Have you ever faked an illness to get something you wanted? Most of us have. There is, however, a small population who live this way all the time. In 20-30% of doctor's visits, no physical complaint is found; in nearly 16% of ER visits, no clear medical problem is found. Perhaps 10% of these visits could be described as illegitimate. These are the troubled folks who need to be sick or need to engender sickness in another. The patients caught up in "sick role enactments" are literally "dying for attention." They sacrifice careers, relationships, and even their health for this. They do not know how to get their needs met in healthy, socially acceptable ways. They may engage in "pseudologia fantastica", an elaborate embellishment or crafting of one's history. They experience immediate gratification when they play these roles. People are genuinely concerned and drawn in.
Because medical people are trained to have compassion, to trust and to respect their patients, detection of factitious disorder is difficult. Feldman estimates the costs placed on the medical system by factitious disorder are in the same league with serious health problems such as MS and Parkinson's disease. He discusses possible interventions for these patients such as making the signing of releases mandatory for hospitalization, telling the patient that they have a known disorder, or simply "outing" the patient in direct confrontation. Family members and medical people who went to bat for the patient are their victims. They need to be prepared for an intense emotional reaction when such a person is first confronted.