factitious-disorder-imposed-on-self-with-combined-psychological-and-physical-signs-and-symptoms

f68-13

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

Factitious disorder imposed on self is a mental health condition where an individual deliberately produces or feigns physical or psychological symptoms to assume the sick role. This disorder is characterized by a combination of psychological and phys

Overview

Factitious Disorder Imposed on Self, classified under ICD-10 code F68.13, is a complex mental health condition where individuals intentionally produce or feign psychological or physical symptoms. These individuals often seek to assume the sick role, leading to significant challenges in healthcare settings. Epidemiologically, the disorder is relatively rare, with estimates suggesting a prevalence of 0.5% to 1% among psychiatric populations. However, the true incidence may be underreported due to the deceptive nature of the disorder. Clinically, it poses a substantial burden not only for the affected individuals but also for healthcare systems. Patients frequently experience unnecessary medical interventions, prolonged hospitalizations, and additional healthcare costs. The stigma associated with mental health issues can further complicate their treatment and reintegration into society. For instance, a case study involving a 35-year-old woman who feigned numerous symptoms, leading to multiple unnecessary procedures, underscores the severe ramifications of this disorder. Her story illustrates how a lack of understanding can hinder appropriate care and recovery, making awareness and education critical for healthcare professionals. The condition's complexity necessitates a multi-faceted approach, balancing the need for compassionate care with the challenges of accurate diagnosis and effective management.

Causes

The etiology and pathophysiology of Factitious Disorder Imposed on Self are not fully understood, but several contributing factors have been identified. Psychologically, individuals may have underlying issues such as a history of trauma or neglect, which can predispose them to seek attention inappropriately by assuming the sick role. The disorder has been linked to a desire for empathy, care, and attention that may have been lacking in childhood. Additionally, some patients may harbor a pathological need for recognition as a patient, which can be rooted in deep-seated psychological issues. The biological basis might involve dysregulation in neurotransmitter systems associated with reward and motivation, leading to behaviors that seek validation through illness. For example, an individual might experience temporary feelings of euphoria or relief when receiving medical attention, reinforcing the cycle of behavior. Environmental influences, such as a stressful life event or significant loss, can act as triggers for the onset of symptoms. Clinicians must also consider the role of personality disorders, as individuals with traits of narcissism or borderline personality may exhibit more pronounced behaviors associated with Factitious Disorder. Understanding these complex interactions is crucial for developing targeted therapeutic interventions.

Related ICD Codes

Helpful links for mental health billing and documentation

f65-1

Transvestic fetishism

f68-11

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

f68-12

Factitious disorder imposed on self, with predominantly physical 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 for Factitious Disorder Imposed on Self requires a comprehensive clinical evaluation that includes detailed patient history, physical examination, and psychological assessment. Diagnostic criteria as outlined in the DSM-5 stipulate that the individual deliberately induces or feigns symptoms, with the intent to assume the sick role. Assessment tools such as structured clinical interviews can help gather essential information regarding the patient’s behavioral history and motivations. Differential diagnosis is critical as it helps to distinguish Factitious Disorder from other conditions like malingering, somatic symptom disorder, or genuine medical illness. In cases where diagnosis is unclear, collaboration with mental health professionals may be beneficial. Diagnostic testing may include laboratory workup or imaging studies to rule out actual medical conditions, but clinicians should be cautious as over-investigation can perpetuate the cycle. Clinical decision-making should be grounded in an understanding of the patient's history and presentation, with a focus on building rapport. For example, a clinician may find that a patient presenting with recurrent symptoms has a history of psychiatric hospitalization. By approaching the diagnosis with empathy and a nonjudgmental stance, healthcare providers can create a therapeutic alliance that facilitates more effective management.

Prevention

Preventing Factitious Disorder Imposed on Self requires a proactive approach that encompasses primary, secondary, and tertiary prevention strategies. Primary prevention may involve educational initiatives aimed at healthcare professionals to enhance awareness about the disorder, enabling early identification and intervention. Secondary prevention can focus on screening high-risk populations, such as those with previous trauma or existing mental health conditions. Encouraging open communication about mental health and the importance of seeking help can reduce stigma and promote early treatment. Public health approaches might also involve community outreach programs targeting mental health literacy to foster a supportive environment for those at risk. Lifestyle modifications, including stress management techniques and resilience training, can also play a crucial role in reducing the incidence of the disorder. Regular monitoring strategies in at-risk individuals can aid in identifying early signs of factitious behavior, allowing for timely intervention. Overall, integrating these strategies into routine healthcare practices can create a more responsive system capable of addressing the complex needs associated with this disorder.

Related CPT Codes

96116 - Neurocognitive assessment
90791 - Psychiatric evaluation
99213 - Office visit, established patient, 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 varies widely based on several factors, including the presence of comorbid psychiatric conditions, the individual's support system, and their engagement in treatment. While some individuals may experience periods of recovery, relapses are common, particularly if underlying psychological issues remain unaddressed. Long-term considerations include the potential for chronic health issues resulting from self-induced symptoms or unnecessary medical interventions, which can significantly impact quality of life. Recovery potential can improve with consistent therapeutic engagement, but patients often face substantial social stigma. Prognostic factors, such as a supportive family environment and willingness to engage in psychotherapy, can enhance outcomes. However, untreated patients may continue a pattern of healthcare misuse, leading to further complications. A real-world example includes a patient who, after a comprehensive treatment plan that included psychotherapy and community support, managed to significantly reduce hospital visits and improve her overall well-being. Such cases are indicative of the complex nature of recovery, emphasizing the necessity of a multifaceted approach to treatment.

Risk Factors

The risk factors associated with Factitious Disorder Imposed on Self can be categorized into modifiable and non-modifiable aspects. Non-modifiable risk factors include a personal or family history of mental illness, particularly personality disorders, which can predispose individuals to this condition. Gender also plays a role, with some studies indicating a higher prevalence in females. Modifiable factors, such as stress, trauma, and chronic illness, can contribute to the onset of the disorder. Certain occupations may also increase risk, particularly healthcare professionals who may have greater knowledge of medical conditions and treatment protocols. Environmental influences, including a lack of social support or history of abuse, are significant contributors as well. Screening for risk factors should be a routine part of healthcare assessments, particularly in patients with unexplained symptoms or frequent hospitalizations. Prevention opportunities might involve education for healthcare providers to recognize early signs, thus facilitating timely intervention. Primary care settings should also foster a supportive environment to encourage patients to discuss their mental health openly, allowing for a holistic approach to care. For instance, a physician recognizing patterns of repeated emergency room visits could initiate a dialogue about the patient’s psychosocial background to identify potential contributing factors.

Symptoms

The clinical presentation of Factitious Disorder Imposed on Self is marked by a deliberate production of symptoms, which can be psychological, physical, or both. Early symptoms may include vague complaints like fatigue, pain, or psychological distress that prompt medical attention. For instance, a patient might report recurrent abdominal pain, leading to extensive diagnostic tests that yield no clear results. As the disorder progresses, individuals might escalate their behavior, engaging in self-harm to produce genuine symptoms or manipulating medical devices (like tampering with their medications) to simulate illness. Variations across populations can be significant; for example, individuals with a history of trauma, those with a background in healthcare, or specific personality disorders, such as borderline or narcissistic, may exhibit more severe manifestations. Severity spectrums can also vary widely; some patients may only feign mild symptoms, while others may undergo invasive procedures, endangering their health. A poignant case involves a middle-aged man who repeatedly visited emergency departments, claiming new-onset seizures. His extensive medical history and psychological evaluation revealed a pattern of behavior indicative of the disorder, highlighting the importance of recognizing atypical presentations. Clinicians should remain vigilant for patterns of frequent, unexplained medical visits and a lack of cooperation with medical evaluations, which can be telling signs of this disorder.

Treatment

Treatment and management of Factitious Disorder Imposed on Self remain challenging, primarily due to the complexity of the disorder and the resistance commonly exhibited by patients. Evidence-based treatment options often involve a combination of psychotherapy and medication management. Cognitive-behavioral therapy (CBT) has shown promise in addressing maladaptive thought patterns and behaviors. In practice, a therapist may work with a patient to explore the underlying emotional needs driving their behavior and develop healthier coping mechanisms. Individualized approaches are essential, as treatment must be tailored to each patient’s history, motivations, and comorbid conditions. Multidisciplinary care involving psychiatrists, psychologists, social workers, and primary care providers can enhance treatment efficacy. Regular monitoring protocols should also be established to track progress and adjust treatment strategies as necessary. For instance, a patient who initially presents with self-harming behaviors may require close psychiatric supervision and a supportive therapeutic environment to encourage positive change. Follow-up care is critical, as recurrent patterns of behavior may require ongoing management. In cases where patients are admitted to medical facilities, ethical considerations arise regarding the balance between providing necessary care and avoiding reinforcement of the sick role. Clinicians must navigate this delicate landscape with sensitivity and an emphasis on the patient’s overall well-being.