Addiction and Factitious Disorder
Men and women with factitious disorder are intentionally deceitful about their health, or about the health of a child or someone else in their care. They may lie about being sick or induce illness or injury in themselves or others to gain the attention of medical professionals. Factitious disorder is a serious mental health condition that can have terrible consequences if left untreated—and with accompanying substance use disorders the risks are even greater. Addiction and factitious disorder do respond well to treatment, however, and with long-term therapy each condition can be overcome.
What Is Addiction and Factitious Disorder?
People with factitious disorder crave the attention of doctors and other medical professionals, and they will invent imaginary conditions to get it, or induce actual illnesses or injuries to guarantee it. The sympathy and compassionate care they receive when they are ill, injured, or suffering from a chronic disorder brings them enormous satisfaction.
Because they so frequently seek medical attention, people with factitious disorder may become addicted to prescription drugs, which they acquire through trickery and deceit. They may even use drugs or alcohol to intentionally to make themselves ill, and that behavior can also lead to drug or alcohol dependency.
Another factor is the stress that inevitably accompanies a lifestyle based on deception and manipulation. Plagued by anxiety, shame, and low self-esteem, people with factitious disorder may use and abuse drugs and alcohol to make themselves feel better. Or, in some instances the co-occurrence of factitious disorder and addiction may be entirely coincidental, emerging from shared risk factors that leave people vulnerable to both.
Types of Factitious Disorder
People with factitious disorder, which is technically identified as factitious disorder imposed on self, use imaginary or artificially created illnesses or injuries to get attention from medical authorities. They will lie about their medical conditions to family and friends as well, in their desire to create a network of sympathizers and enablers.
But there is a second form of factitious disorder, known as factitious disorder imposed on another, that involves unwitting victims in the deception. People with this condition rely on surrogates (usually their own children) to gain entrance to hospitals or clinics, secretly inflicting injuries or illnesses on them or reporting false symptoms consistent with serious disorders and diseases. They are the ones who crave the attention, but they prefer to play the role of the suffering caretaker rather than the patient.
Factitious disorder imposed on another is unique among mental illnesses in that it is also a crime. Victims of this disorder are at severe risk for real health consequences, and if the deception continues unabated their very survival could be at stake. The perpetrators only crave attention and may not mean to cause irreparable harm, but that is exactly what can happen if their behavior remains undetected.
These two forms of factitious disorder used to be known as Munchausen Syndrome and Munchausen Syndrome by proxy, respectively. The latter condition in particular has been portrayed quite often in movies and television shows, although its actual incidence is believed to be quite rare.
Facts and Statistics
Factitious disorder imposed on self and factitious disorder imposed on another may be under-diagnosed, since those who have these disorders make a great effort to hide the truth about their behavior and its motivation.
Absolute percentages of incidence are unknown. However, studies show that up to three percent of patients referred to psychiatrists by general practitioners will demonstrate symptoms consistent with factitious disorder, while up to .9 percent of cases treated in psychiatric specialty clinics will involve one of the two forms of this condition.
Overall, about two-thirds of those who develop factitious disorder are women, and up to 85 percent of those with factitious disorder imposed on another are the mothers of the children being victimized.
Symptoms and Diagnosis of Addiction and Factitious Disorder
People with factitious disorder exhibit certain characteristics that will eventually betray the presence of their illness.
The distinctive symptoms of factitious disorder include:
- Weekly visits to doctors, clinics, or hospital emergency rooms
- “Accidental” illnesses or injuries that involve intentional acts (taking more of a prescription medication than prescribed, car accidents when driving recklessly, self-harming behavior, drinking too much alcohol or taking multiple illicit drugs, etc.)
- Reports of vague symptoms that are, by their nature, difficult to link to specific conditions
- Extensive knowledge of medical terminology, diseases, and healthcare-related topics
- Reports of new or worsening symptoms when the person is about to be discharged from a clinic or hospital
- Frequent medical tests that come up negative for biological illness
- A preoccupation with illness that makes it a constant topic of conversation with friends, family members, and co-workers
- Use of self-pity or other manipulative strategies designed to gain the sympathy of others
- Constant claims of relapses with conditions that had supposedly gotten better
- An obsession with medical TV shows, especially documentaries or reality shows
- An unwillingness to let healthcare providers communicate with family or friends, or with other medical professionals who have provided the person with treatment
The diagnostic process for factitious disorder imposed on self or another starts with a series of extensive tests, which are designed to rule out any organic causes for the symptoms of illness reported. If nothing is found the person suspected of having factitious disorder will be referred to a psychiatrist or psychologist for further evaluation.
For one or the other type of factitious condition to be diagnosed, it must be confirmed that the person did not invent a false medical history to gain tangible rewards, but only did so (compulsively and repeatedly) to gain attention and sympathy from healthcare providers and loved ones. In its essentials factitious disorder is unlike other forms of mental illness, and that makes diagnosis fairly straightforward in most instances.
People with factitious disorder may relish the attention they receive for their imaginary or self-induced conditions and symptoms. But substance dependency is an unwelcome complication that makes normal functioning impossible for anyone.
The telltale symptoms of drug or alcohol addiction include:
- Growing tolerance for the substance of choice
- Physical and psychological cravings
- Experience of withdrawal symptoms
- Substance use that is frequently heavier than planned
- An inordinate amount of time spent taking, acquiring, or recovering from drugs or alcohol
- Previous attempts to quit that all ended in failure
- The experience of significant disruptions in daily activity related to alcohol or drug use
- Interpersonal conflicts related to substance use that haven’t led to sobriety
- Experience of significant physical or mental illness caused or worsened by drugs or alcohol
- Abandonment or neglect of favorite activities as a result of the substance use
- Risky and impulsive behavior somehow linked to substance use
At least two of these symptoms must be reported before a drug or alcohol use disorder can be diagnosed. Because people with factitious disorder are prone to fabrication about their health, the markers of substance use must be clear and unambiguous, likely backed by the testimony of loved ones who can confirm the truth of the patient’s claims.
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Addiction and Factitious Disorder Causes and Risk Factors
Factitious disorder is likely caused by a chronic lack of self-esteem and a sense of powerlessness. Those who develop it have a compulsive need to receive sympathetic attention from authority figures, who make them feel noticed and cared for.
Some of the known risk factors for factitious disorder include:
- Family history of mental and behavioral health issues
- Personal history of mental health disorders
- Extended hospitalization for authentic medical conditions in childhood or adolescence
- Exposure to physical, emotional, or sexual abuse in childhood
- Trauma in the family, experienced either as a child or adult (divorce, parental abandonment, exposure to domestic violence, loss of a close family member to death, etc.)
- Employment in the medical field
Dangers of Overdose
Drug overdoses are now the leading cause of accidental death in the United States, with fatalities caused by alcohol poisoning contributing even more to this ongoing tragedy. People who have co-occurring mental disorders are especially vulnerable, since they are prone to compulsive and excessive drug or alcohol consumption when their symptoms become overwhelming.
Signs that might indicate an overdose of intoxicants include:
- Excessive drowsiness (if the person has consumed depressants like alcohol or opioids)
- Extreme agitation (if the person has been taking stimulants)
- Slurred or incoherent speech
- Mental confusion, memory lapses
- Poor balance and coordination
- Fainting spells or loss of consciousness
Anytime an overdose is suspected, emergency assistance should be requested immediately, no matter how much the individual showing the symptoms of an overdose protests.
Withdrawal and Detox
Serious drug and alcohol dependency can be overcome, but anyone addicted to an intoxicating substance will have to go through a period of withdrawal, which can produce painful, stressful, debilitating, and occasionally dangerous side effects.
During the initial stages of withdrawal, when symptoms are most acute, people striving to maintain newfound sobriety should enroll in a medically-supervised detox program offered by a licensed addiction treatment center.
Depending on the substances used and the depth of the addiction, they will likely remain in detox for a period of 7-10 days, where they will be closely monitored round the clock by a staff of trained medical professionals. After detox is completed and withdrawal symptoms have stabilized, the patient will be ready to move on to formal treatment.
Other mental health issues are frequently experienced by men and women with factitious disorder. In one comprehensive study of sufferers, 46.5 percent were diagnosed with additional psychiatric disorders.
There is a strong correlation between personality disorders and factitious disorder in general, with borderline personality disorder being by far the most commonly diagnosed. Depressive disorders are also extremely common among men and women with factitious disorders, with frequent bouts of major depression reported.
While their lists of risk factors are not identical, factitious disorders, personality disorders, and depressive disorders all have deep roots in abuse or neglect experienced during childhood. Such experiences are also predictors for substance use disorders in adulthood, and research has revealed that substance abuse co-occurs with factitious disorder more frequently when personality disorders and depressive disorders are also present.
Treatment and Prognosis for Addiction and Factitious Disorder
When allowed to continue without acknowledgement or intervention, factitious disorders will only worsen over time, until real and lasting damage is inevitable. The same is true for substance use disorders, and when the two types of conditions occur together the circumstances can quickly become dire.
But there is cause for hope. Dual diagnosis treatment programs for those with co-occurring addiction and factitious disorder can produce remarkable results, if treatment begins early enough and the patient is willing to face the truth about the dysfunctional nature of their behavior.
Inpatient and outpatient treatment plans will include a mix of individual, group, and family therapy, with equal priority being given to both diagnosed conditions. Although there are no medications approved for the treatment of factitious disorder, they may be prescribed to assist with withdrawal symptoms or for any mood disorders or anxiety disorders that may be present.
Holistic therapies like meditation, yoga, biofeedback, arts and music therapy, and massage therapy may also be included in a program for co-occurring disorders based on the preferences and interests of the patient. Aftercare programs will help reinforce the lessons learned during the person’s 30-90-day stint in formal treatment, and long-term therapy should be considered vital for people with self-destructive habits to overcome.
Factitious disorder is a challenging opponent, and recovery from a substance use disorder is a lifelong affair. But with an honest and reflective approach to healing that makes no excuses and rejects all forms of denial, good health and a brighter future are both achievable.