Factitious Disorder and Drug Addiction

People with factitious disorder crave the attention of doctors and other medical professionals, and they will invent imaginary conditions to get it, or induce actual illnesses or injuries to guarantee it. The sympathy and compassionate care they receive when they are ill, injured, or suffering from a chronic disorder brings them enormous satisfaction.

Because they so frequently seek medical attention, people with factitious disorder may become addicted to prescription drugs, which they acquire through trickery and deceit. They may even use drugs or alcohol to intentionally to make themselves ill, and that behavior can also lead to drug or alcohol dependency.

Another factor is the stress that inevitably accompanies a lifestyle based on deception and manipulation. Plagued by anxiety, shame, and low self-esteem, people with factitious disorder may use and abuse drugs and alcohol to make themselves feel better. Or, in some instances the co-occurrence of factitious disorder and addiction may be entirely coincidental, emerging from shared risk factors that leave people vulnerable to both.

People with factitious disorder, which is technically identified as factitious disorder imposed on self, use imaginary or artificially created illnesses or injuries to get attention from medical authorities. They will lie about their medical conditions to family and friends as well, in their desire to create a network of sympathizers and enablers.

But there is a second form of factitious disorder, known as factitious disorder imposed on another, that involves unwitting victims in the deception. People with this condition rely on surrogates (usually their own children) to gain entrance to hospitals or clinics, secretly inflicting injuries or illnesses on them or reporting false symptoms consistent with serious disorders and diseases. They are the ones who crave the attention, but they prefer to play the role of the suffering caretaker rather than the patient.

Factitious disorder imposed on another is unique among mental illnesses in that it is also a crime. Victims of this disorder are at severe risk for real health consequences, and if the deception continues unabated their very survival could be at stake. The perpetrators only crave attention and may not mean to cause irreparable harm, but that is exactly what can happen if their behavior remains undetected.

These two forms of factitious disorder used to be known as Munchausen Syndrome and Munchausen Syndrome by proxy, respectively. The latter condition in particular has been portrayed quite often in movies and television shows, although its actual incidence is believed to be quite rare.

Factitious disorder imposed on self and factitious disorder imposed on another may be under-diagnosed, since those who have these disorders make a great effort to hide the truth about their behavior and its motivation.

Absolute percentages of incidence are unknown. However, studies show that up to three percent of patients referred to psychiatrists by general practitioners will demonstrate symptoms consistent with factitious disorder, while up to .9 percent of cases treated in psychiatric specialty clinics will involve one of the two forms of this condition.

Overall, about two-thirds of those who develop factitious disorder are women, and up to 85 percent of those with factitious disorder imposed on another are the mothers of the children being victimized.

Factitious disorder is likely caused by a chronic lack of self-esteem and a sense of powerlessness. Those who develop it have a compulsive need to receive sympathetic attention from authority figures, who make them feel noticed and cared for.

Some of the known risk factors for factitious disorder include:

• Family history of mental and behavioral health issues
• Personal history of mental health disorders
• Extended hospitalization for authentic medical conditions in childhood or adolescence
• Exposure to physical, emotional, or sexual abuse in childhood
• Trauma in the family, experienced either as a child or adult (divorce, parental abandonment, exposure to domestic violence, loss of a close family member to death, etc.)
• Employment in the medical field

Other mental health issues are frequently experienced by men and women with factitious disorder. In one comprehensive study of sufferers, 46.5 percent were diagnosed with additional psychiatric disorders.

There is a strong correlation between personality disorders and factitious disorder in general, with borderline personality disorder being by far the most commonly diagnosed. Depressive disorders are also extremely common among men and women with factitious disorders, with frequent bouts of major depression reported.

While their lists of risk factors are not identical, factitious disorders, personality disorders, and depressive disorders all have deep roots in abuse or neglect experienced during childhood. Such experiences are also predictors for substance use disorders in adulthood, and research has revealed that substance abuse co-occurs with factitious disorder more frequently when personality disorders and depressive disorders are also present.

When allowed to continue without acknowledgement or intervention, factitious disorders will only worsen over time, until real and lasting damage is inevitable. The same is true for substance use disorders, and when the two types of conditions occur together the circumstances can quickly become dire.

But there is cause for hope. A high-quality dual diagnosis drug treatment program for those with co-occurring addiction and factitious disorder can produce remarkable results, if treatment begins early enough and the patient is willing to face the truth about the dysfunctional nature of their behavior.

Individualized treatment plans will include a mix of individual, group, and family therapy, with equal priority being given to both diagnosed conditions. Although there are no medications approved for the treatment of factitious disorder, they may be prescribed to assist with withdrawal symptoms or for any mood disorders or anxiety disorders that may be present.

Holistic therapies like meditation, yoga, biofeedback, arts and music therapy, and massage therapy may also be included in a program for co-occurring disorders based on the preferences and interests of the patient. Aftercare programs will help reinforce the lessons learned during the person’s 30-90-day stint in formal treatment, and long-term therapy should be considered vital for people with self-destructive habits to overcome.

Factitious disorder is a challenging opponent, and recovery from a substance use disorder is a lifelong affair. But with an honest and reflective approach to healing that makes no excuses and rejects all forms of denial, good health and a brighter future are both achievable.