Elizabeth was a single mother that worked on construction sites throughout her native city of Memphis, until she badly sprained her ankle in a working accident. Being on paid leave while her ankle healed was a blessing. She had more time to get things done around the house and spend more time with her daughter, without worrying about her work. At her doctor’s appointment on Friday, she was cleared to work the following Monday, if she did not overdo it. Elizabeth started to think. “Having time off has really been great. I get to spend more time with my daughter and not having to work is just so much easier! You know what, I’m not ready to go back to work.”
Thinking back to her physician’s words, she created a plan. She exclaimed, “The doctor said I would not be able to work if I put unnecessary stress on it, so I’ll make my ankle even worse!” The next day, while driving her daughter to school, Elizabeth slipped on a pair of her highest heels. She was sure they would do the trick to worsen her sprained ankle. She did not plan on taking them off, until they did further damage to her injury. After dropping off her daughter and walking back to her car, Elizabeth noticed her ankle became swollen and red, and it hurt much worse than before. Even after this, she continued to walk on.
Elizabeth is experiencing factitious disorder. Factitious disorder is when an individual produces or fakes physical or mental illness, while intentionally worsening a minor illness or injury. A person with factitious disorder may also transfer a false illness or injury to another person. In some cases, this individual may benefit from the situation they create, such as getting out of school or work (American Psychiatric Association, 2017). This disorder can range in intensity from mild to severe. Symptoms can range from slight exaggerations, to tampering with medical tests, to convincing others that treatment such as serious surgery is needed. That being said, it is important to distinguish that factitious disorder is not equivalent to conjuring up medical problems for the sole purpose of personal benefit. Though this disorder may present itself as such, these individuals might not understand the “reasons for their behaviors”, or even recognize they are having a problem (Mayo Clinic, 2018).
In Elizabeth’s case, she purposefully worsened her ankle injury by intentionally wearing heels too soon. This is considered mild on the spectrum of symptoms of factitious disorder. She knew it would strain her injured ankle and as a result, she would not have to return to work. She wanted her injury to appear much worse than it actually was, leading her family and coworkers to believe her injury was serious. When questioned about her recovery, Elizabeth was able to respond swiftly and intelligently, having done her research to ensure she would have extended time off. All of Elizabeth’s actions fall under the umbrella that should be recognized as factitious disorder (Mayo Clinic, 2018). This disorder does not seem that pressing of a problem at first and is difficult, both to identify and treat. However, psychiatric and medical support is vital for “preventing serious injury and even death caused by the self-harm typical of this disorder” (Mayo Clinic, 2018).
Treatment is carried out by both psychiatrists and medical physicians. There are no standard therapies, due to the patient not wanting to recover. Therefore, it is best to take a gentle and nonjudgmental approach so the person will even slightly consider receiving help. Treatment usually starts with the primary care doctor. The physician will try medical treatment with the individual, and if that does not encourage recovery, then together they can explore possible psychological causes for the illnesses or symptoms. The most common psychological treatments are talk therapy and behavioral therapy. During these sessions, a trusted psychiatrist can help to develop coping skills and control stress (Mayo Clinic, 2018). Though not an easy road, treatment of factitious disorder is possible, and a better quality of life is achievable.
American Psychiatric Association. Factitious Disorder. Retrieved 1 November, 2019, from, https://www.psychiatry.org/patients-families/somatic-symptom-disorder/what-is-somatic-symptom-disorder
Mayo Clinic. Factitious Disorder. Retrieved 1 November, 2019, from, https://www.mayoclinic.org/diseases-conditions/factitious-disorder/symptoms-causes/syc-20356028