Factitious disorder

[[File:Patient suite at CK Birla Hospital for Women.jpg|thumb|right|165px|The favorite place of someone with factitious disorder]]
{{psychology}}
'''Factitious disorder''' (formerly known as '''Munchausen syndrome''') is a rare mental illness in which someone invents [[medical]] symptoms in order to receive care. Unlike in malingering, people who have factitious disorder are seeking sympathy and attention rather than looking for [[money]] or trying to avoid work. Since people with factitious disorder may resort to dangerous methods like poisoning, it can result in [[death]].

While the condition is real, there is also a concerning history of cases of actual illnesses being misdiagnosed as factitious disorder.

==Signs of factitious disorder==
Signs of factitious disorder include:<ref name="mayo">[https://www.mayoclinic.org/diseases-conditions/factitious-disorder/symptoms-causes/syc-20356028 Factitious disorder] - Mayo Clinic</ref><ref>[https://www.webmd.com/mental-health/factitious-disorders#1 Factitious Disorders] - Web MD</ref>
*Extensive medical knowledge
*"Shopping around" for doctors
*Dramatic medical history with many conditions
*Making excuses not to share old medical records with their doctors
*Inconsistent or vague symptoms
*Eagerness to undergo testing and procedures (even surgery)
*Multiple surgical scars
*Symptoms don't match test results, or can't be tested for
*Symptoms worsen at home and improve during medical care
*Frequent relapses or new symptom development (especially after negative test results)
*Frequent tests and hospital stays
*Friendly and polite attitude towards medical staff
*Frequent posting on social media support groups

Faking symptoms can be done a number of ways:<ref name="mayo" />
*Exaggerating or inventing symptoms
*Inventing histories
*Faking hard-to-test-for symptoms (like dizziness, fainting, or seizures)
*Self harming
*Tampering with equipment and test results

People with factitious disorder may have a history of abuse or rejection as a child, a history of illness, or disorders such as borderline personality disorder.<ref>[https://www.mdedge.com/psychiatry/article/66168/when-mothers-love-hurts When a mother’s love hurts]</ref> Some have lived through severe [[child abuse]].<ref name="avigal" /> They may not know how to cope with stress, and they create an identity as either a perfect patient or perfect caregiver.<ref name="pt" /> Faking a medical problem gives them attention and an escape from the demands of the outside world.

It should not be mistaken for [[illness anxiety disorder]] (also called hypochondria), somatoform disorder (which involves stress manifesting as physical symptoms), or malingering (which is done to gain physical things like money or medication, or to avoid undesirable things like work, physical activity, or military service).<ref>{{wpa|Malingering}}</ref><ref>[https://emedicine.medscape.com/article/918628-overview Somatoform disorder], MedScape</ref>

It can be hard to distinguish between cases in which someone is actually sick and in which it is being faked for sympathy. In particular, [[faking disability]] as a form of self-therapy for [[body integrity dysphoria]] may be hard to tell from faking disability to get attention.

==Factitious disorder imposed on self==
{{cquote|I started faking the symptoms of other peoples' illnesses… I felt terribly, terribly guilty, yet I would get the relief that I wanted – the attention, the feeling of control over my life that I didn't have that I wanted.|||"Lindsay"<ref name="lindsay">[https://www.foxnews.com/health/addicted-to-illness-how-one-woman-recovered-from-a-20-year-struggle-with-munchausen-syndrome Addicted to illness: How one woman recovered from a 20 year struggle with Munchausen syndrome] - Fox News</ref>}}

{{cquote|At 5, I went into the bathroom and cut my finger with glass and showed my parents. I thought it would stop the arguing and it didn't work, but I got the attention I wanted.|||"Andrea Avigal"<ref name="avigal">[https://abcnews.go.com/Health/reparenting-treat-woman-munchausens-syndrome/story?id=22773089 'Reparenting' Used to Treat Woman with Munchausen's Syndrome] - ABC News</ref>}}

'''Factitious disorder imposed on self''' (FDIS) occurs when a person attempts to make themselves sick or injured. They may fake symptoms, expose themselves to germs or poisons, injure themselves on purpose, tamper with test results, and use other methods (from minor to extreme) to gain attention and care.

If they attempt to injure or poison themselves, they are at risk for accidental [[suicide]]. They also risk being branded as a liar and then being ignored when they have a real health problem.<ref name="scott">[http://www.forensic-psych.com/articles/artNYTimesPretender072099.php A Great Pretender Now Faces the Truth of Illness] - Forensic Psych</ref>

===Recovery===
Recovery from factitious disorder is rare, but possible. In many cases, the person has another underlying issue (such as anxiety or depression), and treating this condition may alleviate symptoms of factitious disorder. "Lindsay," who has co-occurring bipolar disorder and FDIS, likened FDIS to addiction.<ref name="lindsay" />

Near-death experiences and health scares may frighten someone into wanting to recover. "Miss Scott" said that severe complications from an unnecessary operation (as well as being responsible for a kitten) helped her want to recover.<ref name="scott" />

"Lindsay" stated she hasn't feigned illness in 2 years,<ref name="lindsay" /> and "Andrea Avigal" has gone 14 years without faking.<ref>[https://www.insideedition.com/woman-munchausen-syndrome-reveals-why-she-pretended-be-sick-years-53844 Woman With Munchausen Syndrome Reveals Why She Pretended to Be Sick for Years] - Inside Edition</ref> While evidence is limited due to rarity, it suggests that recovery is possible.

There is a forum for people trying to recover from factitious disorder.<ref>[https://www.psychforums.com/munchausen-syndrome/ Munchausen Syndrome Forum]</ref> Unfortunately, it's mostly inactive, so people with FDIS may have to do some searching in order to find a supportive community.

==Factitious disorder imposed on another==
[[File:FactitiousDisorderAnother.jpg|thumb|right|The parent creates the child's illness or injury for emotional gain. Like playing dolls, except the doll is a human being with wants, needs, and nerve endings.]]
{{cquote|I had thought I wanted to be healthy, but when I found out I was, I felt alone and confused. I wanted to be sick because sick people get more love and attention.|||Marisa Gwidt, describing a fake cancer scare orchestrated by her mother when Marisa was 10<ref name="Marisa">[https://narratively.com/for-my-entire-childhood-my-mom-convinced-me-i-was-dying/ For My Entire Childhood, My Mom Convinced Me I Was Dying]</ref>}}

'''Factitious disorder imposed on another''' (FDIA) goes by many names: fabricated induced illness, medical child abuse, or the now outdated term '''Munchausen syndrome by proxy'''. This form of [[child abuse]] involves a parent pretending that their child is sick. They may [[lie]] about symptoms, and even tamper with evidence or intentionally poison the child (!). Luckily, this form of abuse is rare, with only about 1 in 200,000 children experiencing it.<ref name="community" />

"The purpose is not to kill the child but to keep her sick, so that the mother can be in a relationship with the doctor, who would recognize her devotion, knowledge, and sacrifice," explains Herbert Schreier.<ref name="pt" />

FDIA is obviously a form of child abuse. Subjecting children to unnecessary medical treatments and taking them away from healthy childhood activities is never justified.

In rare cases, FDIA can happen to pets.<ref>[https://www.spreaker.com/user/mhnrnetwork/dr-marc-feldman-and-stiles-mhnr-edit-9-2 Medical Abuse of Pets with Dr. Marc Feldman] - Podcast on Spreaker</ref>

===Effects===
Sometimes perpetrators of FDIA end up killing their victims. The most dangerous time for the victim is when they begin to question whether they are actually sick or to assert that the perpetrator is actually poisoning them or faking their symptoms. The perpetrator may resort to more dangerous methods to "prove" that the victim is sick.<ref>[https://www.lohud.com/story/news/crime/2015/03/07/lacey-spears-munchausens-role/24548933/ Munchausen's role in the strange case of Lacey Spears]</ref>

FDIA survivors can face long-term anxiety issues, especially related to doctor visits or any physical symptoms.<ref name="Marisa" />

===Anti vaxxers, autism and factitious disorder===
[[File:Angel Mom and Demon Child.png|thumb|right|162px|Imagine growing up hearing your parent say you [[Jenny McCarthy|didn't have a soul]].]]
In some cases, [[Anti-vaccination movement|anti-vaccine]] "warrior moms" with so-called "vaccine injured" autistic children may cross the line into FDIA. Unwilling to accept any perceived defect in their children,<ref group="note">The alternative is to stop seeing your autistic child as defective.</ref> they decide to do everything under their power to "fix" it. Some of these parents have begun micromanaging every aspect of the poor kids' lives, particularly their diet and supplements. Rather than accept their autistic child and provide appropriate support, they pursue pseudoscientific conditions and treatments in the hopes of turning their child into something different.

One case involved an autistic young man (M) who was on over a dozen supplements. His mother stridently believed she knew best and constantly complained about her son's disability. One doctor explained that she "needs M to be a victim so that she can save him and meet her own needs for attention, to be important and to be cared for."<ref>[https://ukhumanrightsblog.com/2014/10/15/munchausen-mmr-and-mendacious-warrior-mothers/ Munchausen, MMR and mendacious "warrior mothers"] - UK Human Rights Blog</ref> She wrapped his electronics in tinfoil to "protect" him, refused to get him help for a painful abscessed tooth ''for an entire year,''<ref group="note">Ever had an abscess? Trust us, they hurt A LOT.</ref> and denied him any independence.<ref>[https://sciencebasedmedicine.org/andrew-wakefield-the-mmr-and-a-mother-warriors-fabricated-vaccine-injury-story/ Andrew Wakefiled, the MMR, and a "mother warrior's" fabricated vaccine injury story] - Science-Based Medicine</ref>

There's a tragedy here, and it's not autism.

===Gypsy Rose Blanchard===
{{cquote|Gypsy was infantilized and kept away from her peers. She was little more than a tool for Dee Dee to navigate through the world the way she wanted to.|||Marc Feldman, professor of psychiatry<ref>[https://www.news-leader.com/story/news/crime/2016/07/06/munchausen-expert-says-gypsy-blanchard-case-unprecedented/86763054/ Munchausen expert says Gypsy Blanchard case is unprecedented] - Springfield News-Leader</ref>}}

One highly-publicized case involved Gypsy Rose Blanchard, whose mother Dee Dee pretended that Gypsy had [[cancer]], muscular dystrophy, seizures, and other illnesses. Gypsy had to endure numerous surgeries and medications that she didn't actually need.<ref>[https://www.oxygen.com/martinis-murder/dr-phil-interview-gypsy-rose-blanchard-nicholas-godejohn-murder 'It Didn’t Sink In Until It Was Actually Happening,' Gypsy Rose Spills Disturbing Details Of Mom's Murder] - Oxygen</ref> When Gypsy began to start asserting herself as a young adult, her mother claimed that she was too intellectually disabled or drugged-up to understand the extent of her impairments. Sick of being abused, Gypsy and her boyfriend murdered her mother. This caused a media circus, with TV shows covering the crime.<ref>[https://allthatsinteresting.com/gypsy-rose-blanchard The Story Of Gypsy Rose Blanchard, The ‘Sick’ Child Who Killed Her Mother Dee Dee Blanchard] - All That's Interesting</ref>

==False accusations==
Sometimes accusations of factitious disorder may be used to discredit or ignore someone who is displaying symptoms of a difficult-to-diagnose disorder, sometimes with dangerous results if the person is denied care.<ref>[https://www.news.com.au/lifestyle/health/health-problems/the-woman-hospitals-refuse-to-treat/news-story/b6e1d86e2b0880d9177502992c09f5f5 The woman hospitals refuse to treat]</ref>

Claiming factitious disorder may also be a way to [[gaslighting|gaslight]] someone who is actually sick or disabled.

===False accusations of FDIA===
FDIA may be over-diagnosed, with devastating results for families.<ref>[https://www.bbc.com/news/health-48151355 False allegations of fabricated illness 'ripped family apart'] - BBC News</ref><ref name="pt">[https://www.psychologytoday.com/us/articles/200709/munchausen-unusual-suspects Munchausen: Unusual Suspects] - Psychology Today</ref> Some people have cautioned against claiming FDIA without proof, with concerns that parents who have real worries about their children could be mistakenly labeled as abusive.<ref>[https://www.alexlowery.co.uk/why-are-mums-whose-children-have-autism-still-being-accused-of-munchausin-by-proxy// Why are mums whose children have autism still being accused of Munchausin by proxy?] - Sylvia Lowery</ref>

False accusations of FDIA may stem from a difficult relationship between doctor and parent.<ref name="pt" />

[[Autism|Autistic]] parents may be accused of FDIA when they're simply worried about their children and may struggle to express themselves.<ref>[https://www.pdasociety.org.uk/files/download/297b6070b91354f Munchausen by proxy: underrecognition of autism in women investigated for fabricated or induced illness] - PDA Society (PDF download)</ref> Deeply concerned about their kids, they may be hyper-attuned to their kids' symptoms and thus worry too much about something when it's actually fine. They may also be accused of "making up" signs of autism in their children<ref>[https://www.theatlantic.com/family/archive/2017/05/autism-parenting/526989/ The Joys and Challenges of Being a Parent With Autism] - The Atlantic</ref> (even though autism is mostly genetic, so you'd think autistic parents would often have autistic kids). Checking parents for signs of autism may help doctors know that the parent needs extra guidance instead of legal action.

Parents of kids with [[disability|disabilities]] may sometimes be accused of inventing the disability, especially in cases like pathological demand avoidance, in which the child behaves better at school than at home and won't respond to conventional treatments.<ref name="community">[https://www.communitycare.co.uk/2019/05/15/pathological-demand-avoidance-social-workers-need-know/ Pathological demand avoidance: what is it and why do social workers need to know?] - Community Care</ref><ref>[https://www.pdasociety.org.uk/blog/2019/03/fabricated-or-induced-illness Fabricated or Induced Illness] - PDA Society</ref>

It can also be difficult to distinguish between sudden infant death syndrome (a tragic occurrence with no clear explanation) and [[Filicide|infanticide]] related to FDIA.<ref>[https://pediatrics.aappublications.org/content/118/1/421 Distinguishing Sudden Infant Death Syndrome From Child Abuse Fatalities]</ref>

==See also==
*[[Self-diagnosis]]
*[[Child abuse]]
*[[Anti-vaccination movement]]

==Notes==
{{reflist|group="note"}}

==References==
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[[Category:Mental health]]

Categories: Mental health