Descriptive Psychopathology: The Signs and Symptoms of ...

363 Chapter 15: Abnormal trait behaviorsChronic use of illicit drugs is also associated with personality change. 70Chronic heavy use of stimulants leads to executive function deficits, apathy andmovement problems. Lack of spontaneity and initiative, loss of drive, ambitionand interests, sluggish thinking, and being socially isolative occur. Some patientsbecome irritable and emotionally labile, restless, impulsive, self-destructive andunrealistic in plans, and lack insight. Persons who repeatedly inhale the vaporsfrom volatile industrial liquids can be violent and suspicious. Patients who usehallucinogenic drugs can be avolitional and apathetic.Malingering and factitious disorderThe separation of malingering from factitious disorder is based on psychologicaltheory without supporting evidence. Patients in both groups feign illness. Themalingerer has a clearly identifiable goal, such as avoiding prosecution, obtaininginsurance money, and avoiding responsibilities. Malingering is associated withantisocial personality disorder. 71The person with factitious disorder is said to have no obvious reason to fakeillness, but rather the “psychological need” to be a patient. When pronouncedand chronic, it is referred to as Munchausen’s syndrome. Such patients commonly“hospital-hop”, seeking admission for various medical complaints. 72 Parents whofake signs of illness and laboratory tests of their children are said to have factitiousdisorder “by proxy”. Although treated as child abusers, these parents are still saidto have a “psychological need” to be in a sick role. An example of a patient witha likely factitious disorder follows.Patient 15.5A 12-year-old boy was seen in the emergency room after having a “spell” justprior to going to school. In recent weeks he had other episodes described asfainting spells, aggressive episodes during which he damaged some object andthrew things, “dissociative-like” periods during which he appeared sleepy butresponsive, spells during which he acted like an infant or young child orinsisted on lying on the floor, and times when he referred to himself as “theother Barry [name changed]”. During these events he was somewhat verballyinteractive and responsive, but on other occasions “the other Barry” carriedon elaborate conversations with his parents and younger sibling.Initially saying that he had no memory for earlier spells, the patient saidhe remembered the more recent ones. During his spells, his parents wereextremely solicitous. Twenty-four hour continuous EEG and video monitoringcaptured a spell in association with a normal tracing.