Factitious disorder is pretending to have or producing physical or psychological symptoms for no apparent external reason (not for a clear benefit, such as missing work or school).
The cause is unknown, but stress and a severe personality disorder may contribute.
Symptoms may be dramatic and convincing.
People may wander from one doctor or hospital to another in search of treatment.
Doctors diagnose the disorder after excluding other disorders and after discovering evidence that symptoms have been faked.
There are no clearly effective treatments, but psychotherapy may help.
Factitious disorder imposed on self was previously called Munchausen syndrome. Factitious disorder may also be imposed on someone else (formerly called factitious disorder by proxy [see Factitious Disorder Imposed on Another and Overview of Somatic Symptom and Related Disorders]).
People with factitious disorder imposed on self repeatedly fake having a disorder. If they have a disorder, they exaggerate or lie about the symptoms, pretending that they are sicker or more impaired than they are. However, this disorder is more complex than simple dishonesty. It is a mental health problem that is associated with severe emotional difficulties.
What causes factitious disorder imposed on self is unknown, but stress and a severe personality disorder, most often borderline personality disorder, may be involved. People may have an early history of emotional and physical abuse, or they may have experienced a severe illness during childhood or had a seriously ill relative. They appear to have problems with their identity and/or self-esteem, as well as unstable relationships. Faking an illness may be a way to increase or protect self-esteem by blaming social or work problems on their illness, by being associated with prestigious doctors and medical centers, or by appearing unique, heroic, or medically knowledgeable and sophisticated.
People with this disorder resemble malingerers (people who pretend to have a physical disorder to get some type of benefit, such as collecting insurance payments or getting time off from work) because their actions are conscious and intentional. However, unlike malingerers, people with factitious disorder are not motivated by external rewards.
Symptoms of Factitious Disorder Imposed on Self
People with factitious disorder imposed on self may report physical symptoms that suggest a particular disorder, such as chest pain that resembles a heart attack. Or they may report symptoms that could result from many different disorders, such as blood in their urine, diarrhea, or fever. They often know a lot about the disorder they are pretending to have—for example, that pain from a heart attack may spread from the chest to the left arm or jaw. They may change medical records to provide evidence that they have a disorder. Sometimes they do something to themselves to produce the symptom. For example, they may prick a finger and put the blood in a urine specimen. Or they may inject bacteria under their skin to produce a fever and sores.
People with the disorder are usually quite intelligent and resourceful. They not only know how to convincingly fake a disorder, but they also have sophisticated knowledge of medical practices. They can manipulate their care so that they are hospitalized and subjected to intense testing and treatment, including major operations. Their deceits are conscious, but their motivation and quest for attention are largely unconscious. They often wander from one doctor or hospital to another for treatment.
Factitious disorder imposed on self may continue throughout life.
Diagnosis of Factitious Disorder Imposed on Self
A doctor's evaluation, based on standard psychiatric diagnostic criteria
A physical examination and sometimes medical tests to evaluate for physical disorders
Doctors first check for physical and mental health conditions by taking a thorough medical history, doing a thorough physical examination, and doing tests. Most of the time, the person's description of symptoms is convincing, sometimes misleading doctors. However, doctors may suspect factitious disorder imposed on self based on the following:
The medical history is dramatic but inconsistent.
Treatment worsens rather than relieves symptoms.
After test results come back negative or after people are treated for 1 group of symptoms, people develop different symptoms or go to another hospital for care.
People have an extensive knowledge of medical practice.
People are willing or eager to have diagnostic tests and surgical procedures.
They have a history of frequent visits to many different doctors and hospitals.
They resist letting doctors talk to family members and to doctors who have treated them in the past.
The diagnosis of factitious disorder imposed on self is made when all of the following are confirmed in a person who presents as sick, impaired, or injured:
Doctors observe or discover evidence of exaggeration, faking, falsification, self-induced symptoms, or alterations in the medical history.
The person has no obvious external incentives for faking or exaggerating symptoms.
Other disorders are ruled out.
Doctors may refer the person to a psychiatrist or other mental health professional.
If the disorder is diagnosed early, risky invasive testing, surgical procedures, and unnecessary treatments can be avoided.
Treatment of Factitious Disorder Imposed on Self
No clearly effective treatments
There are no clearly effective treatments. If people are treated for the disorder that they are faking, they may temporarily feel relief but then typically report additional symptoms and demand further treatments. An important part of treatment is for doctors to avoid doing unnecessary tests and treatments.
Psychotherapy, particularly cognitive-behavioral therapy, may help. It focuses on changing the thinking and behavior of the person. It may also help the person identify and work on underlying issues that are causing the disorder.
