Last week in Abnormal Psychology we talked about Factitious Disorder (the disorder formerly known as Munchausen’s). My professor handled a serious case of Factitious Disorder imposed on another back in the 90’s but this week we moved on to substance abuse which she seemed uneasy with, as falling outside her specialty. But she covered it in lecture because it’s such a common presentation.
I see them as similar insofar as both involve denial. Factitious disorder seemed fairly exotic to many of my classmates, whereas substance abuse is so pervasive, it’s hard to see what it has in common. I assume that people with Factitious disorder kind of know they shouldn’t be doing what they’re doing. It’s a deception, that’s what distinguishes it from a somatic disorder. I think the internal dialogue is probably not that different from substance dependency, where you knows you’re going too far, and really should stop, but not right now, not today. Today you need to do this to get through what you’re dealing with.
Factitious symptoms are a way of getting to that feeling of being a patient and getting sympathy, of feeling cared for that you’ve become dependent upon. It is definitely similar to the mental process underlying compulsive (or even emotional) eating. I assume it’s similar to tobacco use. I’ve met smokers here and there who really don’t believe it’s bad for them, but most people seem to know they should quit, if they could. It’s a little blearier with alcohol use, since limited alcohol use is socially acceptable and even touted as healthy (in studies of populations from which smokers and the obese have been deselected.)
For myself, I was sick a lot as a teenager, in seventh and eight grade. Whether it was factitious disorder or malingering is debateable. It depends on whether I was motivated by spending more time with my mother or less time with the rest of my family. I was a middle child in a very large family. It did get me out of school. But when ninth grade came along I was sufficiently impressed upon with the idea that I was in the pipeline for my college record, and so I stopped letting illness affect me as often. I also had subjects I really enjoyed and felt validated with my achievements in, and there were boys I had crushes on. Maybe it was a dependency shift, what 12 steppers call an addiction amoeba.