ABSTRACT
Mental disorders are health conditions characterized by alterations in cognition, mood, or behavior associated with subjective distress and/or impaired functioning. In clinical practice, the assumption is that these abnormalities are largely out of the person’s control and that the person does not desire them. Factitious disorder (FD) is a psychiatric condition in which a person acts as if he or she has a physical or mental illness when, in reality, the person has consciously and deliberately created the symptoms. The name factitious comes from the Latin word for “made up” or “fabricated.” Medical and psychological practitioners assume that when an individual seeks assistance for a physical or mental condition the motivation is the desire to get better as soon as possible. Practitioners also assume that the history given by their patient is generally accurate. Repeated presentation to the doctor’s office is frequently taken to mean that the patient is: very motivated to improve, physically or mentally vulnerable and therefore taking a long time to improve, or very focused on the illness. Doctors are not trained to suspect that an individual may be creating symptoms or even the illness in a willful manner. According to Elwyn and Ahmed (2007), individuals with FD are among the most challenging and troublesome for busy clinicians. These authors state that FD patients violate three key unwritten rules: (1) patients provide a reasonably honest history; (2) symptoms result from accident, injury, or chance; and (3) patients want to recover and cooperate with treatment toward that end. The individual with FD violates this unspoken doctor/patient contract by seeking to remain in the sick role as a primary goal (Eisendrath & McNiel, 2004).
