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When illness is feigned, one may or may not be able to
discern a more or less understandable motive. When one can,
for example when someone complains of a “bad back” to
escape the draft, such feigning is referred to as
“malingering.” When one cannot find a motive—indeed
when it appears that the only possible motive could be the
desire to be a patient in the hospital—one speaks of a
“factitious illness.”
Typically the patient presenting at the emergency room with
a factitious illness has a personality disorder with prominent
borderline, masochistic, and at times antisocial traits. Often
they also have had some exposure to medicine and hospitals,
having worked as aides, physical therapists, and the like. The
frequency with which hospitalization is sought varies widely.
On the one hand, admission may be quite sporadic and occur
only at times of great stress. On the other hand, however,
there are some whose lives are consumed by these un-needed
hospital stays. One variety of this severe pattern is known as
“Munchausen’s syndrome,” named after the famous German
baron who traveled from city to city, telling fascinating tales
about himself. Patients with Munchausen’s syndrome, in
addition to wandering and being hospitalized in numerous
different cities, often also display what is known as
“pseudologia fantastica,” or a capacity for spinning out
elaborate tales, at times intermixed with some actual facts,
which listeners often find, sometimes despite themselves,
intriguing and fascinating.
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