The factitious/malingering continuum and its burden on public health costs: a review and experience in an Italian neurology setting

Abstract

Factitious disorder is classified as one of the five aspects of somatic symptom disorders. The fundamental element of factitious disorder is deception, i.e., pretending to have a medical or psychiatric disorder, but the enactment of deception is considered unconscious. Indeed, volition, i.e., the perception of deliberate deception, is blurred in patients presenting with factitious disorder. In the USA and the UK, factitious disorder has received constant media attention because of its forensic implications and outrageous costs for the National Health Systems. Unfortunately, a comparable level of attention is not present in Italian National Health System or the Italian mass media. The review analyzes the classifications, disorder mechanisms, costs, and medico-legal implications in the hope of raising awareness on this disturbing issue. Moreover, the review depicts 13 exemplification cases, anonymized and fictionalized by expert writers. Finally, our paper also evaluates the National Health System's expenditures for each patient, outlandish costs in the range between 50,000 and 1 million euros.

Keywords: Factitious disorders; Functional neurological symptoms disorder; Hysteria; Malingering; Munchausen’s syndrome.

Fig. 1

The presence of a medical condition can often mesh with deception and somatization. The fictionalized cases presented in the paper, unveil a mixture of somatic symptoms (conversion or functional neurologic disorders (FND)) and factitious disorder that co-exist in the same patients, thereby supporting the hypothesis of a hystero-malingering continuum. Reproduced, with modifications, from Feldman and Yates, 2018