هنگامی که دروغ به عنوان حقیقت عنوان می شود:تجزیه و تحلیل تئوری زمینه ای یک گروه پشتیبانی آنلاین برای اختلال ساختگی

Factitious disorder (FD) is poorly understood because of the elusiveness of sufferers. What is known is based on speculation from observational case studies and this is evident by the manifold diagnostic and treatment issues associated with FD. This study sought to fill the gap in the literature and overcome the elusiveness of FD sufferers by analysing their text communications in two online communities. One hundred twenty four posts by 57 members amounting to approximately 38,000 words were analysed using grounded theory. The analysis showed that contrary to current theories of FD, motivation is conscious and not unconscious, members did experience symptoms associated with the disorder, and they were also upset by their behaviour and wanted to recover but were deterred by fear. Furthermore, using the excessive appetitive model by Orford (2001) it is hypothesised that the characteristics of FD described by the members were congruent with those associated with addiction.

The DSM-IV-TR categorises factitious disorder (FD) into three sub-types: FD with predominantly psychological signs and symptoms; with predominantly physical signs; and symptoms and with combined psychological signs and symptoms. According to the DSM-IV-TR, diagnosis is dependent on clinicians establishing “A: the intentional production or feigning of physically or psychological signs or symptoms; B: the motivation for the behaviour is to assume the sick role; C: the external incentives for the behaviour are absent”. In practice criteria B and C are very difficult for a clinician to establish and instead they rely on criterion A, establishing intentionality (Kanaan and Wessely, 2010). Clinicians must collect circumstantial evidence to develop an index of suspicion and then confirm suspicion through irrefutable evidence of deception (Steel, 2009, McDermott et al., 2000 and Meadows, 1982). Therefore formal diagnosis only occurs when the patient either admits to feigning or is caught producing symptoms (Guzman and Correll, 2008).

Theories regarding the aetiology of FD are speculative, based on observational case studies. This is reflected in the practical diagnostic and treatment problems which surround the disorder. The debate has become stagnated because of the limited information available on what it is like to have the disorder from the sufferer׳s perspective as FD sufferers are highly elusive. The current study used a novel method of accessing firsthand experiences, analysis of text communication in two online communities for FD. The study set out to examine a number of core questions about the nature of the disorder: is the motivation to occupy the sick role conscious or unconscious, are symptoms experienced, if so what are they, are sufferers disturbed by their behaviour, if so do they want to recover and why are they reluctant to engage in treatment? The analysis found the members were aware of their motivations, challenging the common perception that motivation is unconscious. Furthermore, members provided numerous theories as to why they felt the need to occupy the sick role, while these are admittedly interpretive, the majority concur with previous theories. Contrary to the conventional view of FD, the members also described experiencing internal symptoms associated with the disorder, reported being upset by their behaviour, and claimed to want to recover. However, they were deterred from seeking formal help by anticipated fears and instead opted for self-management strategies. A common thread which ran through the analysis was the congruence between the experiences of FD reported by the members with the model of excessive appetite described by Orford (2001) and direct addiction research. They share the same primary and secondary processes and both groups are reluctant to seek formal treatment instead preferring self-management strategies. Given the nature of the data the findings presented by this study are very much a working hypothesis but nevertheless supported by a larger base of evidence than any published studies to date.