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Factitious
is not synonymous with fictitious. Factitious is not the same as the
act of malingering. Malingering does not constitute a mental disorder;
factitious disorder does constitute impaired psychological
functioning. Factitious Disorder involves voluntary amplification or
production of physical and psychological symptoms due to internal
motivation, an unconscious need to maintain oneself in the role of
patient.
Factitious
disorders are considered mental disorders and fall within the province
of those psychological conflicts which warrant treatment. For complex
reasons, the patient suffering from factitious disorder needs to be
perceived as injured or ill in order to meet underlying, chiefly
unconscious, needs.
Patients
with factitious disorder will willfully submit to painful,
dehumanizing and even dangerous diagnostic and therapeutic procedures
in order to meet these unconscious needs. In medical clinics, it is
not unusual to find patients who have undergone multiple invasive
procedures designed to treat conditions or disease processes which
were found not to exist.
By
contrast, patients who are malingering are consciously aware of not
only their acts but also of their motives. They feign symptoms in
order to secure financial remuneration, to avoid demands made upon
them, to escape responsibility or to deliberately control the behavior
of others.
Patients
with factitious disorders will present with psychological and/or
physical complaints and will work vigorously to maintain themselves in
the patient role and to secure the attention, affection and special
considerations our society affords those who are validly ill.
There
are clinical reports of mothers who have harmed their own children in
order to secure for themselves the role of life-saver and/or life
protector. This vicarious living-through the patient role created for
their victimized children is also a form of factitious disorder.
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