Lesson 1: Clinical Disorders – Part B

THE MYSTERY OF FACTITIOUS DISORDERS

Jenny (a pseudonym) was one of those “invisible” people we all know and overlook each day. A secretary for a manufacturing company, Jenny was as a diligent employee, but one who had not developed many friends at work. Nevertheless, she seemed to find all the companionship she needed in her relationship with her live-in boyfriend. Week in and week out, her world seemed never to change, and yet she seemed satisfied. Then one day, everything suddenly and quietly fell apart.

Jenny’s boyfriend announced he was leaving her; he had fallen in love with another woman and was moving out. Horrified and adrift, with no one to call on for comfort, Jenny chose a remarkable way out of her loneliness. She mobilized an instant support network by showing up at work one day and announcing, “I’ve just been diagnosed with breast cancer. And it’s too late. It’s terminal.”

It was also a lie. Jenny had found a remarkable and desperate way to mobilize an instant support network of sympathetic co-workers. Eventually she enrolled in a breast cancer support group, shaved her head to mimic the effects of chemotherapy, and dieted to lose 50 pounds all to keep the illusion alive.

Jenny was suffering not only from a broken heart, but from an emotional ailment called “factitious disorder.” People with factitious disorder feign or actually induce illness in themselves, typically to garner the nurturance of others. In bizarre cases called “Munchausen syndrome by proxy,” they even falsify illness in another person (such as their own children) in order to garner attention and sympathy for themselves as the heroic caregiver.

Desperate? Of course. Yet more common than you might think. Experts estimate that one percent of hospitalized patients are faking their ailments. The medical bills in one case alone amounted to $6 million. Clearly factitious disorders are sapping an already-burdened health care system.

They also defy the imagination. Patients have bled themselves into anemia and then showed up at a doctor’s office stating they haven’t a clue about how they became so ill. Others have secretly taken laxatives to induce diarrhea, or mimicked seizures so convincingly that neurologists hospitalized them on the spot.

The good news: this phenomenon is finally coming out of the closet. In recent months, newspapers, magazines, and TV news programs have all described cases of factitious disorder, helping both health professionals and the general public to become aware. At the same time, factitious disorder patients are recognizing that, twisted as their behaviour may seem even to themselves, help is available.

In Jenny’s case, the ruse of cancer came crashing down when the leaders of the breast cancer support group discovered that she had lied about her medical care. Referred for psychiatric care, Jenny revealed feelings of overwhelming depression, and this deep depression had fueled her factitious behaviour. Treated with antidepressant medication and psychotherapy, Jenny ended her illness portrayals and moved on-- decisively--with her life. She has never resorted to factitious illness again.

The first step for factitious disorder patients is to realize they cannot go it alone. Though this is a hurdle they inevitably find intimidating, they simply must reach out to a therapist. The therapist can help them realize why the feigned illnesses began in the first place: why had the need for sympathy become so intense? The therapist can also discover underlying emotional problems--as in Jenny’s case--that must be treated at once, and also provide the very caring these patients had previously had to go to extremes to elicit. Finally, the therapist can help teach the patient ways to get needs met without resorting to self-defeating, and even literally self-destructive, actions.

Families who suspect that a loved one has factitious disorder are invariably hungry for education about it. Consulting with a knowledgeable professional or reading about the disorder are important steps to take before they actually confront the patient. Heavy-handed, punitive confrontation doesn’t work. Instead, we now know that factitious disorder is among the trickiest of psychological ailments to address, and intervention must be informed, carefully planned, and, above all, humane.