Treatment and management of factitious disorder require a multifaceted approach that involves psychiatric intervention, psychoeducation, and often, a collaborative care model. Given the complexity of the disorder, individualized treatment plans tailored to the patient's specific needs and circumstances are critical. Cognitive-behavioral therapy (CBT) has shown promise in addressing the maladaptive thoughts and behaviors associated with factitious disorder. This therapeutic approach assists patients in recognizing and modifying their patterns of seeking attention and examines the underlying emotional difficulties that contribute to the disorder. Additionally, establishing a strong therapeutic alliance is essential, as patients may initially respond defensively to being confronted about their symptoms. Multidisciplinary care often includes collaboration with primary care providers, psychiatrists, social workers, and other specialists to ensure a comprehensive treatment strategy. Monitoring protocols should be implemented to track the patient's progress, including regular follow-ups and reassessments of their mental health status. Furthermore, psychoeducation for both patients and their families about the nature of the disorder can enhance understanding and aid recovery. Support for managing underlying psychological issues, such as depression or anxiety, can be crucial in preventing relapse and improving overall quality of life.