Widely misunderstood even by health professionals, factitious disorders must be considered in a modern perspective instead of the historical vi

* Personal and medical histories that are fraught with acute and harrowing adventures that seem to just fall on the wrong side of truth

Victims of factitial patients are not always primary victims, as in Munchausen by Proxy cases, but secondary victims are much more common and are part of every case. These victims are the family, friends, medical personnel, and others who become engaged in the ruse and devote time and energy to support the pretender. Victims must remember that the patients are very glib and tend to say what people want to hear. Fakers have been known to talk family members out of believing that any ruse occurred. Duped, then disillusioned, they may need therapy themselves, and, as integral players, they merit attention in their own way.

Munchausen's Syndrome can occur in children, adolescents, and adults in varying degrees and often coexist with symptoms of some other psychological disorder, such as depression, borderline personality disorder, and/or a social disorder. People with factitious disorders often have histories of turbulent and painful childhoods, unsettled adulthoods, and unstable relationships; however they may also be employed and have roots in the community. More signs of a Munchausen patient include: people with poor job histories, drifters, self-destructive behavior, and submissive behavior in submitting to countless unnecessary surgeries and dangerous diagnostic procedures. In a Toronto study, Munchausen patients ranged in age from 19 to 64, with a median age of 26, The average age at onset of disease simulation was 21 years, with 80 percent of patients admitting to having begun their behavior before the age of 28. They length of time of the factitial behavior averaged 4 years, but ranged from 0 to 11 years. Recently doctors have come to realize that Munchausen patients make the simulation of the disease the center of their lives. Their portrayals of the illness are frequently dramatized with lies unrelated to the illness, and sometimes in creating symptoms they endanger their own lives. Munchausen patients' jobless and itinerant natures often put them at odds with the law and push them over the line that separates malingering from factitious disorders. They often use their symptoms to garner room and board and other types of "ill-gotten" gains. Many Munchausen patients have also developed drug dependencies, probably because of painkillers administered by well meaning doctors who are trying to relieve their "symptoms", or because they have self-induced their illness that mandates some sort of pharmacological relief. Yet another motivation for their drug-seeking behavior is the thrill of putting one over on the physician. Researchers have said that for many Munchausen patients there's and almost "orgasmic" feeling associated with seeing the look on their doctor's faces as they start to realize they've been fooled. Mental health treatment is also essential, but often refused. However, some Munchausen patients appear not to have had troubling backgrounds, instead coming from apparently healthy families. A number of researchers believe that underlying brain dysfunction may be partly responsible in this case. Some patients have abnormal findings on imaging studies of the brain or cognitive tests, and this area of investigation has exciting potential.

While well known to psychiatrists and psychologists, factitious disorders are often misinterpreted by the uninformed to be merely lying; a vicious way to use others for personal gain. Factitious disorders are far more complex than that, however, and surpisingly far-reaching in their effects on the general public and medical community. The main question to ask yourself when you are dealing with a Munchausen's patient is this: Is there an underlying problem, such as depression, in which doctors can intervene? It is important to acknowledge the various psychological or environmental contributions in order to underscore that a factitious disorder

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Approximate Pages = 12 (250 words per page double spaced)