When patients lie: Factitious Disorder in the family practice setting

Abstract

Background and purpose: Patients with Factitious Disorder (FD), a psychological disorder where one falsifies or induces illness in the absence of any external reward, present an intellectual, emotional and ethical challenge to their Family Physicians. Understanding of this complex disorder is thus pertinent for Family Physicians, in order to prevent morbidity and mortality associated with this disease, identify child maltreatment, and mitigate unnecessary costs to the healthcare system.

Methods: This review looked at twenty case studies, literature reviews and systematic reviews of Factitious Disorder published in the past twenty years.

Results: It found that patients with FD tend to be females in their 30s-40s with a background working in healthcare. In many cases, the patient with FD has a history of trauma. Red flags that for FD are inconsistencies in the patient's history/presentation/investigations; treatment failure or high disease reccurence; and a strong interest on the part of the patient to undergo invasive testing or procedures. If the Family Physician suspects FD, they are encouraged to first investigate for organic causes of the patient's symptoms; meticulously document inconsistencies; set clear boundaries with the patient; and communicate with the patient's other care providers as much as possible.

Conclusion: Factitious Disorder is a psychological disorder that can have many consequences when not identified. By developing a basic understanding of this disorder, Family Physicians can make a positive difference in the lives of their patients, as well as prevent associated morbidity and mortality.