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Illness
Falsification
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This study was designed
to evaluate factitious illness in children and adolescents. Factitious
disorder is a chronic condition in which the individual complains of physical
symptoms that are pretended or self-induced; the disorder is also known
as Manchausen's Syndrome. Such individuals want attention and want to
be taken care of. Many are repeatedly hospitalized for investigation of
a variety of ailments.
Factitious disorders are distinguished from acts of malingering. In malingering,
the individual also produces the symptoms intentionally, but has a goal
that is recognizable when the environmental circumstances are known. For
example, the falsification of symptoms to avoid a math test would be classified
as malingering.
Forty-two cases of illness falsification by children were identified,
with a mean age of 13.9 years. The majority of patients were female (71%).
The most commonly reported falsified or induced conditions were fever,
ketoacidosis, purpura, and infections. Fabrications ranged from false
symptom-reporting to active injections, self-bruising, and ingestions.
The mean duration of the falsifications was almost 16 months before detection.
Many of the children admitted their deceptions when confronted. The descriptions
of some of these children as bland, depressed, and fascinated with health
care were remarkably similar to adults with factitious disorders.
Medical conditions fabricated by children may go undetected, or be diagnosed
as somatization (see Comment). Further study of children who falsify symptoms
may in some cases help identify earlier experiences of Manchausen by proxy
abuse or covert parental coaching of illness falsification, and provide
more effective interventions. Better understanding and identification
of these children is likely to help prevent the development of more chronic
adult factitious disorders.
(Libow J. Pediatrics 2000; 105(2):336-342)
Comment: The third condition to be
considered along with factitious disorder and malingering is somatoform
disorder. Somatization refers to the occurrence of one or more physical
complaints for which medical evaluation reveals no physical pathology;
or, when pathology is present, the complaints are grossly in excess of
what would be expected from the physical findings. Pain and somatic symptoms
are problematic when, regardless of cause, they become a dominant force
in the child's life and impair functioning. Somatic complaints.
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