The psychology of factitious disorders. A reconsideration

Factitious disorder (FD) is a form of somatization that involves apparent deception, simulation of illness, and imposture. This deception may be distinguished from other forms of lying in that patients with FD may suffer from underlying disturbances in the sense of reality and in reality testing. These features may be associated with a poorly consolidated sense of self and with difficulty regarding emotional experience as real. Factitious behavior may serve to stabilize the sense of self by concretizing and legitimizing the subjective experience of distress and by evoking responsiveness of a care-giver in a relatively safe, structured context. A psychotherapeutic stance focused on identifying and validating the patient's subjective experience may lead to a reduction in factitious behavior and to a more authentic and stable sense of self, in which emotional as well as physical experience is regarded as real. However, most patients with FD refuse treatment. Further, psychosis and suicidality are complications that may occur during the course of psychotherapy.