Spivak H, Rodin G, Sutherland A
Department of Psychiatry, Toronto Hospital, Ontario, Canada.
Psychosomatics. 1994 Jan-Feb;35(1):25-34. doi: 10.1016/S0033-3182(94)71804-1.
Factitious disorder (FD) is a form of somatization that involves apparent deception, simulation of illness, and imposture. This deception may be distinguished from other forms of lying in that patients with FD may suffer from underlying disturbances in the sense of reality and in reality testing. These features may be associated with a poorly consolidated sense of self and with difficulty regarding emotional experience as real. Factitious behavior may serve to stabilize the sense of self by concretizing and legitimizing the subjective experience of distress and by evoking responsiveness of a care-giver in a relatively safe, structured context. A psychotherapeutic stance focused on identifying and validating the patient's subjective experience may lead to a reduction in factitious behavior and to a more authentic and stable sense of self, in which emotional as well as physical experience is regarded as real. However, most patients with FD refuse treatment. Further, psychosis and suicidality are complications that may occur during the course of psychotherapy.
做作性障碍（FD）是一种躯体化形式，涉及明显的欺骗、疾病伪装和冒名顶替。这种欺骗可能与其他形式的说谎有所不同，因为FD患者可能在现实感和现实检验方面存在潜在障碍。这些特征可能与自我认同感巩固不佳以及难以将情感体验视为真实有关。做作行为可能通过使主观痛苦体验具体化和合法化，并在相对安全、结构化的环境中唤起照顾者的反应，来稳定自我感。专注于识别和验证患者主观体验的心理治疗立场可能会减少做作行为，并带来更真实、稳定的自我感，在这种自我感中，情感体验和身体体验都被视为真实的。然而，大多数FD患者拒绝治疗。此外，精神病和自杀倾向是心理治疗过程中可能出现的并发症。
