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.