Factitious Disorder --in Therapy?

There's a patient who I've occasionally interpreted for who regularly comes into the ER with abdominal pain. A nurse, frustrated and annoyed, told me once that she's had every test there is, more than once, and they can find nothing -there's nothing wrong with her.

Well I ended up interpreting again for her last night and the doctor told me she had "factitious disorder." I didn't know what that was, so I looked it up -it's apparently a psychological disorder:

From the Cleveland Clinic:

People with Factitious Disorder deliberately create or exaggerate symptoms of an illness in several ways. They may lie about or mimic symptoms, hurt themselves to bring on symptoms, or alter diagnostic tests (such as contaminating a urine sample).

Those with Factitious Disorders have an inner need to be seen as ill or injured, but not to achieve a concrete benefit, such as a financial gain. Individuals with Factitious Disorder are even willing to undergo painful or risky tests and operations in order to obtain the sympathy and special attention given to people who are truly ill. Factitious Disorder is considered a mental illness because it is associated with severe emotional difficulties.

According to what I've read, this can occur with the mimicking of both physical and psychological symptoms. So it got me thinking: Is it possible that there are people who mimic/fake (consciously or unconsciously) psychological symptoms in therapy?

Do you think this can happen, and if so, why?

We've had people right here say they have created stories, exaggerated stories, outright lied, etc. about their history to their therapists. I am guessing they either don't feel their reality is serious enough to warrant attention maybe so they make things "worse" than their reality? Or perhaps with some it really is the way they have learned in life to get attention? Clearly they have real psychological issues that need to be dealt with. Somehow the fabrications are a symptom of another problem altogether?

I think i have heard of this, and it was said that it's very common at Psychiatric Inpatient Hospitals.

sometimes i think i am a huge lie to my T

You've all heard of Munchausen's Syndrome?
It's a factitious disorder.

The person truly believes they're sick.

Treatment involves being seen by one doctor only , who's aware of the condition; and sometimes psychological treatment as well.

That's my feeling, as well. From what I read, it often has to do with a desire to be 'in the sick role', wanting to be rescued, and other issues. As you say, clearly there are psychological issues behind this that lead to the need for exaggeration and fabrication, which would be addressed in therapy. Although I don't know how a therapist (or psychiatrist, etc.) would be able to diagnose a 'factitious disorder' unless the patient were to admit to it somehow. It's very different than doing numerous medical tests, for a presumed medical disorder, only to find that the physical complaint doesn't exist (as such); far more complicated, I would think, with psychological-type complaints.

I think people blame the people they cannot help. So it becomes "they are making it up" instead of "we have limits to what we know"
Any number of things go untreated and mistreated and people stop trying to get help because they are dismissed as having nothing really wrong with them because western medical science could not or did not find the problem. People with thyroid disease symptoms, Fibromyalgia, and other things have been dismissed for years. I find the attitude of western medical providers to be insulting and wrong when they take the view that nothing is wrong and you are not having pain just because we can't diagnose it. It is another reason why I only use eastern medicine. And have a field day when I get involved in these type cases as an attorney.

I can accept that the disorder may exist; but whether this person with abdominal pain has it, is another question. I went in and out of hospital last year with abdominal pain and was sent away from ER since with their tests they didn't pick up anything; I was also told that the diagnostic tests were limited and that sometimes only surgery itself will identify problems. Where I am they also don't do much in the way of diagnostic testing apart from ruling out urgent conditions eg. acute appendicitis or a burst ovarian cyst - they leave tests for non-urgent conditions to other medical specialists.

exactly!

as far as in therapy; I've known some people online (this was years ago and long before I was on PC) who have mentioned they did fake their condition (and mimic real conditions) in therapy because they weren't getting the attention they wanted, and also wanted to make things more interesting - not sure that this disorder would apply in those cases though

I just want to agree with this. I had salmonella food poisoning and I was sick for several months before the cause was finally discovered (and only by a stool sample - sorry if that's TMI) and even after it was discovered, I was told there was nothing they could do - that it had to run it's course.

This was before I was told that I was making a big deal out of nothing and countless accusations that I was pregnant and sexually active when in truth I was a VIRGIN. One doctor argued and argued with me....How do you KNOW for SURE you aren't pregnant?.....Because I'm a VIRGIN.....omg

I wonder, when it comes to therapy....what would be the point in making something up? Perhaps people are in such dire need to feel cared for that this is the only way they can?

Last time I was in the hospital, there was a patient who was definitely faking her symptoms. She would fake passing out a couple times a day, sometimes complete with fake seizures. It was obvious she was faking because she would be sure to always do it right in front of the nurses station; you could see her looking around just before hand to time it just so for the greatest effect. It was annoying as heck. Clearly she had psychological issues, but the passing out was not a real medical issue.
It was a fairly common occurrence in the hospital to see faked symptoms used to get attention or for drug seeking.

I am not saying sometimes people do not fake symptoms for various reasons. I believe those reasons may be legitimate reasons to fake something to get what they want - I want drugs so I will do x and I can get them - I don't find wanting drugs to stop pain to be not a good reason even where those without the pain cavalierly suggest that some pain is to be expected and so forth - but that is not how this example reads to me.
This example smacks of "because we can't find anything with our tests, she can't be feeling pain/there is nothing wrong with her."
Which is simply untrue.

Unless someone is faking symptoms for a particular outcome - like pretending they are insane so they get a lesser sentence in a mental hospital instead of going to jail (which, to go off on another tangent, could possibly indicate psychopathy) - then they are likely doing it for attention. That extreme need for attention comes from somewhere - probably from having unmet needs in childhood - like so much other stuff does. I think that the faking of psychological problems in itself would be indicative of a need for psychological treatment, anyway. It's kind of like they're just making their issues more visible - whether consciously or not.

But then isn't there also 'psychosomatic' pain? It's still not 'real' in the sense it can be found in a test, but it is 'real' to the person, they're not 'faking' it.

I've worked in healthcare for a long time, and I completely agree that (and many providers would agree) that there are still things that are not well understood and just because a cause cannot be readily found for symptoms, does not mean they're not 'real.'

For the record, I'll say that I've worked in the type of hospital where a patient like the one I mention would be discharged from the ER each and every time --whereas here, she is generally admitted --for more tests, more sub-specialists, etc. and although they keep admitting her, they do believe at this point that it is psychological, and provide her with psychiatric care as well. Just saying, they're not being dismissive, it's just some staff are frustrated.

In any case, though there are plenty of cases of missing diagnoses, I think 'factitious' disorders do exist as well. It just stands to reason that both exist. But the reasons behind them and how it's treated, particularly regarding psychological symptoms -that's what I'm interested in understanding; it's not something you hear about much.

It's interesting what you say, Sierra, about symptoms appearing when in front of others, etc. --one of the diagnostic 'criteria' for factitious disorders is the symptoms manifesting themselves only in front of others-healthcare professionals (I don't remember if both or either). That sounds difficult to parse out, though.

I think that the faking of psychological problems in itself would be indicative of a need for psychological treatment, anyway. It's kind of like they're just making their issues more visible - whether consciously or not.

Very true, I agree --but what I wonder is how is a therapist going to know that this is going on in the first place, in order to best treat the underlying issues? Or would therapists figure it out on their own, and go on to treat the underlying problems unbeknownst to the patient?

This would seem to be extremely unethical to me. Well it would be a whole list of other things too (paternalistic and dishonest, to name a couple), but unethical would be my starting place. What would ever give a therapist the right to treat problems if the client did not consent to be treated for those problems. Not to mention if it is not a problem for the client, then what give the therapist a right to label it as such and treat it unbeknownst to the client? A horrible horrible situation in my opinion.

I know the very first time I experienced depression, I was unaware of actually being depressed. I was a teenager. I went to the doctor's office complaining of hurting all over. Especially in my arms like when I tried to brush my hair. So I moved my arm up and the pain in my arm was so bad that I started to cry. He was smart enough to figure that I was depressed and he sent me upstairs to a psychologist. My brother, one time when he was depressed, loss all feeling in, and was unable to move, his left arm. Anyway, I am not saying that there are not those out there that pretend to get sick for attention but if they do they are most likely mentally ill. But I am also saying that our mind is also capable of doing things to our body.
Just my opinion, Mickey

I think in some cases this 'faking' can be spotted fairly easily - like was said earlier in the thread about someone 'fainting', but in other cases it may be more difficult to pick up on - although perhaps the therapist would start to notice patterns of behaviour, etc...

In a way I'm not sure how much it would matter, in that I would hope that a competent therapist would get to the root of the issues, and that therefore any negative behaviours would as a result hopefully subside, as they were symptomatic of the underlying problem?
(ETA: underlying issues that would come up and be recognised in the course of the therapy, by talking and working through them, not 'unbeknownst' to the client.)

This is such a complex topic.

I lived for many years with a partner who had a multitude of physical and psychological disorders. In the beginning, I was convinced that her chief problem was not getting the consistent, focused medical care she needed to address her medical issues, and I put myself in charge of helping her get to the bottom of things and get some real treatment.

Over time, through agonizing years of one step forward, two steps back, it became apparent that her mental and physical symptoms were so intertwined and interrelated, it was impossible to determine causality or even the "reality" of her complaints. Even the dramatically visible ones--seizures, disassociation, extreme pain, lack of muscle control--were almost capricious in their manifestation. There was no way to untangle each thread and give her the help she needed, in part because she was unable to face the deep psychological nature of some of her problems and refused treatment on that front.

She lives somewhat on her own now, in poverty, sickness, and hopelessness. Our medical system can't/won't help her, and our mental health system is so deeply F'ed up that she doesn't get what she needs there, either.

While I would never "blame" her for her troubles, there is no doubt in my mind that many of her medical issues have psychosomatic origin. It happens, it's real, and it's the source of incredible pain and frustration to both professionals and loved ones alike.

Edited to add: I have great sympathy for her individual therapists, as she is a convincing liar (who believes most of what she says) and makes it very difficult to get to the "truth." It took me many years to figure things out, and I lived with her and was very focused on her problems. Someone seeing her an hour a week was at a real disadvantage.

"Unbeknownst" was a poor choice of words. But I don't think there would be an easy/clear solution. The therapist could be upfront, 'honest' and confront the patient, but that would be telling the client that they don't believe them; isn't there a good chance they wouldn't be ready/prepared for that? And/or it wouldn't it come off as horrendous in so many ways? Or simply ignore it. But if a therapist felt that, in ignoring it, they would not be able to properly help/treat this person, then should they refer them on? There are other options. I suppose it would depend on both patient and therapist, their relationship, and other factors.

It seems to me that this disorder is related to other delusion disorders. Delusions are defenses, and seem not so far removed from OCD rituals. I think Ts generally accept delusions at face value and their relative truth/falseness and work with them until the client is able to give them up. It can probably be a long process at times requiring a great deal of patience. Countering a defense or trying to force a client to abandon it usually just entrenches it. It isn't lying, and while immensely frustrating, the underlying pain they hide is just as worthy of treatment as any other condition.

This could be either Somatization disorder or Conversion disorder. It is different from factitious disorder in that the patient actually feels pain and is not exaggerating anything. Before I got diagnosed with PTSD & Depression I had all kinds of complains about physical pain and I tried to blow it off for a couple months but every single day I was screaming in pain. My GP gave me pain pills and they made the pain worse! I went to the ER and they ran me through all sorts of machines and scans and asked me all sorts of questions. Eventually they discharged me saying I had an ulcer, and should seek help through a mental health professional, which didn't explain the widespread muscular skeletal pain I was experiencing. As the pain got worse I started having more frequent and intense panic attacks.

Eventually I broke down and called a local therapist with sliding scale, since I was in such huge debt with the hospital. The therapy definitely helped reduce some of the pain, I also used meditation and eventually herbal medication that inhibits the enzyme monoamine oxidase. This increases the amounts of the neurotransmitters in the brain serotonin, dopamine and norepinephrine. These neurotransmitters lifted my mood, increased my motivation and took my pain levels down to an acceptable level. I had another doctor tell me that the pain was caused by the muscles getting so tense and cramped up. It could be an electrolyte imbalance exacerbating the pain this woman is experiencing.

Bottom line is not everybody who has pains that are not explained by medical science is making it up. Munchausen syndrome and factitious disorder should only be diagnosed if the person does not have another psychiatric disorder. People with somatic complaints that cannot be explained from other medical conditions often have anxiety, mood and personality disorders.

I'm sure this is a real issue... But not one for non psych professions to diagnose...my friend had adominal pain for months and drs told her it was all in her head...until one day her stomach was bloated and she was in so much pain she couldnt walk and she was finally diagnosed with ovarian cancer... She almost died at 32.

It would take a lot for me to even believe psych people were diagnosing it correctly.

I couldn't agree more. Just within my family, this has happened numerous times. Before I was born, my mom had all kinds of physical symptoms and doctors were unable to find the cause-- so they told her it was all in her head. For years, she would get sicker and sicker and the doctors kept saying it was all psychological. Well, finally, when she got bells palsy and couldn't move her face or her legs, they sent her to a specialist who diagnosed her with advanced MS. Had the doctors taken her seriously and got her on medication years earlier, I wonder if I would have had a "mom."

Now, I'm having an impossible time getting the medical care I need for serious neck problems that have been going on for 4 years. I've been to a handful of doctors, and none of them can figure out exactly what's wrong. My GP has known me for many years and knows that I'm not "faking it." I've never had a mental health condition, I've never complained about any other pains that did not have a clear diagnosis, I refuse to take pain meds because I want to find he source of the problem rather than mask it with meds that could hinder my career performance, etc. I also have other diagnosed medical problems, and have already had surgery twice this year (and I'm only 28). Both of my parents have auto-immune and neurological disorders, and it's not exactly surprising that I have some of the same symptoms. However, the neurologist I got sent to told me that, while I have other "real" diagnoses, the neck pain is "all in my head" because he can't find the source. So, he wrote something in my medical file that basically says I'm a hypochondriac. Well, two days after he sent me home by saying that I'm "fine," I passed out on the sidewalk in the snow in front of my office-- and laid there for who knows how long until someone found me. After that, I was so angry I went online and looked up the doctor-- turns out there are all kinds of complaints filed against him by women saying "he told me my problem was all in my head-- then I ended up in the hospital with a life threatening condition." So, I'd be very, very wary about telling a patient that their problem was "all in their head" just because a doctor couldn't diagnose the problem. I still don't know exactly what is wrong with my neck-- or why tweaking my neck causes me to pass out and go blind temporarily-- and because of this doctor's note in my file, I have a hard time finding other doctors who will take me seriously. So, I continue to live with pain every day, and am very careful about not turning/twisting my neck, lest I pass out again (it also happened in the middle of a yoga class, and a few other times). My T says that I shouldn't have to live like this-- I'm obviously not crazy; my symptoms are obviously real-- but I don't have the time or money to spend going to more doctors who won't take me seriously and won't be able to help me. I'm a professor, so hopefully I won't pass out while I'm teaching a lecture hall full of students!

It might be possible.

I actually have this big fear that I'm some sort of pathological liar. I fear that I'm faking and/or exaggerating my symptoms. I worry that perhaps I'm just imagining all of them and that I'm making them up or making them seem worse than they are just to get attention. I still worry about it but it's not as bad as it was about a year ago. Back then it was all I could think of. It consumed my life and gave me such horrible anxiety that I literally hit my head because I wanted it to stop. It made me research things over and over and over again. It made me go through memories, lists, conversations etc repeatedly to make sure I had told no lies and that I hadn't faked any symptoms.

Sometimes I still worry I'm faking. What if I am? Perhaps I have some sort of Factitious Disorder. I really hope that's not true.

EDIT: However, if I look at it rationally (which is difficult to do sometimes) I realise that there's probably no way I could fake 10+ years of mental illness. And I guess if I really had Factitious Disorder I wouldn't worry about it, right?