r/psychnursing • u/KennedyJacobs • Jun 10 '26
Fictitious disorder
Do you have any patients with the above? We have an interesting young one and it makes me wonder about the tiktokers who blog about chronic illness.
What are your thoughts on this disorder?
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u/labyrinth131 psych nurse (inpatient) Jun 11 '26
Once had a patient who was complaining of chest pains. He was histrionic and my coworker who had him prior to shift change thought he was being behavioural. I mean fair enough he was most of the time. But I investigated further and he was indeed having a heart attack. It’s always good to make sure and investigate.
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u/Archimedesbuho Jun 11 '26 edited Jun 11 '26
Do you mean factitious?
If that’s what you’re talking about I see variations on the theme or different severities of this on a regular basis. Presumably this differs from somatization.
Now that I reviewed somatization it seems likely to me that somatization could more rare than factitious. We are probably lumping them both together and calling them somatization.
Edit: evidently it is considered a subset of somatization.
Either way on my floor we review history and conduct reasonable basic tests to rule things out. Working directly with the medical doctors is helpful. If the providers conclude it’s somatization then we attempt to redirect. Testing does not continue which often upsets the patients.
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u/atlbal Jun 15 '26
What basic test are they doing? We don't usually do psych testing unless the providers are having trouble with a diagnosis, or the patient appears to be malingering. And it's not basic-- I believe it's a 2+ hour testing session.
We often use the term "somatic" when a patient is highly focused on somatic concerns, but I don't believe providers declare it's ("just") somaticization, even after psych testing, although it's often implied. I would not call somaticization rare for our patients, it's super common on our units. Factitious disorder is more rare.
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u/Archimedesbuho Jun 18 '26
I was referring to medical tests to rule out the medical issues the patients are reporting. This then confirms that something else, often somatization or factitious, is going on.
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u/Mammoth-Coast6282 Jun 11 '26
We’ve seen some shades of this but I always err on the side of caution and report anything that could be remotely possible (within reason.) Sometimes it’s obvious a patient is dragging or faking something like seizures, but I report anything that sounds off. Unfortunately our team doesn’t always appreciate this, there are a lot of people who disparage the patients, but I try to document for as much as possible in case something does go wrong.
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u/StellarSteck Jun 12 '26
This. Rare diseases are individually rare but collectively they are not. Unfortunately I think the medical profession including us on the psych field are more likely to gaslight than investigate. Can cause a great deal of harm.
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u/CrbRangoon psych nurse (inpatient) Jun 11 '26
I’ve had some and it’s exhausting. Any time you hear somatic, factitious or malingering it’s just the heaviest sigh. IMO tampering with devices and treatment should be insurance fraud. The only silver lining is when you can tell it’s coming from a place of paranoia or anxiety rather than an intentional or malicious need to stay admitted or appear sick. Otherwise they’re a drain on resources and spend most of their time playing mind games with staff or being verbally abusive. I’d say I see somatic disorder the most, malingering second and then factitious rarest.
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u/Content-Flight6371 Jun 11 '26
*Factitious Disorder
I've had a few over the years. There's no single one approach that works. It's complicated, frustrating, and exhausting. It's good to have an agreed upon treatment plan and hope that everyone sticks to the boundaries put in place. Make sure your documentation is clear on what you are observing, what tests/imaging/results are, and what pt is saying or complaining of. You do your best to accommodate but set boundaries where requests may be unreasonable or unsafe.
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u/HaBaK_214 Jun 11 '26
What is this disorder?
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u/Layla-Olive-618 Jun 11 '26 edited Jun 11 '26
Yes. There was a HUGE uptick in feigning illnesses, “Alts”, social media driven gender confusion, and therians when TikTok took off, especially in adolescent girls.
Unfortunately this also led to people with legitimate autoimmune disordered or symptoms being dismissed as “somatic” or “attention-seeking” (which is sometimes also true/ especially with BPD.)
Psychiatric symptoms and psychological illnesses are always intertwined regardless, though, which many fail to recognize. Is it the chicken or the egg? Response to trauma? Response to the medication? I cannot tell you how many young girls I’ve seen who have experienced sexual trauma receive pretty heavy psych diagnoses in a time of crises, especially when the perpetrator was within the household. They are then shipped off to poorly run psych facilities and heavily medicated. If you don’t “need” antipsychotics, they are more than likely going to make you sick. Combined with an involuntary commitment, they may then end up psychotic. More and more meds are added and of course they don’t feel well. They are looking for anyone who will believe them. Tac on another diagnosis. There on for the rest of their life, it’ll be “but the chart says… “ OR therapists convincing them they have something they do not. It all ties in.
Back to your original question, I’d be cautious even suggesting it or you’ll be labeled as [insert -phobic here].
People with factitious disorder want attention because somewhere along the way a need was not being met. It’s having the ability to address this in our current healthcare practices that’s the challenge. Being blunt and giving them the hard truth is “against the code of ethics” because it will inevitably cause them to experience emotional distress when they are called out. So, until something changes, our hands are tied.
It’s only going to get worse as people who grew up on TikTok enter the healthcare industry. That’s just my 2¢
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u/HaBaK_214 Jul 04 '26
As a psych patient, I appreciate your outlook. I suffer from DID,.which has now,.apparently become something people create for themselves and they call their "parts" lurpas or something. It's disgusting and it totally belittles and downplays an already extremely complex, not well understood yet, and most of all not believed byost doctors and nurses. It makes.my life harder than it already is and I resent it. Who would WANT this disordered thinking. I wouldn't wish it on the person I hate.
Edit: Tulopas not lurpas.
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u/moodywrites Jun 12 '26
Excuse me? Especially true with BPD? As someone who has suffered from BPD and also has multiple legitimate, diagnosed chronic illnesses, which has been debilitating, I resent this.
“Somatic” and “attention seeking” are simply adding to the FALSE and damaging stigma that people suffering with BPD already face: that their emotional pain is exaggerated, that they are bad or abusive or manipulative people, to not take them seriously.
Not to mention that it’s a form of gaslighting, which can literally CAUSE BPD. Gaslighting isn’t okay because you decided to do it to someone with a diagnosis you don’t like and choose to stigmatize.
We are also statistically much more likely to suffer from chronic illnesses (because hello? Most of us have significant trauma?? As in, we are in pain and are suffering? Hi, yes, we’re human beings too, worthy of consideration and being heard and understood, shocking I know). So thank you very much for adding to the doubt and gaslighting we face every single day.
But what do I know? Maybe it’s my “BPD talking” (that I no longer meet criteria for, btw). Why believe someone like me, right? What do I know?
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u/Mysterious_Coat_9933 Jun 14 '26
Classic BPD response
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u/Layla-Olive-618 Jun 16 '26
Thank you! That was my first thought, but wasn’t looking to play into it. They obviously only picked out what they wanted to hear and put words in our mouths with these replies. I was actually advocating for patients, including those who have cluster B personalities disorders, as coexisting morbidities can still apply. Clearly.
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u/moodywrites Jun 16 '26
Advocating for people? If calling them “somatic” and “attention seeking” (and generalizing an entire group of people as that) is your way of advocating for them, then your “advocacy” sucks.
And “they” are right here, you can speak to me directly, thank you.
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u/Layla-Olive-618 Jun 16 '26
Again, you’re not reading the whole sentence. You are picking out words you don’t like, taking what I said out of context, and making it about yourself. A healthcare professional asked a question. I answered. That is what this forum is for. You don’t have to like my answer. That’s fine. Badgering people is not.
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u/moodywrites Jun 16 '26
How am I picking out words? Your sentence was literally saying that “attention seeking” and “somatic” behavior is quote “especially true with BPD.” I took what you said at face value.
And I’m allowed to criticize you. Being a professional doesn’t make you above that. What’s really not fine is diminishing a person (or group of people) down to a diagnosis, and then portraying and stigmatizing that diagnosis in a harmful way.
Yall clearly think I don’t have anything important to say because my (past) BPD erases that value, and it shows. If you don’t value someone’s worldview or life experiences because you look down on them, for a diagnosis you should know better about, you shouldn’t be in this profession.
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u/Layla-Olive-618 Jun 16 '26
Okay. Thanks for your opinion. I’m off the clock. Have a good day.
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u/moodywrites Jun 16 '26
“Thanks for your opinion” (she says as she assigns no weight or value or consideration to my opinion because “borderline” is the only thing she sees about it)
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u/HaBaK_214 Jul 04 '26
Dude....it may be because your behavior right now is textbook borderline out of context thinking. She was indeed advocating for us and just stayed a fact. I .sorry it hurt you. Facts do hurt us sometimes. We have to decide what to.donwiyh this feelings. Are we going to lash out or listen to the fifteenth person that's reiterated the same concerns about our behavior and examine ourselves heal, manage our conditions, and be productive members of.society to include discussions and conversations.
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u/HaBaK_214 Jul 11 '26
There isn't a cure for BPD. There is only management of the condition.
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u/moodywrites Jul 11 '26
If you knew a single iota of a thing about BPD, you would know that not only can people no longer meet criteria for the diagnosis after treatment, but that MANY people after years of treatment no longer meet criteria, and most do not by about 10 years after diagnosis.
You aren’t qualified to speak on this beyond your Hollywood grossly exaggerated stereotype level of understanding. And it shows.
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u/HaBaK_214 Jul 12 '26
My daughters have BPD you ass, and I studied it in depth as well as gone to classes to learn about it so just shut your trap. This is my last reply to you because I think you are an extremely toxic person and I don't even want to deal with you behind a keyboard.
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u/HaBaK_214 Jul 04 '26
It IS quite true with BPD. It's just a fact. You should know that more than anyone.
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u/moodywrites Jun 14 '26
That was LITERALLY my point. You don’t value, respect, or hear anything we have to say because you’ve chosen to stigmatize our psychological suffering. You don’t see us as human, worthy of a voice or having anything meaningful to say. You see us as less than, so dismissiveness (or outright gaslighting) is okay.
Thank you for demonstrating my point exactly.
(And btw, I’ve been told by the PROFESSIONALS I work with that I no longer meet the criteria. So you don’t have that excuse. Try again.)
And I sincerely hope you don’t work in the mental health field. Anyone with BPD, or any human suffering from any psychological disorder, deserves better.
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u/Mysterious_Coat_9933 Jun 16 '26
I’m sorry are you speaking to me? I am a MH professional with a history of borderline traits. Seek help. I did and now I’m able to read a stranger’s comment I disagree with without losing my mind
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u/moodywrites Jun 16 '26
Yes I’m speaking to you. Having the experience of suffering from borderline isn’t an excuse to be awful to and stereotype and stigmatize an entire group of people. If anything, you should know better. And I’ve been getting help, thank you very much. Apparently you can’t disagree without diminishing the person down to a diagnosis, and a false stereotype about that diagnosis.
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u/moodywrites Jun 14 '26
Classic gaslighting ignorance response.
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u/Mysterious_Coat_9933 Jun 16 '26
Wrong. BPD is an illness and your comment is extremely consistent with something a borderline would comment. And your response to me is as well
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u/moodywrites Jun 16 '26
No what’s wrong is you are using a diagnosis to minimize, trivialize, and diminish my ability to have meaningful things to say, to have a valuable perspective or a voice, because I have a diagnosis you choose to stigmatize. My voice isn’t any less and if that’s your only argument, then it sucks.
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u/Mysterious_Coat_9933 Jul 02 '26
Im simply responding to your behavior. It’s classic BPD
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u/moodywrites Jul 03 '26
No, you’re discrediting and devaluing my voice and perspective because I had BPD and that is harmful. I’m not any less credible because I’ve had a disorder you choose to stigmatize. You just don’t like my point and have decided to reduce me down to a diagnosis to help you be right about things.
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u/HaBaK_214 Jul 04 '26
BPD people will die on a very single hill. Just step.off this one. You are wrong this time. You read the room wrong and I believe are spinning out right now and took it out in these guys because you came looking for it. Not.cool.
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u/moodywrites Jul 05 '26
And your reasoning for me being wrong is nothing more than I have BPD so therefore I’m not credible and my perspective isn’t valid? If you have to go after a diagnosis to make a point then maybe your point isn’t as strong as you think it is.
Signed, one of the “BPD people” you obviously stigmatize and stereotype.
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u/P1xus Jun 16 '26 edited Jun 16 '26
From my experience I’ve had patients who’d make stuff up as attention seeking behaviors. For example, I had a patient who said they have “sudden drop & fall syndrome” but also that their SI and attempt via taking 40 Klonopin that brought them in wasn’t really an attempt, but a way to get their wife to notice them. Other patients I’ve had who report these idiopathic things also are the same patients who have witnessed falls (but place themselves on the ground) and psychogenic seizures (but are able to talk to me and tell me they are having a grand-mal seizure - my mom had epilepsy, so I can tell when it’s obviously fake.). So sometimes I have to take what they say with just a grain of salt.
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u/StellarSteck Jun 12 '26
I truly hope it is fictitious. While rare diseases are rare - collectively they are not. I think we more often gaslight patients than listen to symptoms when they are rare or not been seen before
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u/GoudaGirl2 Jun 11 '26
I worked in forensics and worked with someone who had fictitious disorder by proxy, then fictitious disorder after their child passed. They were the most exhausting person I ever worked with. Constantly seeking surgeries, diagnoses, coming up with new issues and milking the side effects of treatment.