How to spot & help people who fake mental illness

How to spot & help people who fake mental illness

In this article, we are going to tell you how to spot & help people who fake mental illness. We will present to you the characteristics of these types of people, and cause a differential diagnosis.

How to spot people who fake mental illness?

People who fake mental illness have what it is called a factitious disorder.  Factitious disorder or Munchausen’s Syndrome is a condition in which the patient, consciously and deliberately, acts as if he had a physical or mental illness when nothing happens to him.

Patients with this disorder create and exaggerate the symptoms of a disease in different ways. They can lie about their symptoms, hurt themselves as a way to create visible symptoms, or alter medical tests (for example, a urine sample) to make them look sick.

They can undergo painful tests or risky surgeries to obtain the sympathy of people who pay attention to individuals who are ill.

They are usually people with emotional difficulties.

How to spot & help people who fake mental illness

This behaviour is considered a disorder because it is associated with serious emotional difficulties. But, besides, people who suffer from this psychopathology often suffer other mental health problems, such as personality disorders. 

In other words, these individuals often have long-lasting patterns of thought and behaviour that differ from what society considers normal. Besides, they also tend to have poor coping skills and serious problems relating to others.

Characteristics of a person with Factitious Disorder

People with this disorder usually present these characteristics:

  • Dramatic but inconsistent medical history
  • Unclear symptoms that are not controllable and that become more severe or change once treatment has started
  • Predictable relapses after disease improvement
  • Presence of many scars
  • The appearance of new or additional symptoms after the negative results of a medical or psychological test
  • Presence of symptoms only when the patient is with others or is being observed
  • The desire for testing or operations
  • Patient reluctance to allow healthcare professionals to speak to family members, friends, and previous doctors. 

Individuals with this psychopathology mimic the typical symptoms of schizophrenic disorder. Therefore, they often simulate confusion, make absurd statements, and claim to have hallucinations or delusions; for example, hearing voices.

Diagnosis

In the first place, the doctor rules out the existence of physical and mental disorders by preparing a medical history, a complete physical examination and carrying out diagnostic tests. Most of the time, the person’s description of the symptoms is compelling and sometimes misleading doctors. 

However, doctors may suspect the presence of the disorder based on the following:

  • The medical history is spectacular but inconsistent.
  • Treatment worsens symptoms rather than relieves them.
  • When test results turn out to be negative or after treatment of a group of symptoms, the person develops different symptoms or goes to another hospital for care.
  • The person has extensive knowledge of medical practice.
  • And she is eager and anxious to have diagnostic tests and surgical procedures.
  • She has a history of frequent visits to many different doctors and hospitals.
  • She refuses to let doctors talk to family members and doctors who have treated her previously.

The diagnosis of self-imposed factitious disorders is made when all of the following aspects are confirmed:

  • Other disorders have been ruled out.
  • Doctors observe or discover evidence of exaggeration, simulation, falsification, self-induced production of symptoms, or changes in medical history.
  • The person has no obvious external incentives to simulate or exaggerate the symptoms.

Doctors can refer the person to a psychiatrist or other mental health professional. If the disorder is diagnosed early, risk tests, surgical procedures, and unnecessary treatments can be avoided.

How to spot & help people who fake mental illness

Differential Diagnosis Between Factitious Disorder and Somatoform Disorder

Factitious disorder is similar to another psychopathology that is called a somatoform disorder, which also includes the presence of symptoms that are not related to an actual disease. However, people with the somatoform disorder do not fake symptoms or deceive others, but think they have diseases that they do not have.

Somatoform disorders are a group of mental disorders that have as a basic feature the accusations of somatic symptoms, together with the constant request for medical investigations despite repeated negative findings and medical assurances that the symptoms do not have an organic substrate.

If there is a somatic condition, the symptoms are much exaggerated and more varied than those normally expected in the disease. Usually, the onset of accusations is closely related to unpleasant life events, difficulties and conflicts, but the patient does not accept the possibility of a psychological cause. 

It can be associated with anxiety (unexplained fear, anxiety) and depression (prolonged sadness, easy crying, insomnia, lack of motivation).

To treat the cause of the accusations related to the patient, individualized treatment is necessary from case to case, the main therapeutic method being psychotherapy (cognitive-behavioural, relaxation techniques, supportive, family, etc.). 

Most of the time, it is necessary to combine a drug treatment, to remit the annoying symptoms (constipation, diarrhoea, diffuse pain, bloating, menstrual disorders, etc.). Psychoactive medication is customized according to the particularities of each patient and may include antidepressants, anxiolytics and antipsychotics. 

Any medicine in this category of patients should be used with caution because there is an increased risk of addiction, abuse and drug interactions.

In conclusion, for any chronic symptoms (lasting more than 2 years), with fluctuating and variable evolution, with a multitude of medical investigations performed – which does not reveal a concrete cause – and visits to a large number of doctors, should be taken into consideration the possibility of a psychogenic aetiology. 

Psychiatric consultation as early as possible in the evolution of the disease prevents the development of related diseases and directs the therapeutic approach to healing.

Factitious Disorder Causes

The exact causes of this disorder are not known, but researchers believe it is due to biological and psychological factors.

Some theories affirm that these patients have suffered abuse or lack of affection during childhood that may have serious emotional problems associated with them, as well as a medical history characterized by the frequent presence of diseases that require hospitalization.

Studies suggest that this condition is more common in men than in women. In contrast, factitious disorder imposed on another is more common in women.

You should read books about mental illness, in order to understand what it really is and how one can be helped.

How to spot & help people who fake mental illness

How to help people who fake mental illness?

The most important goal of treating this disorder is to modify patient behaviour and eliminate or reduce the misuse of medical resources. In the case of factitious disorder imposed on another, the primary objective is the protection of any potential victim.

Once these goals have been met, the next step is to understand the psychological reasons that are causing the patient’s behaviour. The treatment of par excellence is psychotherapy, preferably cognitive-behavioural therapy. In this way, the patient’s thinking and behaviour are acted upon.

Family therapy can also be helpful so that family members do not reward the prejudicial behaviour of the patient. In severe cases, antidepressant and anti-anxiety drugs are administered.

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How to spot & help people who fake mental illness

Juanita Agboola

Juanita Agboola is the editor in chief of HFNE and an expert in mental health online. She has been writing about online behavior, mental health and psychology issues since 2012. All Guides are reviewed by our editorial team which constitutes various clinical psychologists, PhD and PsyD colleagues.