Dying to Be Ill

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