Factitious Disorders

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.