In Factitious Disorder With Predominantly Psychological Signs and Symptoms, the intentional giving of approximate answers may occur (e.g., “8 times 8 equals 65”). The individual may surreptitiously use psychoactive substances for the purpose of producing symptoms that suggest a mental disorder (e.g., stimulants to produce restlessness or insomnia, hallucinogens to induce altered perceptual states, analgesics to induce euphoria, and hypnotics to induce lethargy). Combinations of psychoactive substances can produce very unusual presentations.
Individuals with Factitious Disorder With Predominantly Physical Signs and Symptoms may also present with Substance Abuse, particularly of prescribed analgesics and sedatives. Multiple hospitalizations frequently lead to iatrogenically induced general medical conditions (e.g., the formation of scar tissue from unnecessary surgery, or adverse drug reactions). Individuals with the chronic form of this disorder may acquire a “gridiron abdomen” from multiple surgical procedures. Chronic Factitious Disorder is usually incompatible with the individual’s maintaining steady employment, family ties, and interpersonal relationships. Possible predisposing factors to Factitious Disorder may include the presence of other mental disorders or general medical conditions during childhood or adolescence that led to extensive medical treatment and hospitalization; family disruption or emotional or physical abuse in childhood; a grudge against the medical profession; employment in a medically related position; and the presence of a severe Personality Disorder, most often Borderline Personality Disorder.