Effective Factitious Disorder Treatment Relies on Compassionate Care
If you suspect that your loved one is struggling with factitious disorder, you may feel confused about why someone would pretend to be sick or even make themselves sick. However, the logic of factitious disorder tells them that illness is a way to get the love, care, and attention they crave. By recognizing your loved one’s symptoms and helping them connect to specialized factitious disorder treatment, you can help them truly regain their health and learn how to meet their needs in healthy ways.
Sarah was devastated when her sister, Catherine, began experiencing a severe and unidentified gastrointestinal condition at age 37. “It was terrifying,” she remembers. “And it felt so unfair. Catherine had already been through so much, medically speaking. She was always dealing with some sort of illness, although none as serious as this. She couldn’t eat, she was so tired all the time, and she lost so much weight I was scared she would get organ damage.”
Despite the seemingly dire circumstances, Sarah knew her sister was a fighter and with, the right medical care, she believed she would get a proper diagnosis and begin healing. Medical care, however, was expensive and time-consuming and the illness was already significant financial toll, as Catherine’s symptoms left her unable to work. Sarah wanted to help in any way she could. Turning to her virtual community, she set up a GoFundMe account, which spread quickly as family and friends shared links on Facebook. “Initially, that GoFundMe account seemed like a gift. People—even strangers—were so generous, and knowing Catherine would be able to afford time off and medical care took away some of our worry,” she says. But eventually, GoFundMe led Sarah to begin questioning everything.
“I kept the fundraiser page updated with progress reports on my sister’s care to let everyone know how things were going. People I didn’t even know started sending me messages about their own struggles with difficult gastrointestinal diagnoses and suggestions for things to try.” Catherine, however, refused to hear them and became defensive when Sarah tried to bring them up; how could people who had never even met her know better than her own doctors? But Sarah couldn’t stop thinking about it. “Catherine never wanted me to go with her to her appointments and I had always respected her wishes; I know that people deal with these issues in their own way,” she says, “But I asked to accompany her to an appointment to go over her care for my own peace of mind—I wanted to be sure she was being taken care of properly. That’s when she lost it. I’d never seen her so angry and I suddenly realized something was very wrong. And it wasn’t about her physical health.”
Sarah was right. While her sister was struggling with a serious medical condition, it wasn’t a physical ailment, but factitious disorder of the self. Previously known as Munchausen syndrome, people with this disorder deliberately deceive others by producing or exaggerating symptoms of an illness, often to the detriment of their own physical health. Healing from this troubling condition requires dedicated factitious disorder treatment designed with the unique needs of these clients in mind.
The Logic of Factitious Disorder
In recent years, factitious disorder of the self has gained wider attention in part due to the arrival of blogs, fundraising websites, and social media platforms that allow users to easily share their medical conditions with others. However, factitious disorder is nothing new; the first references to this condition were made by Claudius Galen, a physician in second-century Rome. Since that time, factitious disorders have been recognized by a broad range of healthcare professionals and understood to encompass everything from patients who quietly mimic illness to those who “force themselves on a surgeon, preferably one who is strong and dynamic.”
While the emergence crowdfunding has led many to conflate factitious disorder with malingering, factitious disorder is not spurred by a desire for financial gain, although feigning financial need may be a part of the overall feigning of a medical condition. Rather, factitious disorders arise from a desire to be treated as someone with an illness, particularly by medical professionals. “Many of us cannot imagine why a person would wish to remain sick,” says Dr. Lois Krahn. “Why would someone be willing to endure pain and multiple hospital stays, remain isolated from family, and risk permanent disability? Yet, an unknown number of people strive to appear unwell so that they can receive ongoing medical care. Their objective is to assume the sick role.” Although some people achieve this by inventing symptoms, others induce real symptoms through a variety of mechanisms such as intentionally infecting wounds, surreptitiously taking unnecessary or even dangerous medications or supplements, or self-injury.
So what is it about medical attention and being sick that is so attractive? Experts believe that it’s about seeking compassion, care, attention, and love, even if it means being subjected to painful medical procedures and endangering one’s own physical health. Nellie, for example, had always felt “a deep need for affection that was not being met.” When she was 18, however, she thought she found a way to get it. In an article published in Nautilus, Linda Marsa writes, “She was hospitalized when she was in a car accident, and suddenly discovered how much unconditional love she received while she was recovering. After that, most of her attention was focused on injuring herself so she could be hospitalized.” She was hospitalized between 30 and 40 times, undergoing elaborate diagnostic procedures and multiple surgeries. “Being sick had become a way of life and I was unable to stop,” she says. “The rewards were just too great.”
Gregory Yates of King’s College shares his insight into the complex motivations behind factitious disorder of the self, emphasizing that it is often closely related to a comorbid psychiatric condition:
Many patients with Munchausen syndrome pretend to be ill because they feel this is the only way anyone will pay attention to them. They believe that having an illness will make them feel special. Patients who are diagnosed with Munchausen syndrome are almost always found to be struggling with something—perhaps depression or a traumatic childhood. They need help. But for whatever reason, they cannot admit this to others and so they use illness as an excuse to reach out for emotional support.
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Recognizing Factitious Disorder Symptoms
In order for convincing deception to take place, many people with factitious disorder rely on in-depth medical knowledge to accurately mimic symptoms. Thanks to the internet, those suffering from the condition can now easily access virtually limitless information about illnesses that can help them dupe even highly trained medical professionals. “It used to be that factitious disorder patients would have to get medical textbooks and read up on how to fake an illness to get the attention they craved,” says Dr. Mark Feldman, a psychiatrist specializing in factitious disorder. “[N]ow anyone can become an expert in even esoteric medical problems online. They don’t have to be good actors anymore. They just have to be skillful with words.”
Due to the expertise with which some describe their symptomatology and the lengths they may go to in order to induce actual symptoms, identifying factitious disorder can be difficult for both health care workers and for family and friends of those struggling with the condition. However, there are symptoms that can help identify the presence of factitious disorder of the self, including:
- Extensive knowledge of medical conditions and terminology
- Worsening of symptoms for no apparent reason
- Non-responsiveness to standard treatment
- Seeking treatment from many different providers
- Inconsistent and nonspecific symptoms
- Reluctance or refusal to allow family or friends to talk to treatment providers or accompany them to treatment
- Eager participation in testing and procedures, including surgeries
- Frequent medical appointments or hospitalizations
- Frequent disagreements with doctors and staff
If you suspect that your loved one is struggling with factitious disorder, it can be very difficult to express your concerns. What if you are wrong? What if you damage your relationship? These are normal worries, but it is important to remember that factitious disorder is not only a sign of psychiatric dysfunction, but can be physically dangerous; unnecessary medical procedures and inappropriate medication can have serious and lasting consequences.
For Nellie, those consequences almost included death. After injecting feces into her bloodstream, she went into septic shock. “For the first time, I found myself really scared that I might die,” she remembers. It was only then that she was ready to admit the truth about her medical condition—that her symptoms were invented, exaggerated, and artificially created and that her true condition was a factitious disorder. “I lost the support of nearly all my friends and family when they realized I had deceived them,” she says. But she entered treatment and she got better. “I didn’t stop until I realized, through therapy, that there were reliable and safe ways to meet my need to be cared about. I used to think that my ruses were the answer to my problems. Now I realize that they only created more problems and solved nothing.”
The Need for Compassionate Factitious Disorder Treatment
The nature of factitious disorder can present serious concerns for both healthcare professionals and for patients. Not only must your loved one break through their own denial, they then have to ensure that they do not take factitious disorder treatment as an opportunity to perpetuate their condition and their identity as a sick person. As such, helping them connect to a treatment provider who has the expertise necessary to effectively care for your loved one is essential for the healing process.
The treatment process must begin with a thorough psychological assessment in order to correctly identify the presence of a factitious disorder. Input from family, friends, and outside treatment providers can be invaluable during this process, as people with factitious disorder of the self may not realize or admit to the extent of their illness. Additionally, many people with this condition struggle with comorbid psychiatric conditions, such as depression, trauma-based disorders, or personality disorders, which will need to be treated simultaneously in order to create true recovery.
Once a diagnosis has been made, comprehensive factitious disorder treatment should begin. Often, people with this condition readily accept treatment and are willing to participate as assuming the role of the sick person fulfills a deep emotional need. However, it is critical that psychiatrists and therapists use psychotherapy to guide your loved one toward healing rather than allow them to linger within their illness. To do this, clinicians should lead them toward a deeper understanding of their condition in a non-judgmental way, allowing them to recognize the roots of their disorder and acknowledge their struggles without fear of humiliation. Within the context of a strong therapeutic alliance, they can then begin to identify their needs and formulate strategies for addressing those needs in healthy ways. Throughout this process, they will have the opportunity to explore who they can be without their illness; what is possible when they are not sick? What kind of relationships can they forge? What passions do they have? By imagining an identity and a future beyond illness, they can lay the foundation for profound personal growth. Meanwhile, addressing comorbid conditions can help your loved one gain greater emotional stability, resilience, and inner harmony.
However, factitious disorders don’t just affect your loved one. Often, family members are intimately—and unknowingly—involved in the effects of the condition, and healing requires a transformation of the entire group. As such, the treatment program your loved one attends should include family therapy options designed to give you the support you need throughout the treatment process. Initially, this may involve addressing the anger and sense of betrayal you may feel as the result of discovering your loved one has been feigning or inducing symptoms. Processing these feelings and coming to understand your loved one’s struggles while acknowledging your own can be an essential part of healing. As your family member begins their recovery journey, it’s also important for both of you to explore your changing dynamics, particularly if you have taken on a caretaking role. Developing healthy boundaries, addressing conflict, and identifying your own needs as you transition into a new sense of self will help both of you move forward.
For Catherine and Sarah, treatment was truly transformative. “She was finally able to meet her needs in an authentic way. She was able to feel loved and cared for simply for being herself, not because she was sick,” Sarah says. “And I was able to begin a new relationship with her, one that isn’t dictated by her illnesses. It was very difficult at first for both of us; she was very scared and I was very angry. But we both got the support we needed to heal and become stronger together.”
Bridges to Recovery offers comprehensive treatment for mental health disorders as well as process addictions and phase of life issues. Contact us to learn more about our renowned Los Angeles and San Diego-based programs and how we can help you or your loved one start on the path to healing.