Get the Facts on Factitious Disorders

Understand the truth behind fabricated symptoms for proper ICD-10-CM coding.

Factitious disorder is a condition where a person intentionally produces or exaggerates physical or psychological signs and symptoms. They may even hurt themselves or others to bring on symptoms. This is considered a mental (rather than a physical) ailment, although the cause of factitious disorder is not completely known.
As opposed to a “malingerer” who feigns illness for external incentives, such as financial gain, or to avoid criminal penalties or military duty, the individual suffering from factitious disorder may be serving an inner need for attention.
The word factitious comes from a Latin word that means “artificial” or “contrived.” Factitious disorder has earned many nicknames, such as hospital addiction, pathomimia, polysurgical addiction, peregrinating patients, compensation neurosis, and hospital hopper syndrome. There are no reliable statistics about how common it is, but reports of this condition have been described since at least biblical times. It was originally referred to as Munchausen syndrome, named after the fictitious character Baron Karl Friedrich Hieronymus Freiherr von Münchhausen, an 18th century German military officer whose stories about his military exploits became increasingly exaggerated and outlandish.

Types of Factitious Disorder

There are four main types of factitious disorder:
F68.11    Factitious disorder imposed on self, with predominantly psychological signs and symptoms
As the description implies, these patients mimic behavior that is typical of a mental illness, such as schizophrenia, and may exhibit confusion and report hearing voices or seeing hallucinations.
F68.12    Factitious disorder imposed on self, with predominantly physical signs and symptoms
People with this disorder claim to have symptoms related to a physical illness, such as symptoms of chest pain, stomach problems, or fever.
F68.13    Factitious disorder imposed on self, with combined psychological and physical signs and symptoms
People with this disorder produce symptoms of both physical and mental illness.
F68.A      Factitious disorder imposed on another/Factitious disorder by proxy
People with this disorder produce or fabricate symptoms of illness in another person (children, elders, even pets) under their care. The disease is more prevalent in mothers but may occur in fathers and other caregivers, who intentionally harm their children to receive attention.

How Is Factitious Disorder Diagnosed?

Properly diagnosing factitious disorder is challenging, but there are common symptoms:

• The patient may try to mimic illness symptoms, report dramatic and inconsistent medical histories, and may hurt themselves or tamper with medical tests to gain the attention they desire. A person feigning a psychological illness may try to appear confused, make absurd statements, and even report hallucinations.
• The patient may have extensive knowledge of hospitals and medical terminology, as well as the textbook descriptions of illnesses. People with this disorder often are medical professionals.
• The patient may present with unclear symptoms that are not controllable, become more severe, or change when treatment has begun. Relapses may often follow improvement in the condition, and normal treatment options may not work as expected. Appearance of new or additional symptoms may follow negative test results.
• Symptoms may be reported as being present only when the patient is not being observed.
• The patient may be willing or eager to have medical tests, surgeries, or other procedures. The patient may seek treatment at many hospitals, clinics, and doctors’ offices, possibly even in different cities.
• The patient may not want their healthcare provider to talk to friends or family members.
• The patient may refuse psychiatric or psychological evaluation.
• The patient may forecast their own negative medical outcomes despite no evidence that these outcomes are probable.
• It is not unusual for such a patient to sabotage their discharge plans or suddenly become more ill as they are about to be discharged from the hospital setting.

Causes of Factitious Disorder

Although the cause of this disorder is not known, there are general trends. Many patients with factitious disorder have a history of abuse, trauma, family dysfunction, social isolation, early chronic medical illness, or professional experience in healthcare (training in nursing, for example). Some have a history of borderline or antisocial personality symptoms, or a grudge against the medical profession and society. Adults aged 20-40 years are most likely to develop it.

Treatment of Factitious Disorder

It has been estimated that unnecessary tests and waste of other medical resources caused by factitious disorder may cost the government as much as $40 million per year. To reduce the misuse of medical resources and to prevent harm to patients, psychotherapy may be used as a treatment to change the thinking and behavior of the individual with the disorder. Family therapy may also help in teaching family members not to reward or reinforce the behavior of the person with the disorder.

Sandra Pedersen, CPC, CEMC, CPMA, has 16 years’ experience in the medical field, including coding department management, practice management, and auditing. She has been a certified auditor and coder for nine years. Pedersen holds a Bachelor of Science in Microbiology from the University of Kansas. She is a member of the Scottsbluff, Neb., local chapter.

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