Diagnostic criteria in most widely used diagnostic systems (DSM IV and ICD 10) are similar. In both systems diagnostic criteria for psychiatric factitious disorder are identical to those for factitious disorder with physical signs and symptoms.
In both systems the diagnostic of factitious disorder supposes that the patient feign or produce the signs or symptoms with (the presumed) motivation of assuming the sick (or patient) role.
In addition, the DSM emphasizes the lack of external incentives and the ICD mentions that the disorder is often combined with marked disorders of personality and relationships.

Because of specificity of psychiatric diagnosis (i. e. that it entirely relies on statements made by the patient) those criteria, in the first place designed for factitious disorder with physical symptoms are difficult to use for factitious disorder with psychiatric presentation.
Based on proposals made by other authors and analysis of clinical characteristics of reported cases I suggest the following, more practical, criteria.

Proposals for (more practical) diagnostic criteria

1. Severe disorder, usually incompatible with individuals maintaining steady employment, family ties and interpersonal relationships, with onset in early adulthood and following a generally chronic course.

2. Characteristics of symptomatology:

• the symptoms are labile and inconstant, changing markedly from one day to another or from a hospitalization to the next one;
   
• the changes in symptoms are not related to the treatment but are often influencedby the environment as manifested by the suggestibility, mimicry and exacerbation when the patient feels observed;
   
• unconventional and fantastic symptoms;
   
• an uncommon association of a large number of symptoms occurring simultaneously or successively, belonging to several psychiatric disorders;
   
• association with other factitious disorders (factitious disorder with physical signs, factitious bereavement etc.).
   

3. Patient's real medical history and biographical data are difficult to obtain because:
 

• the presentation made by the patient is a mixture of exaggerated, dramatic stories (pseudologia fantastica) and vague details often putting forward memory dysfunctions;
   
• typically the patient with factitious disorder has few or no visitors and prevents medical staff from contacting family members or other persons able to provide information.

4. The external, material incentives are either absent or the symptomatology is very exaggerated considering the advantages. The distinction between material and psychological incentives is an important one for "care behavior" in others is an important incentive, always present in such cases.

We hope that this web site, providing an opportunity for discussion ("Comments" section) and standardized reporting of cases ("Any new case?" section) will contribute to refine the diagnostic criteria.

Src: http://andreisz.club.fr

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