The Diagnosis of Factitious Disorder in General Hospitals in the United States: A Retrospective Analysis of the National Inpatient Sample

Abstract:
Background/Significance: Deceptive patients - those who deliberately falsify or induce symptoms - pose a particular challenge when admitted to a general hospital. Multiple deception syndromes, including malingering and factitious disorders, are defined in the psychiatric literature, but it is unclear which patients receive such diagnoses in the general hospital setting. Our recent study characterized general hospital patients with a diagnosis of malingering in an effort to understand better how this label is applied (Punko et al., 2023). Similar data on factitious disorders will broaden our understanding of deception syndromes as a whole with the aim of effectively recognizing, diagnosing, and ultimately managing these cases in general hospitals.

Methods: The National Inpatient Sample (NIS), an all-payors database of acute care general hospital discharges in the United States, was queried for adult patients discharged for ICD-10-CM codes associated with factitious disorder. We examined this group for socio-demographic variables in addition to associated diagnoses and admission characteristics. As the study was performed on publicly available de-identified data, the Mass General Brigham Institutional Review Board determined this to be Not Human Subjects Research.

Results: Our preliminary analysis revealed findings consistent with classic teachings on factitious disorder, for instance, an overrepresentation of female patients. However, some results were unexpected, such as the absence of a higher frequency of weekend admissions and fewer medical comorbidities among hospitalizations with a discharge diagnosis of factitious disorder. Further analyses are planned comparing findings with malingering and incorporating multiple years of NIS data to augment the sample size. The full presentation will include results from these additional investigations.

Discussion: Early recognition of deception syndromes is vital for improving patient outcomes and preventing iatrogenic harm. This study underscores the importance of considering socio-demographic factors in identifying and managing factitious disorders and other deception syndromes, informing targeted interventions, and enhancing clinical suspicion among healthcare providers. Multidisciplinary collaboration and clear communication among healthcare teams are essential for addressing the complex challenges presented by these conditions. Ethical considerations loom large, requiring a delicate balance between patient autonomy, beneficence, and justice.
Conclusion/Implications: Accurate characterization of factitious disorders, supported by reliable data from large samples, holds the key to improved detection and care for affected patients. Increased awareness and collaboration among healthcare professionals can mitigate the adverse consequences of associated with deception syndromes. Further research is warranted to elucidate optimal strategies for preventing, detecting, and managing deception syndromes in general hospital settings to optimize patient care and the broader impact on healthcare.