F68.13 Factitious disorder imposed on self, with combined psychological and physical signs and symptoms

Name of the Condition

• Factitious Disorder Imposed on Self, with Combined Psychological and Physical Signs and Symptoms
• ICD-10 Code: F68.13

Summary

This condition involves the intentional production or feigning of both psychological and physical symptoms in oneself, without external incentives (e.g., financial gain). The individual may seek medical care or undergo procedures to maintain the sick role, leading to significant impairment in functioning. The behavior is not better explained by another mental disorder and persists despite negative consequences.

Causes

The exact causes are often complex and may involve psychological factors such as a need for attention, emotional distress, or unresolved trauma. Underlying personality traits or maladaptive coping mechanisms may contribute to the development of this disorder.

Risk Factors

• History of trauma or abuse
• Personality disorders (e.g., borderline personality disorder)
• Chronic stress or unstable social environments
• Prior experience with medical care or hospitalization
• Emotional deprivation or neglect during childhood

Symptoms

• Deliberate induction of combined psychological and physical symptoms (e.g., feigned hallucinations with self-inflicted injuries)
• Frequent hospitalizations or medical visits
• Inconsistent or vague medical histories
• Evasion of psychiatric evaluation
• Resistance to discharge or treatment
• Pseudologia fantastica (exaggerated or fabricated stories)

Diagnosis

Diagnosis requires careful clinical evaluation, including a thorough history, physical examination, and psychological assessment. Laboratory tests or imaging may be used to rule out genuine medical conditions. The clinician must confirm the intentional production of symptoms and exclude other mental disorders or external incentives. Collaboration with mental health professionals is often necessary to establish the diagnosis.

Treatment Options

Treatment typically involves psychotherapy, such as cognitive-behavioral therapy, to address underlying psychological factors. Medications may be used to manage co-occurring conditions like depression or anxiety. A multidisciplinary approach, including medical and psychiatric care, is often necessary. Building a trusting therapeutic relationship is critical for engagement in treatment.

Prognosis and Follow-Up

Prognosis varies, with some individuals achieving remission through consistent treatment, while others may experience chronic symptoms. Regular follow-up with mental health professionals is essential to monitor progress and adjust treatment as needed. Early intervention and sustained support improve outcomes.

Complications

• Worsening of physical or psychological symptoms due to self-induced harm
• Iatrogenic complications from unnecessary medical procedures
• Strained relationships with healthcare providers
• Social isolation or occupational impairment
• Co-occurring mental health disorders (e.g., depression, anxiety)

Lifestyle & Prevention

• Engage in regular mental health check-ups to address underlying stressors
• Develop healthy coping mechanisms for emotional distress
• Maintain open communication with healthcare providers about symptoms
• Avoid self-harm or manipulation of medical conditions
• Seek support from trusted individuals or support groups

When to Seek Professional Help

Seek immediate professional help if you or someone you know is intentionally inducing symptoms, experiencing severe impairment in daily functioning, or showing resistance to medical or psychiatric care. Early intervention can prevent complications and improve long-term outcomes.

Tips for Medical Coders

Document the presence of both psychological and physical signs and symptoms to support the use of F68.13. Ensure clinical notes specify the intentional production or feigning of symptoms without external incentives. Include details about the impact on functioning and any co-occurring conditions to justify the diagnosis.