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Questions and Answers
What distinguishes factitious disorders from malingering?
What distinguishes factitious disorders from malingering?
Which of the following is a common comorbidity associated with factitious disorder?
Which of the following is a common comorbidity associated with factitious disorder?
What is a characteristic behavior often exhibited by individuals with Munchausen syndrome?
What is a characteristic behavior often exhibited by individuals with Munchausen syndrome?
Which statement best describes the treatment approach for factitious disorder?
Which statement best describes the treatment approach for factitious disorder?
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What makes the diagnosis of factitious disorders particularly challenging?
What makes the diagnosis of factitious disorders particularly challenging?
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How might someone with a genuine physical disease manipulate their condition to resemble factitious disorder?
How might someone with a genuine physical disease manipulate their condition to resemble factitious disorder?
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Which of the following best explains the impact of severe personality disorders on factitious behavior?
Which of the following best explains the impact of severe personality disorders on factitious behavior?
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What key element must be ruled out when diagnosing factitious disorders?
What key element must be ruled out when diagnosing factitious disorders?
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What often indicates that a mother may be causing her child's illness in cases of factitious disorder imposed on another?
What often indicates that a mother may be causing her child's illness in cases of factitious disorder imposed on another?
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What psychological traits are commonly observed in patients with factitious disorder imposed on self?
What psychological traits are commonly observed in patients with factitious disorder imposed on self?
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What is a notable laboratory finding in patients exhibiting factitious disorder behavior?
What is a notable laboratory finding in patients exhibiting factitious disorder behavior?
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What consequence might arise from reasonable suspicion of factitious disorder imposed on another?
What consequence might arise from reasonable suspicion of factitious disorder imposed on another?
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Which of the following best describes a key characteristic of neuroimaging studies related to factitious disorder?
Which of the following best describes a key characteristic of neuroimaging studies related to factitious disorder?
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What demographic commonly experiences high mortality rates due to factitious disorder imposed on another?
What demographic commonly experiences high mortality rates due to factitious disorder imposed on another?
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In the context of diagnosing factitious disorder, what is a frequent challenge faced by healthcare providers?
In the context of diagnosing factitious disorder, what is a frequent challenge faced by healthcare providers?
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What is the hallmark of Munchausen syndrome by proxy?
What is the hallmark of Munchausen syndrome by proxy?
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What is a primary characteristic of patients with common factitious disorder?
What is a primary characteristic of patients with common factitious disorder?
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Which of the following best describes Factitious Disorder Imposed on Another?
Which of the following best describes Factitious Disorder Imposed on Another?
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What motivates the behavior in Factitious Disorder Imposed on Another?
What motivates the behavior in Factitious Disorder Imposed on Another?
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Which statements accurately describe Munchausen syndrome by proxy?
Which statements accurately describe Munchausen syndrome by proxy?
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What is a key diagnostic challenge in identifying factitious disorders?
What is a key diagnostic challenge in identifying factitious disorders?
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In which year was Factitious Disorder Imposed on Another first described?
In which year was Factitious Disorder Imposed on Another first described?
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How do patients with factitious disorder typically react when confronted with evidence of their condition?
How do patients with factitious disorder typically react when confronted with evidence of their condition?
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Which characteristics are often associated with patients diagnosed with common factitious disorder?
Which characteristics are often associated with patients diagnosed with common factitious disorder?
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Study Notes
Factitious Disorder Imposed on Oneself
- Patients with factitious disorder imposed on oneself often have severe characterological problems like sociopathy, narcissism, or histrionic personality traits.
- Approximately 30% of patients with factitious disorder imposed on oneself have some form of cerebral dysfunction.
- This dysfunction is often demonstrated by a significantly higher verbal IQ score compared to performance IQ score, possibly linked to pseudologia fantastica.
- Test results of patients with factitious disorder imposed on oneself are consistent with histrionic or borderline personality traits, somatic preoccupation, and conflicts about sexuality.
Factitious Disorder Imposed on Another (Previously Factitious Disorder by Proxy)
- This disorder involves a perpetrator (usually the mother) presenting another individual (the victim) as ill, impaired, or injured, with a clear intent to deceive.
- The deceptive behavior is evident even without obvious external rewards.
- The behavior is not explained by other mental disorders like delusional disorder or another psychotic disorder.
- The diagnosis is given to the perpetrator, not the victim.
- This disorder was first described in 1978 and has been widely reported since, with every major children's hospital seeing several cases per year.
- The perpetrator usually presents the child with either simulated or factitiously produced diseases.
- The perpetrator is often intensely involved in the child's care and with hospital staff, willingly signing consent forms for invasive procedures or treatment.
Symptoms and Behavioral Patterns
- The child may inexplicably improve when the mother is out of the hospital for a period of time.
- The child's father is usually uninvolved or absent.
- When confronted with suspicions or proof, the mother often reacts with angry denial. Hospital staff may also express disbelief.
Diagnostic Considerations
- Suspicion: Reasonable suspicion of factitious disorder imposed on another requires reporting to child protective services as a form of child abuse.
- Mortality Rate: Children affected by this disorder have a high mortality rate, with almost 10% dying before reaching adulthood.
- Sibling Implications: Studies show a similarly high mortality rate among the siblings due to the potential for perpetration on subsequent children.
- Placement: Children may need to be placed outside the home, with relatives or in foster care.
Laboratory Findings
- Laboratory testing may reveal inconsistent findings, not typical of known physical diseases (e.g., hypokalemia from surreptitious ingestion of diuretics).
- The presence of toxins or medications denied by the patient can establish the diagnosis (e.g., phenolphthalein in the stool of a baby with diarrhea due to Munchausen Syndrome by Proxy).
Neuroimaging
- There are no specific neuroimaging studies reported for factitious disorder.
Differential Diagnosis
- Genuine Physical Disease: Factitious disorders must be ruled out from genuine physical disease processes.
- Malingering: The key difference is motivation. In malingering, an external goal motivates the behavior (e.g., disability payments), while in factitious disorder, the goal is to fulfill psychological needs by assuming the "sick role."
- Comorbidity: Patients often have comorbid somatic symptom disorder, major depression, or schizophrenia and are likely to have a Cluster B personality disorder (antisocial, borderline, histrionic, narcissistic).
Treatment
- Therapeutic approaches for factitious disorder are distinct from those used for specific disease states.
- Treatment plans must be individualized due to differing motivations and associated personality disorders.
- The clinician must be cautious of manipulative behavior and hostility displayed by these patients, who often deny their problems despite clear evidence.
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Description
Explore the intricacies of factitious disorders imposed on oneself and others. This quiz highlights key characteristics, psychological challenges, and common traits associated with these disorders, including the role of deception. Test your knowledge on the differences and psychological implications surrounding these complex conditions.