This disorder occurs when a person fakes an illness in an attempt to make people think he/or she is sick. These individuals do this for their own "psychological" reasons to be in the sick role. People with this disorder may go to extremes to maintain that they are sick. Sometimes people with this disorder will falsify their medical histories and even take medications so that they will become physically ill to substantiate their claim of being sick. They will often move from hospital to hospital to receive care.

Patients with Factitious Disorder are usually loners who have a history of severe trauma and deprivation. They generally have extreme difficulty in establishing close interpersonal relationships and often have personality disorders. This disorder is distinguished from Malingering in several ways. First, patients with Factitious Disorder seek the sick role for secondary psychological gain. Perhaps they believe that being sick is the only way to make contact with others and to get them to care for them. Malingerers are feigning sickness for other secondary gain (e.g. monetary, to get out of some responsibility). It is likely that patients with Factitious Disorder really believe that they are sick, even if they go to great lengths get into the role (they may justify this by saying that while they are sick, people don't believe them).

Factitious patients are unlikely to seek out psychological help and generally focus on medical treatment. However, patients may feign psychological symptoms as well. General medical practitioners or ER attendants are often the first to encounter these patients. They are often difficult to distinguish from somatic disorders. Some believe that Factitious Disorder is unconsciously motivated. However, the difference is that motivation for Factitious Disorder is motivated by "external" incentives, whereas Somatic Symptom Disorder is motivated by internal conflict. Patients may make themselves sick through a variety of means (e.g. taking stimulants to create tachicardia, swallowing metal, taking anticoagulants, and producing a fever by manipulating the thermometer).

Theoretical approaches associated with Factitious Disorder are cognitive-behavioral, reality, and psychodynamic. Hypnosis and "face saving" techniques like double bind have proven to be effective in treatment. These techniques help the client to accept therapy in a more positive light than by confrontational treatments.

You will need to conduct an assessment and make the diagnosis first. After you have made the diagnosis, you will establish a rapport with the patient so you can create motivation for the psychotherapy. This may be done by noting that being so sick is obviously stressful and perhaps talking about this stress would be helpful. Next, you will need to determine whether the client is a danger to himself/or herself or others. Increasing motivation for treatment with the patient may be difficult since people with this disorder often resist referrals to mental health professionals. Since the patient is motivated to get attention, it may be possible give them what they need and thereby engage them in treatment. However, it is likely that the patient with Factitious Disorder will fear being "found out" and may continue to resist treatment.

Finally, you should make the patient feel accepted and show empathy. You will want to focus on the patient's underlying dysphoric feelings by making them the focus of the treatment. Their self-destructive behavior might be tactfully pointed out to them after a solid rapport is developed.