Factitious Deception Disorders, Self-Inflicted Illnesses, and Simulation

Sherman Hoover
Factitious Deception Disorders, Self-Inflicted Illnesses, and Simulation

The most frequent lie is the lie that one tells himself. Nietzsche

Antisocial behaviors in adulthood are characteristics of a great variety of people, from those who do not denote any type of psychopathology, to those who suffer from serious psychopathology, such as psychotic disorders, and cognitive disorders, among others. This type of behavior is common in everyday life and can be observed in normal subjects..

For example, could we ensure that we have never lied or told a half-truth?

The same could be said of other behaviors such as petty theft, drinking before driving, defrauding the ranch or jumping a red light. Therefore there are antisocial characteristics that appear in normal subjects, and the abnormal thing is that they do not exist.

Deception is making someone else believe something that is not true. In general, you learn to cheat at a very young age, and it is a behavior that appears in all socioeconomic status, and educational groups.

Pathological lying refers to a lie that is compulsive or impulsive, and appears with some regularity (Hall, 1996). This type of behavior occupies a privileged place in legal psychiatry, and we will refer to them briefly in this chapter. For its presentation we are going to establish the following sections: factitious disorders, fantastic pseudology, compensation neurosis and simulation.


  • Factual Disorders
  • Fantastic pseudology
  • Compensatory neurosis
  • Simulation

Factual Disorders

Factitious disorders are characterized by the intentional production of signs or symptoms of a medical or mental pathology intentionally, the subjects misrepresenting their stories and symptoms. The only apparent purpose of this behavior is the acquisition of the sick role.

Psychiatric evaluation of these patients is necessary in 50% of the cases, usually when the presence of a false illness is suspected. The psychiatrist is requested to confirm the diagnosis of a factitious disorder.

In these circumstances, it is necessary to avoid accusatory questions that can cause the patient to flee from the healthcare center. These subjects tend to show emotional lability, loneliness, attention seeking, and tend to establish good rapport. Many cases usually meet the criteria of fantastic pseudology. The psychiatric examination should place special emphasis on obtaining reliable information from a friend, relative, or other informant, since interviews with these sources often reveal the false nature of the patient's illness..

People affected by factitious disorder with a predominance of physical signs and symptoms are typically admitted to the hospital with an acute but not entirely convincing history. They are generally evasive and truculent and it can be revealed that they have been treated in other hospitals, often causing voluntary discharge..

Münchausen syndrome, defined by Richard Asher in 1951, is a rare and serious form of factitious disorder. Asher used this term because of the similarity between the incredible stories that are told in the adventures of the German Baron in the work of Rudolf Erich Raspe (1784) and the fantastic pseudology that characterizes many of these patients. It has been classified as a factitious disorder with predominantly somatic signs and symptoms..

Referred to by Kraepelin as "hospital scammers", this disorder has also been called by other expressions, including: "hospital addiction", "poly-surgical addiction", and "professional patient syndrome" (Leamon et al. 2000).

In 1977, the pediatrician Roy Meadow, described the Münchausen syndrome by Powers. It is very similar to the Münchausen syndrome, but it is a form of abuse in which the simulation, fabrication or exaggeration of the disease is done through innocent victims, usually children, who pay in terms of disease for the pathological hypochondria of their parents (or sometimes another adult). The only apparent purpose of this caregiver behavior is to indirectly assume the role of the patient.

Deception may include a false medical history, contamination of laboratory samples, alteration of results, or the induction of injury or illness in the child..

Fantastic pseudology

Lying, as we have already commented, is a human activity, frequent and possibly universal. The most extreme form of pathological deception is fantasy pseudology, in which some real events are interspersed with highly elaborate fantasies (Ford, 1996).

Fantastic pseudology is suffered by those subjects who are pathological liars. This clinical picture is also known as mythomania..

The interest of the listener satisfies the patient and therefore reinforces the symptom. However, the distortion of the truth is not limited to the history or symptoms of the disease; patients often give false information about other circumstances in their life.

It is a condition that frequently appears related to Münchausen syndrome, and in the same way that it happens in this disorder, the reason is unconscious. Schneider (1943) includes these patients in the group of psychopaths in need of estimation.

The lies in this table can generate such deception that they make it difficult to distinguish these patients from those with delusional symptoms. In fact Kraepelin (1896) included several patients with systematized delusions under the heading of fantastic pseudology, and Krafft Ebing (1886) used the term "invented paranoia" to define pathological liars and delusional subjects..

These subjects tend to show emotional lability, loneliness, seek attention, and tend to establish a good rapport..

“The interest of the listener satisfies the patient and therefore reinforces the symptom. However, the distortion of the truth is not limited to the history or symptoms of the disease; patients often give false information about other circumstances in their life (Kaplan 1998) ”.

Compensatory neurosis

Compensation neurosis is a pejorative and controversial term that has been designated by other unflattering epithets: situational neurosis, income neurosis, accidental neurosis, ticket neurosis, rentosis, unconscious feigned disease, American disease, Mediterranean disease, or Greek disease ( Enoch, 1990, Gunn 1995).

Arises when symptoms are unconsciously acquired or prolonged, in association with possible compensation.

Three main types of post-traumatic syndromes have been described and must be distinguished: post-traumatic neurosis (post-concussion disorder), compensation neurosis, and sham disease..

For Vallejo (1998) the terms simulation, income neurosis and hysteria are often used indiscriminately because they are all introduced in the same diagnostic context. In income neurosis, the patient unconsciously uses his organic problem (accidents, injuries, operations, etc.) to reorganize his life, obtaining a secondary gain from his illness, thanks to which he can abandon his obligations.

It differs from hysteria in that in the latter the ultimate goal is in the affective management of the environment rather than in its material use..

Less psychological damage appears after an organic injury if the injury is accepted as part of a natural order. Feelings of anger and resentment exacerbate physical and mental symptoms.


Simulation is characterized by the voluntary production and presentation of false or highly exaggerated physical or psychological symptoms. The DSM-V indicates that a differential diagnosis with factitious disorders should be established based on the fact that in the simulation the production of symptoms seeks an external incentive, while in factitious disorder there are no external incentives, but the need to acquire the role sick.

The simulators present subjective and vague symptoms. They may complain sourly, describing how the symptoms disrupt their normal life, and how disturbing they are..

They tend to go to the best doctors, who are the most trusting (and perhaps the easiest to fool), and pay immediately for all visits and scans, even excessive ones, to impress doctors with their integrity.

The simulation can be an adaptive behavior, for example, pretending an illness while in prison.

The DSM-V indicates that a simulation should always be suspected when any of the following combinations is detected: medical-legal context of presentation (eg, the person reaches a medical specialist through the mediation of a lawyer); marked discrepancy between the complaints or disabilities alleged by the person, and the objective findings; lack of cooperation during the diagnostic evaluation with compliance with the therapeutic regimen and the presence of an antisocial personality disorder.

Before diagnosing a simulation, a complete medical evaluation should always be carried out..

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