HEALTH
It's bad enough being seriously ill or injured, but hospital
patients also must endure an appalling lack of privacy, the perpetual
poking and prodding of doctors and nurses, and meals that leave one
nostalgic for airplane food.
So why do folks with "factitious disorder" actually feign
life-threatening illness? Why would someone dramatically exaggerate his
symptoms, even injecting fluid into his leg to simulate a tumor?
According to James Hamilton, Ph.D., it can be a quest for self and
identity--even if the identity is that of a "fatally ill" patient.
Because full-fledged factitious disorder is rare, studying a group
of such patients is all but impossible. But Hamilton wondered if he could
learn something about why people invent ailments by studying the
psychosocial factors that lead normal people to over-report their
symptoms.
Previous studies suggest that people who exaggerate or fake illness
tend to be depressed. So Hamilton, a psychologist at the University of
Alabama, asked mildly depressed, or dysphoric, individuals to read a list
of medical symptoms and to mark those that had ever ailed them.
The symptoms were afflictions that many of us have experienced at
some point in our lives--sleep difficulties, unexplained heart racing,
serious stomach cramps. But Hamilton threw in a subtle twist. For some
participants, he labeled the questionnaire the Michigan Common Symptom
Checklist. The rest filled out an otherwise identical form called the
Michigan Rare Symptom Checklist.
That single-word alteration didn't affect responses of normal
controls. But dysphoric individuals admitted to 70 percent more symptoms
when the items were labeled "rare." Most likely that's because rarity
connotes seriousness, Hamilton told the American Psychological
Association. In a culture that lionizes victims, the prospect of an
unusual or fatal disease can make folks with low self-esteem feel
special.
"Reporting symptoms perceived to be rare or unusual is a way of
setting ourselves apart from others," he contends. Sure enough, rarity
seemed to bolster mood. Dysphoric subjects who believed their symptoms to
be rare felt less depressed after completing the checklist.
Exactly how minor identity problems blossom into factitious
disorder remains unknown. But Hamilton's results are further evidence
that doctors can't ignore their patients' minds when they treat their
bodies.
ILLUSTRATION
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