Clinical features

Clinical features are diverse; attempts to subtype patients have not always been helpful. One common approach has been to describe wanderers and non-wanderers as, for example, in a British study where wanderers were more often men, unemployed, motivated by material gain, complained of psychiatric and abdominal symptoms, changed jobs frequently, displayed aggressive behaviour and personality, abused drugs and alcohol, possessed histories exceeding 10 years, had criminal records, and showed criteria of social maladjustment. In contrast, most of the non-wanderers with factitious physical disorder were socially conformist young women (often nurses) with less dramatic symptoms and relatively stable social networks.(3) Similar findings have been reported in North American studies.(45)

Factitious disorders typically begin before the age of 30 years; (6,3 there are often prodromal behaviours in childhood and adolescence (see below). These individuals often report an unexpectedly large number of childhood illnesses and operations, and many have some association with the health-care field. (5) High rates of substance abuse, mood disorder, and borderline personality disorder have been reported. (36) Table 1 summarizes the main representative studies of factitious disorder patients: 176 (84 per cent) of the total 210 patients were women, and 55 per cent worked in medically related occupations.

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Table 1 Reports on series of patients with factitious physical disorders

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