Factitious Disorders

Factitious disorder (FD) is a psychiatric disorder in which patients deliberately perpetrate or lie about medical and/or psychiatric illness in themselves or others. Although it has been thought to be driven by the need to take the patient role, no body of research has clearly identified the underlying motivation, cause, or treatment for it. Illness deception, along with the similarity to other diagnostic categories, such as somatic symptom disorder, personality disorder, and malingering (which is not considered a mental illness but can be a focus of clinical attention), has hindered basic and clinical research into the nature and treatment of FD. Still, moving psychiatric treatment of FD forward can take advantage of tools already available to clinicians, including motivational interviewing techniques to facilitate empathic confrontation in the general hospital. Despite the lack of treatment studies, employing therapies known to be effective for borderline personality disorder, which is similar in many ways to FD, for FD patients willing to participate might be helpful. This review contains 4 figures, 5 tables and 26 references Key words: factitious disorder imposed on another, factitious disorder imposed on self, malingering, medically unexplained symptoms, Munchausen by proxy, Munchausen syndrome, pseudologia fantastica, somatic symptom disorders

Medicine as Message: Caregiving, Illness Deception, and the Cultural Evolution of Harmful Treatments 2018

Why did harmful medical treatments like bloodletting persist for centuries? We propose the following solution to this important cultural evolution question: Illness or injury often leaves people incapacitated for long periods. Caregiving - the provision of food, shelter etc. - is an important medical practice that enables ill or injured people and their dependents to survive these periods. However, caregiving is vulnerable to exploitation via illness deception whereby people feign illness in order to gain access to care. Harmful treatments helped to solve the problem of illness deception because only individuals who stand to gain substantially from care will accept the treatment. To investigate the plausibility of this theory we develop a mathematical model using evolutionary game theory and invasion analysis. We show that decreasing the benefit of caregiving via aversive and unpleasant medical treatments can counter-intuitively increase the range of conditions where caregiving is evolutionarily viable. Thus poisoning, cannibalism, emetics, bloodletting and other such treatments may be solutions to the problem of allocation of resources to people with unclear need.