Factitious disorder is the conscious or intentional feigning or production of physical or psychological symptoms in order to assume the sick role. Impos-turing or "playing sick" is at the core of the disorder. This disorder is marked by a persistent and repeated fabrication, exaggeration, and/or inducement of one's own illness to continue to be engaged with others in the context of being a patient. Some adults with factitious disorder engage in pathological lying that extends beyond illness, whereas others limit their deceptions to illness-related events.
Individuals with factitious disorder present as continuously ill or may have exacerbations of illness. As is typical of adults with MBP, adults with factitious disorder work very hard to maintain their roles as patients. Acknowledgment often leads to personality disorganization. Most, if not all, adults with factitious disorder have severe personality disorders, most often borderline personality disorder (American Psychiatric Association 2000). According to the literature, 30%-55% of women with FDP also have factitious disorder (Ayoub 2006; Sheridan 2003); the presence of factitious disorder in a mother with FDP signals a poor prognosis for any reunification or contact between the mother and the abused child (Feldman et al. 1997; Jones 1987).
Libow (2002) suggested that factitious disorder may present during adolescence and that some youngsters do independently falsify illness. She proposed that these individuals may have had earlier experiences as victims of MBP or experienced modeling or encouragement of illness falsification by a parent or caregiver. She suggested dynamics that include powerlessness, disappointment, loss, and lack of control as those that lead to illness falsification behavior before adulthood.
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