Factitious Disorder – An Overview of the Condition & ICD-10 Codes

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Factitious disorder is a mental health condition in which people fake a physical or mental illness for sympathy and attention. People suffering from this disorder crave the attention of doctors and other medical professionals by appearing sick purposely or by self-injury. People with this disorder often go to great lengths to attain attention from others. They may pretend to be sick, induce sickness in themselves, corrupt with medical tests or cause harm to another weak person, such as a child, a disabled relative, or an older adult. The exact cause of factitious disorder is unknown. The condition may be caused by a combination of psychological factors and stressful life experiences. Identifying the exact symptoms and treating factitious disorder is quite challenging. The primary treatment will focus on changing the thinking and behavior of the individual with the disorder. Psychotherapists or other physicians providing treatment for such conditions can rely on medical coding companies to meet their reimbursement concerns.

Although people with factitious disorder know that they are causing their symptoms or illnesses, they may not understand the exact reasons for their behaviors or recognize they have a problem. A wide range of factors may contribute to or increase the risk of developing this condition – childhood trauma (such as emotional, physical or sexual abuse), a poor sense of identity or self-esteem, a serious illness during childhood, personality disorders, depression and loss of a loved one through death, illness or abandonment.

Types of Factitious Disorder

There are two types of factitious disorders – those imposed on the self and those imposed on others.

  • Factitious Disorder Imposed on Self – People will fake physical or psychological problems in themselves, or may self-induce an injury or disease. They will act as sick or injured to others and will continue this trick even if they do not receive any external rewards. They may appear confused, make absurd statements, and report hallucinations (the experience of sensing things that are not there,such as hearing voices).
  • Factitious Disorder Imposed on Another – People with this disorder will falsely claim that another person has physical or psychological signs or symptoms of illness, particularly someone who is vulnerable and under their care (such as a child, disabled persons or elder adults).

Warning Signs and Symptoms

Factitious disorder symptoms involve mimicking or producing illness or injury or exaggerating symptoms or impairment to deceive others. The signs and symptoms can range from mild to severe. Common warning signs and symptoms include –

  • Seeking treatment from many different doctors or hospitals, which may include using a fake name
  • Reluctance by the patient to allow healthcare professionals to meet with or talk to family members, friends, and prior healthcare providers
  • Refusal of psychiatric or psychological evaluation
  • Presence of many surgical scars
  • Inconsistent medical history
  • Having few visitors when hospitalized
  • Frequent stays in the hospital
  • Extensive knowledge of medical terms and diseases
  • Eagerness to have frequent testing or risky operations
  • Conditions that get worse for no apparent reason
  • Forecasting negative medical outcomes despite no evidence of this
  • Sabotaging discharge plans or suddenly becoming more ill as one is about to be discharged from the hospital setting
  • Vague or inconsistent symptoms

As people with this mental health condition become skilled at faking symptoms, diseases or inflicting real injuries upon themselves, it may be difficult for healthcare professionals to identify whether these illnesses are real or not. People may make up symptoms or cause illnesses in several ways, such as – framing false medical history, causing self harm, faking and exaggerating existing symptoms and tampering.

How Is Factitious Disorder Diagnosed and Treated?

Diagnosing factitious disorder is often difficult, as this mental health condition involves deceptive behaviors. Often, the person’s use of fake name and multiple physicians and hospitals may make it difficult to gather information about previous medical experiences.

Physicians may generally suspect factitious disorder when they find –

  • No physical reason for the symptoms
  • If the illness does not follow the usual course
  • Inconsistent symptoms or lab test results
  • If the person’s medical history doesn’t make sense

If any of these conditions are met, physicians may further refer the person to a psychiatrist or psychologist. As part of initial diagnosis, psychiatrists/psychologists may conduct a detailed interview, review past medical records and discuss with family members for more information. In addition, they may use the criteria for factitious disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Treatment of factitious disorder is often difficult, and there are no standard therapies. As people with this condition want to be in the sick role, they’re often unwilling to seek or accept treatment for the disorder. The initial goal of the treatment will be to change the person’s behavior. In case of factitious disorder imposed on another, the main goal is to ensure the safety and protection of any real or potential victims. Once the initial goal is fulfilled, treatment will be started to resolve any underlying psychological issues that may be causing the person’s behavior.

The primary treatment for this mental health condition is psychotherapy – a type of counseling which focuses on changing the thinking and behavior of the individual and developing positive coping skills to build self-esteem. In addition, family therapy may also be recommended, so that family members can learn to support the person with this disorder without reinforcing harmful behaviors. Medications are generally not prescribed to treat factitious disorder, unless the individual suffers from any specific related disorders such as depression, stress or anxiety. Factitious disorder patients need to be constantly monitored for substance abuse and potential suicidal behaviors, as they are at higher risk than the general population.

Psychiatrists/psychologists performing the diagnosis and other treatment procedures must use the correct medical codes for documentation purposes. Medical billing and coding services ensure this so that claim denials are avoided.

ICD-10 Codes for Factitious Disorder

  • F68 – Other disorders of adult personality and behavior
    • F68.1 – Factitious disorder imposed on self
      • F68.10 – Factitious disorder imposed on self, unspecified
      • F68.11 – Factitious disorder imposed on self, with predominantly psychological signs and symptoms
      • F68.12 – Factitious disorder imposed on self, with predominantly physical signs and symptoms
      • F68.13 – Factitious disorder imposed on self, with combined psychological and physical signs and symptoms
  • F68.A – Factitious disorder imposed on another
  • F68.8 – Other specified disorders of adult personality and behavior

As the exact causes of factitious disorder are unknown, there’s currently no known way to prevent it. However, early recognition of symptoms may help avoid unnecessary and potentially dangerous tests and treatment.

Medical billing and coding for mental health disorders can be challenging. However, the support of an experienced medical billing and coding outsourcing company can prove to be very valuable when it comes to ensuring timely and accurate claims submission for optimal reimbursement.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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