The factitious/malingering continuum and its burden on public health costs: a review and experience in an Italian neurology setting

Marco Onofrj, Anna Digiovanni, Paola Ajdinaj, Mirella Russo, Claudia Carrarini, Massimo Di Giannantonio, Giovanni Martinotti, Stefano L. Sensi

Research output: Contribution to journalReview articlepeer-review

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Abstract

Abstract: Factitious disorder is classified as one of the five aspects of somatic symptom disorders. The fundamental element of factitious disorder is deception, i.e., pretending to have a medical or psychiatric disorder, but the enactment of deception is considered unconscious. Indeed, volition, i.e., the perception of deliberate deception, is blurred in patients presenting with factitious disorder. In the USA and the UK, factitious disorder has received constant media attention because of its forensic implications and outrageous costs for the National Health Systems. Unfortunately, a comparable level of attention is not present in Italian National Health System or the Italian mass media. The review analyzes the classifications, disorder mechanisms, costs, and medico-legal implications in the hope of raising awareness on this disturbing issue. Moreover, the review depicts 13 exemplification cases, anonymized and fictionalized by expert writers. Finally, our paper also evaluates the National Health System’s expenditures for each patient, outlandish costs in the range between 50,000 and 1 million euros.
Original languageEnglish
Pages (from-to)4073-4083
Number of pages11
JournalThe Italian Journal of Neurological Sciences
Volume42
Issue number10
Early online date4 Aug 2021
DOIs
Publication statusE-pub ahead of print - 4 Aug 2021

Keywords

  • Review Article
  • Factitious disorders
  • Malingering
  • Functional neurological symptoms disorder
  • Hysteria
  • Munchausen’s syndrome

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