Factitious Disorder is coded according to the subtype that best characterizes the predominant symptoms.
300.16 With Predominantly Psychological Signs and Symptoms. This subtype describes a clinical presentation in which psychological signs and symptoms predominate. It is characterized by the intentional production or feigning of psychological symptoms that are suggestive of a mental disorder. The individual’s goal is apparently to assume the “patient” role and is not otherwise understandable in light of environmental circumstances (in contrast to the case in Malingering). This subtype may be suggested by a wide-ranging symptomatology that often does not correspond to a typical syndromal pattern, an unusual course and response to treatment, and the worsening of symptoms when the individual is aware of being observed. Individuals with this subtype of Factitious Disorder may claim problems such as depression and suicidal ideation following the death of a spouse (the death not being confirmed by other informants), memory loss (recent and remote), hallucinations or delusions, symptoms of Posttraumatic Stress Disorder, and dissociative symptoms. Some individuals may discern from the examiner’s questions the symptoms to endorse during a review of systems. Conversely, they may be extremely negativistic and uncooperative when questioned. The presentation usually represents the individual’s concept of mental disorder and may not conform to any recognized diagnostic category.
300.19 With Predominantly Physical Signs and Symptoms. This subtype describes a clinical presentation in which signs and symptoms of an apparent general medical condition predominate. Common clinical problems that may be feigned or produced include infection (e.g., abscesses), impaired wound healing, pain, hypoglycemia, anemia, bleeding, rashes, neurological symptoms (e.g., seizures, dizziness, or blacking out), vomiting, diarrhea, fevers of undetermined origin, and symptoms of autoimmune or connective tissue disease. The most severe and chronic form of this disorder has been referred to as “Munchausen’s syndrome,” consisting of the core elements of recurrent hospitalization, peregrination (traveling), and pseudologia fantastica. All organ systems are potential targets, and the symptoms presented are limited only by the individual’s medical knowledge, sophistication, and imagination.
300.19 With Combined Psychological and Physical Signs and Symptoms. This subtype describes a clinical presentation in which both psychological and physical signs and symptoms are present, but neither predominates.