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Factitious disorders: reformulating the DSM-IV criteria

Mark A Turner1

  • 1Mental Health Unit, University Hospital of North Tees, Hardwick, Stockton On Tees, UK. mark.turner@tney.northy.nhs.uk

Psychosomatics
|December 31, 2005
PubMed

Insights

This study critiques the DSM-IV criteria for factitious disorders, proposing reformulations for accurate diagnosis. It suggests revising criteria to better classify conditions involving deception and self-harm.

Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Diagnostic Nosology

Background:

  • Current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for factitious disorders present diagnostic challenges.
  • Specific criteria may not adequately encompass all presentations, leading to potential misclassification.

Purpose of the Study:

  • To critically evaluate and reformulate the DSM-IV criteria for factitious disorders.
  • To enhance clinical and nosological sensitivity in diagnosing these conditions.

Main Methods:

  • Critical analysis of existing DSM-IV criteria (A, B, and C).
  • Conceptual reformulation of diagnostic criteria based on clinical and nosological considerations.

Main Results:

  • DSM-IV Criterion A (intentional production of signs/symptoms) is insufficient for conditions like pseudologia fantastica, false confessions, and impersonation.
  • DSM-IV Criterion B (motivation to assume the "sick role") lacks empirical basis and diagnostic utility.
  • DSM-IV Criterion C contributes to misdiagnosis by misplacing factitious disorders into somatoform or malingering categories.

Conclusions:

  • Reformulation of criteria is necessary, focusing on deception (lies) and self-harm as core components.
  • Abandoning Criterion C and revising Criteria A and B will improve the classification and diagnosis of factitious disorders.
  • Implications for understanding conversion disorders and the broader classification of factitious disorders are discussed.

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