Definition, Classification, Descriptive Dimensions Factitious disorders are found less often in primary care than in specialized hospitals and large clinics; on principle, factitious disorders occur in all outpatient areas; para-factitious disorders such as manipulations with insulin by diabetics are found more frequently. Epidemiological data have not yet been confirmed by studies with larger patients’ samples because of disorder-specific problematics. Current prevalence estimates range between 0.05 and 2.0%. Patients with factitious disorders have traditionally been viewed as difficult (‘problem patients’) and little motivated for psychotherapeutic/psychosomatic therapy. Factitious disorders (ICD-10: F 68.1) are defined as self-injuring acts which directly or indirectly result in objectifiable clinically-relevant damage to the organism, without direct intention of suicide. The injurious or illness-inducing act is performed in secret. For outsiders, the relationship between the clinical finding and the patient’s causing or inducing activity is not readily apparent. The self-injuring act is targeted and consciously controlled but often performed in dissociative states, and the patient cannot always remember the act or the emotional state. The patients’ initial goal is hospital admission and medical, sometimes even invasive measures, e.g. surgical. The motivation for the behavior is initially unclear and arises for inner-psychic or even social reasons. A factitious disorder is also present if a patient injures himself by causing a doctor to initiate surgical procedures or invasive or other risk-laden diagnostic measures either by giving misinformation or by malingering. Open self-injuring behavior (cutting, stabbing, burning oneself, etc.) is not unusual in patients with factitious disorders in the course of the disease, sometimes it replaces secret self-injury and represents a transitional phase before the self-injuring behavior can be completely given up. ...

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