Chief, Consultation-Liaison Psychiatry Service and Associate Attending Psychiatrist, New York-Presbyterian Hospital; Associate Professor of Clinical Psychiatry, Weill Cornell Medical College.
Director, Consultation Psychiatry, Long Island Jewish Medical Center/Northwell Health; Assistant Professor of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.
Psychodyn Psychiatry. 2023 Mar;51(1):98-113. doi: 10.1521/pdps.2023.51.1.98.
Factitious disorder is a condition in which patients deceitfully present themselves as injured or ill in the absence of obvious external reward. It is difficult to diagnose and treat, and little rigorous evidence exists in the literature. While larger studies have revealed some clinical and sociodemographic patterns, there is a lack of consensus on psychosocial factors and mechanisms contributing to factitious disorder. This in turn has led to conflicting recommendations on management. In this article, we review major psychopathological theories of factitious disorder, including the role of early trauma and subsequent development of interpersonal dysfunction, as well as maladaptive gratification obtained from assuming the sick role. Common themes of interpersonal disruptions in this patient population include a pathologic need for attention and care, as well as aggression and desire for dominance. In addition to psychodynamic and psychosocial etiologic models of factitious disorder, we also review associated treatment approaches. Finally, we offer clinical implications, including countertransference considerations, as well as directions for future research.
人为障碍是一种患者在没有明显外部奖励的情况下故意表现出受伤或患病的状态。它难以诊断和治疗，文献中几乎没有严格的证据。虽然较大的研究揭示了一些临床和社会人口统计学模式，但对于导致人为障碍的心理社会因素和机制尚未达成共识。这反过来又导致了管理方面的建议相互矛盾。在本文中，我们回顾了人为障碍的主要精神病理学理论，包括早期创伤和随后人际功能障碍的发展，以及从扮演病人角色中获得的适应不良的满足感。该患者群体中人际障碍的常见主题包括对关注和照顾的病态需求，以及攻击性和支配欲。除了人为障碍的精神动力学和心理社会病因模型外，我们还回顾了相关的治疗方法。最后，我们提供了临床意义，包括反移情考虑，以及未来研究的方向。
