A systematic review on factitious disorders: psychopathology and diagnostic classification

Factitious disorder (FD) is a psychiatric disorder in which sufferers intentionally fabricate physical or psychological symptoms in order to assume the role of the patient, without any obvious gain. The clinical and demographic profile of patients with FD has not been sufficiently clarified. The aims of this study are: to outline a demographic and clinical profile of a large sample of patients with FD, to highlight the psychopathological correlates and to study the evolution of position of FD in the DSM. A systematic search for all case reports and case series of adult patients in the databases MEDLINE, Scopus and PsycINFO was conducted. 1636 records were obtained based on key search terms, after exclusion of duplicate records. 577 articles were identified as potentially eligible for the study, of which 314 studies were retrieved for full-text review. These studies included 514 cases. Variables extracted included age, gender, reported occupation, comorbid psychopathology, clinical presentation and factors leading to the diagnosis of FD. 64.5% of patients in the sample were females. Mean age at presentation was 33.5 y.o. A healthcare profession was reported most frequently (n=113). Patients were most likely to present in psychiatry, neurology, emergency and internal medicine departments. Statistical analysis has highlighted significant correlations between factitious disorders and depressive disorders and borderline personality disorder (BPD) and a significant effect of BPD and abuses in childhood on substance abuse. The survey of socio-demographic profile of the sample has highlighted some important points for early diagnosis and early psychiatric treatment. The research also allows deepening the psychopathological correlates of the disorder. The study showed that patients did not meet DSM-5 diagnostic criteria in the 11.3% of cases.