The Intersection Between Factitious Disorder and Eating Disorders: A Narrative Review.

Abstract

Background: Factitious disorder is a rare condition that is important to recognise and treat appropriately. Patients with eating disorders can present seeking care for self-induced illnesses such as complications of purging and deliberate self-harm, the origins of which may not be disclosed by the patient. Rarely, patients will also present self-reporting a history of an eating disorder where there is evidence that this has been fabricated or exaggerated.

Objective: Critically evaluate the literature to better understand the presentation of factitious disorder co-occurring with eating disorders.

Methods: A literature search was conducted to identify published clinical cases of factitious disorder co-occurring with eating disorders. Demographics, clinical presentations, factors leading to a diagnosis of factitious disorder, etiological factors, psychiatric comorbidity, healthcare utilisation, management, and outcomes were examined.

Results: Thirty-four cases were identified in 29 publications across the years 1984-2022 from 10 countries. Mean age of the patients was 27.8 (range 14-48) years, and 94% of the them were female. A healthcare background was identified in 29% of cases. The most common method of producing factitious illness was via self-induction (74%). Most cases represented factitious disorder comorbid with eating disorders, and only 4 cases (12%) described patients presenting with a factitious eating disorder.

Conclusions: Factitious disorder can intersect with eating disorders in a variety of presentations, but this has been rarely described in the literature. Further research is warranted to better characterise this phenomenon.