Author(s): Arumugam Subramanian Senthil Kumar, Krishnappa Aranga Ramalingam Praphaukar Raaj
BACKGROUND: Factitious disorder is a psychiatric diagnosis presenting with feigning of illness, lying in the continuum of somatoform and dissociative disorders through to malingering. Symptoms overlap as traits and gains confound the diagnosis. We wanted to study the pattern of sociodemographic distribution and types of gains between groups of patients with factitious and dissociative disorders, the intensity of factitiousness, masochism and compulsiveness among the two groups, and correlation between the traits. METHODS: A cross-sectional observational study with convenience sampling, with consenting patients with factitious disorder and dissociative disorders, attending the outpatient unit in July 2017 to April 2018 period in the Department of Psychiatry in this tertiary teaching hospital, following institutional ethical committee clearance was undertaken. After case to case matching of patients between the two groups for major types of presenting symptoms, 30 patients in each group were considered for the study. Sociodemographic profile, a self-structured 22 item self-report rating scale for factitious disorder, Yale-Brown Obsessive- Compulsive Scale, and Masochism personality disorder criteria (DSM-III-R) were the tools used. Appropriate descriptive statistics with chi squared and t-tests and correlation coefficients were used.
RESULTS: About 67% and 63% had motor symptoms and 20% and 26.7% had cardiorespiratory symptoms in the two groups. Emotional gains were predominant in two-thirds of patients in both groups. Factitious patients had high scores in a new factitious intensity (FAC22-SR) scale and YBOCS, and mild score in masochism traits.
CONCLUSIONS: Gains have been proved as the driving force in conversion as well as factitious disorder. Early diagnosis of factitious disorder is important as misdiagnosis results in a chronic course with costly complications. Addressing obsessive compulsiveness, and masochist behavioural attributes may improve prognosis.