Friday, 23 June 2017

ABC’s of the DSM-V: Fact? Or Factitious?

Factitious Disorder (FD). An entity that has recently gained mass media coverage due to a high profile murder (we’ve really been stepping into Murderino territory lately, huh!?). There are two types of this disorder; factitious disorder imposed on self, and factitious disorder imposed on another – have you guessed what it is yet?

If you said Munchausen Syndrome (MS) then you were correct! And the case in question is of course the one of Dee Dee Blancharde, which I’ll go into more detail later, but for now, what is it? And why is it called FD?

Like the word Dementia, FD is an umbrella term for disorders where patients falsify symptoms – with MS being an incredibly severe form of the disorder. Sufferers will falsify physical or psychological symptoms of a disorder, disease or injury, cases have been known where people will contaminate urine samples, take drugs to deceive invasive tests (blood, urine etc.), even induce injuries or disease such as an overdose or eating disorders by purposefully bingeing. In the case of MS, this can go to the extreme and all in the search of attention – this can be inflicted on themselves or on another person, known as Munchausens by proxy (MP).

FD stems from malingering – a form of over exaggerating symptoms, a bit like a hypochondriac. Ganser syndrome is a form of malingering or to some, a form of FD – the patient gives absurd answers to basic questions, often seen in prisons (which I personally believe is either due to boredom, lack of attention or a way to distract the doctors for personal gain, eg. “My knee is aching terribly, can I please get a bandage?” doctor then goes to get the bandage and while his back is turned, prisoner steals a handful of pills. I’m speculating, Orange is the new Black is back on Netflix…).

I can’t find any literature on the cause of the disorder, but I have found several reports stating the patients garner sympathy and attention and is therefore a possible motive. Similarly in the cases of MP, caregivers are given attention and praised for being brave and strong, and that feeling of being a “hero” gives them enough gratification to put loved ones in harm’s way.

The most popular case of this is that of Dee Dee Blancharde. Gypsy Rose was born to Dee Dee and Rod Blancharde, as relatively healthy if not slightly premature baby. She had no known health conditions that she was born with, yet throughout her childhood Dee Dee was convinced she was always ill, admitting her to hospital on several occasions for things like sleep apnea and small cuts or grazes. Dee Dee’s obsession with Gypsy’s health only got worse, and from an early age was pulled out of school, confined to a wheelchair (although she could walk) and doted on by her mother – even though her “ailments” weren’t really real.

Dee Dee managed to get financial aid due to Gypsy’s disabilities and her position as primary caregiver, they spent most of their time in various hospitals due to Dee Dee’s claims and was prescribed a plethora of medication such as anti-seizure pills and surgeries that were all falsified by Dee Dee herself. After hurricane Katrina, she managed to get break from having to provide evidence all the time by claiming Gypsy’s medical records were destroyed during the event, and as a result was able to claim as many ailments as she wanted as well as making her younger than she actually was. Which is what she did – they two moved back to Missouri and were able to reap the benefits of Gypsy’s disability – using charity aid and sympathy from friends and family. By the time Gypsy was an adult, people still believed her to be a teenager and treated her as such.

Over time, Gypsy was made to look ill – having her hair shaved and carrying around an oxygen tank and feeding tube whenever they were out to make her appear the most ill she could be. This continued on for a while, with Gypsy Rose not speaking out since her mother used physical abuse to control her.
It all ended when Gypsy struck up an online relationship with a man where she planned to kill her mother. Frustrated at being kept a prisoner in her own home, she and Nicholas Godejohn stabbed Dee Dee in her sleep. They were caught in the end, and Gypsy is now in prison.

That’s just the gist of it but the full story is far more interesting and well worth looking into. This case is one of many that I’ve found when researching this, parents have done some horrible things to their children in the search for attention and praise. One case study mixed her own period blood with her 6 year old child’s urine to make it look like she was peeing blood and had urological problems. Another managed to accidentally (or was it?) kill her own child by giving him large amounts of salt to make it seem like he had hypernatraemia. As I said, these are only a few cases and the manipulative and intelligent nature of the perpetrators, as well as the difficulty of detecting the true cause of the disorders make diagnosing MD and MP extremely difficult. In the case that a patient is confronted with lying, it can lead to ethical issues in the case that they’re not, so it’s very much a case of walking on eggshells a lot of the time.

Recently, the internet has been used as a catalyst for FD. Online – you can be who you want to be, but with the technology of today being so advanced, catfishing isn’t popular anymore. I know more personal stories of people meeting from the internet rather than through old school methods – which is great, I hold nothing against it, but it does leave people vulnerable. Fundraising sites are a common place for this, people can set up fundraises, claiming sick or abused and rely on peoples sympathy when in reality the situation is the complete opposite – this is a case of simple lying but in the case of FD the person will have no conscience about it and do it for the sheer attention and sympathy rather than financial aspect.

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