Sometimes people will fake or induce physical or mental health problems for sympathy and attention. This is a serious mental health disorder known as factitious disorder, and people with this disorder will often go to great lengths to attain this attention from others. They might pretend to be sick, tamper with medical tests, or induce sickness in themselves, or they might cause this harm to another vulnerable person, such as a child, a disabled relative, or an older adult.

Factitious disorder was previous referred to as Munchausen syndrome (and Munchausen syndrome by proxy), but mental health care professionals no longer use that name when diagnosing people with the problem. Diagnosing and treating factitious disorder can be challenging because people with the condition often deny having it and aren’t often fully aware of why they fake symptoms or induce illness in themselves or others.

Prevalence and Causes

Because people with factitious disorder intend to deceive, they usually deny that they have a mental health problem. Therefore it is difficult for researchers to estimate how common the condition is. The Cleveland Clinic reports that roughly 1% of people admitted to hospitals have factitious disorder, but this might be a low estimate.

In a 2016 review of professional literature published in General Hospital Psychiatry, researchers found that roughly two-thirds of factitious disorder patients were female, with an average age of 34 years. Approximately 42% of these patients had depression in addition to factitious disorder, and almost 60% preferred self-inducing injury rather than faking it or lying about an illness.

Researchers do not know the exact cause of factitious disorder. They believe a variety of factors can increase the risk, including:

  • childhood abuse or neglect
  • history of family illness
  • chronic illness in childhood
  • other trauma
  • family dysfunction
  • social isolation
  • professional experience in healthcare
  • personality disorders

Symptoms of Factitious Disorder

There are two categories for symptoms of factitious disorders: those imposed on the self and those imposed on others.

Factitious Disorder Imposed on Self

People with this type of factitious disorder will fake physical or psychological problems in themselves, or they might self-induce an injury or disease. They will present as sick or injured to others, and they will continue this deception even if they do not receive any external rewards.

Factitious Disorder Imposed on Another

People with this type of factitious disorder will fake physical or psychological problems in another person, usually someone who is vulnerable and under their care (such as a child or older relative). They might cause symptoms to appear in the individual and can cause great physical and emotional harm.

Other common signs of factitious disorder can include:

  • complicated and confusing medical history
  • bizarre symptoms that change often
  • symptoms that don’t respond to typical treatments
  • eagerness to have medical tests, procedures, and operations performed
  • extensive knowledge of medical terminology and hospitals
  • evidence of numerous surgeries or procedures (i.e. scars)
  • absence of symptoms when patient is not observed
  • tampering with test results
  • preventing healing of injury
  • hopping from hospital to hospital
  • developing additional symptoms when about to be discharged
  • refusal to have psychological evaluation performed

People who impose factitious disorder on another will be hesitant or refuse to allow healthcare professionals to speak privately or directly to their victim.

Diagnosis 

When diagnosing factitious disorder, healthcare professionals must first rule out physical reasons for all of the symptoms and conditions reported by the individual. Once these factors are ruled out, in order to receive a diagnosis of factitious disorder, an individual must engage in the behaviors above, either imposing them upon themselves or on another person. If factitious disorder is imposed on another, it is the perpetrator and not the victim who has the mental disorder and is given the diagnosis.

It’s important to note that people who fake illness in themselves or another in order to receive external rewards (i.e. money, gifts, missing work) do not have factitious disorder. They must deceive despite lack of external rewards in order to receive a diagnosis.

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If the behaviors are caused by another mental disorder, such as schizophrenia or delusional disorder, then the individual will not be diagnosed with factitious disorder. However, an individual with factitious disorder can have other co-occurring mental health disorders, such as depression, an identity disorder, or a personality disorder.

Treatment

Treatment for factitious disorder can prove extremely difficult, as most individuals are not aware that they have a mental health problem or understand why they impose illness on themselves or another individual.

Treatment first prioritizes ensuring that the individual or their victim are physically safe, as factitious disorder can result in serious injury and even death. Once safety is ensured, psychotherapy or counseling is generally recommended to help the individual examine their thinking and develop positive coping skills to build self-esteem and help manage stress.

Medications are not typically prescribed to treat factitious disorder, unless the individual has another mental health condition such as depression. Family therapy may also recommend, so that family members can learn to support the individual without reinforcing harmful behaviors.

Patients with factitious disorder may also need to be monitored for substance abuse and potential suicidal behaviors, as they are at higher risk than the general population.

If you have a loved one you think may have factitious disorder, be aware that they will likely deny the condition (even when they are presented with evidence) and refuse help for their mental health. Rather than aggressively confronting them, reassure them that you love them and reinforce healthy and positive behaviors rather than focusing on the harmful ones. Seek advice from mental health professionals and legal professionals if you believe that your loved one is a danger to themselves or others.

If your loved one is harming another individual, prioritize the victim and take steps to ensure they are safe, such as notifying another caregiver of your concerns or reporting the abuse. You can call the National Child Abuse Hotline at 1-800-4-A-CHILD (800-422-4453) or the National Domestic Violence Hotline at 1-800-799-7233 to report abuse or for help with connecting to the appropriate resources.

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Last Updated: Oct 23, 2018