Letter to the Editor

Job-hopping and Factitious Victimization

Authors: Marc D. Feldman, MD, James C. Hamilton, PHD

Abstract

As most readers are aware, factitious disorder (FD) involves a person's feigning or producing physical or psychological ailments that can range from infection and fever of unknown origin to bereavement and psychosis. The goal in FD has historically been viewed as the sick role,1 with its attendant attention, nurturance, and lenience. However, a growing literature suggests that the primary goal of the role-playing in FD can be understood more generally as the pursuit of emotional satisfaction or security (in contrast, the goal in malingering is external and often tangible; examples include disability payments and opioids). Indeed, we believe that the sick role may simply be one of many roles that can be taken on illegitimately to serve psychological needs, a suggestion buttressed by Turner's2 recent reformulation of the DSM-IV criteria for FD. This view is also supported by documented cases of FD, including at least one in the SMJ,3 that involve the purloining of the role of “victim”4 rather than “patient.”

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References

1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000, pp 513–517.
 
2. Turner MA. Factitious disorders: reformulating the DSM-IV criteria. Psychosomatics 2006;47:23–32.
 
3. Feldman MD, Ford CV, Stone T. Deceiving others/deceiving oneself: four cases of factitious rape.South Med J 1994;87:736–738.
 
4. Feldman MD. Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder. New York, Brunner-Routledge, 2004.
 
5. Parsons T. The Social System. Glencoe, The Free Press, 1951, pp 436–439.