Factitious Disorder

Factitious disorder is a rare disorder characterized by fake or simulated illnesses. Learn why a person may self-inflict an illness or injury for medical attention.

Factitious disorder is a mental health condition where person purposely fabricates an illness, impairment or injury to receive attention and medical care. Factitious disorder, also known as Munchausen syndrome, may also involve fabricating medical problems for another person in their care, such as a child.

Often seen as a difficult condition to identify and treat, it is beneficial to learn the key points about this disorder, how to differentiate it from other similar disorders and the treatment options available.

What Is Factitious Disorder?

Factitious disorder is defined as a very real mental disorder characterized by fictitious or false physical illnesses or injuries claims that are self-imposed or imposed on others.

Factitious disorder is seen more commonly among women, and especially those who have a background in the healthcare field. This medical background appears to contribute to the knowledge that many people with factitious disorder display and use to their advantage.

Factitious Disorder vs. Malingering

There may be some confusion when considering the differences between factitious disorder vs. malingering. Both disorders consist of a person faking a physical illness or injury, but they differ in their motives. While the incentives for factitious disorder are not clear, they seem to focus on merely playing a sick role to receive medical attention. Affected individuals do not appear to receive any outward benefits outside of medical care. The difference between factitious disorder and malingering is that the incentive for malingering is always attached to an external benefit. For example, a person will exaggerate or feign physical illness to avoid work, leave school or receive drugs.

Types of Factitious Disorders

The modern study of factitious disorder began in the 1960s, but it wasn’t until 1980 that it was first classified in the Diagnostic and Statistical Manual of Mental Health Disorders as Munchausen’s syndrome. Now researchers have identified at least four types of factitious disorders. While the individual makes a conscious decision to mislead healthcare professionals, in all four of these factitious disorder subtypes, the motivation is still unclear both to the healthcare professionals and the individual.

1. Factitious disorder with mostly psychological symptoms: This factitious disorder subtype involves a decision by the patient to feign psychological symptoms, such as claiming to hear voices be depressed
2. Factitious disorder with mostly physical symptoms: This subtype is commonly referred to as Munchausen syndrome and is characterized by the patient consciously choosing to feign or cause physical symptoms such as fever, diarrhea, pain or heart arrhythmia
3. Factitious disorder with both psychological and physical symptoms: This subset combines the first two subsets described above
4. Factitious disorder not otherwise specified: Includes disorders with factitious symptoms but that don’t meet the criteria for factitious disorder and Munchausen by proxy when an individual fabricates the symptoms of another person

Factitious Disorder Imposed on Self

Often, for those who have factitious disorder imposed on self, the motivation of their actions is unconscious or unclear. Typically, those dealing with a factitious disorder will have textbook knowledge of the symptoms related to a certain disease and will go to great lengths to produce those symptoms in themselves. Confusion caused by their misleading answers to questions, tampered lab results, falsified medical records and faked complications to known treatments has encouraged some health care professionals to press for riskier diagnostic or surgical procedures. Often, the patient with factitious disorder undergoes uncomfortable, painful and risky procedures.

Factitious Disorder Imposed on Another

Factitious disorder imposed on another, also known as factitious disorder by proxy, usually involves a caretaker, such as a parent, inducing illness in those under their care, such as their own children. In some cases, to get the dependant to have symptoms of illness, the caretaker may take steps unknown to those in their care to produce those symptoms or make false claims to receive medical attention. Because of the damage that factitious disorder imposed on another can have, especially on small children, many consider these actions as a form of abuse.

Signs of Factitious Disorder

Because those that are affected by factitious disorder often have the symptoms they are seeking medical assistance for, it can be difficult to tell if their symptoms are caused by a real illness or if they’re fabricated. There are some warning signs of factitious disorder that health care professionals regularly look out for in their patients.

Signs of factitious disorder may include:

• Inconsistent symptoms
• Symptoms that don’t respond to standard treatments
• Failure to find evidence backing up a patient’s complaint
• Symptoms that worsen for no apparent reason
• Standard treatments do not improve symptoms
• New symptoms emerge as lab or diagnostic results come back negative
• History of multiple doctors and doctors visits
• Use of a fake name
• Thorough knowledge of diseases, symptoms and medical terms

How Affected Individuals Fake Illness

Human bodies are organic machines. By knowing which buttons to push, individuals with factitious disorder are able to induce symptoms that would require medical attention if they had occurred on their own. For this reason, a person with factitious disorder often has a history of unexplained illnesses, including abnormal test results. The individual with factitious disorder may induce diarrhea by taking laxatives, misuse drugs to produce desired symptoms, hyperventilate, add blood to urine samples, or purposefully damage the skin or other parts of the body to mimic skin conditions. In addition to purposefully causing symptoms, they may go as far as tampering with medical equipment to give desired results, interfere with test samples, remove IV lines or switch patient charts.

Causes of Factitious Disorder

It has been difficult for researchers to pin down what causes factitious disorder due to the difficulty of diagnosis and the lack of follow-up after the patient has left health care facilities. While many health care professionals have ideas as to factitious disorder etiology, there is much disagreement as to what the causes or motives may be.

Some ideas that have been put forward as possible causes for factitious disorder include:

• Abuse in childhood
• Significant childhood illness or illness in a caregiver
• Depression
• Previous work in the medical field
• Low self-esteem or self-image
• A strong sense of guilt
• Comorbid mental health conditions

Complications of Factitious Disorder

The great lengths a person will go to convince others of their sickness puts individuals with factitious disorder in risky and dangerous situations. The decision-making skills in those with factitious disorder may also be hindered by other co-occurring mental health conditions and could further complicate their overall health.

Possible complications of factitious disorder can include:

• Severe injury or possible death from self-inflicted illnesses
• Health problems secondary to unnecessary procedures or operations
• Significant impact on social, family and work-life
• Physical abuse when factitious disorder behavior is inflicted on another person

How Common Is Factitious Disorder?

Different studies have published with varying factitious disorder statistics. Regarding the exact prevalence of factitious disorder, further investigation is required. One study put the prevalence at .985 people in a population of 10,000, which is .00985%, while other studies estimate that the number is as high as 2% of the population. It has been noted that there is a higher rate of women, especially women who are in or associated with health care, than men that are diagnosed with factitious disorder. The difficulty in finding a truer statistic is closely related to the difficulty of diagnosing factitious disorder.

Diagnosing Factitious Disorder

There are no diagnostic tests available to diagnose factitious disorder. It is up to the physician to carefully make the diagnosis after considerable deliberation. According to the DSM-5, an individual must meet all of the following criteria before being diagnosed with factitious disorder:

1. Intentionally causing or lying about symptoms, either physical or psychological
2. The motivation behind these misleading actions is to assume the sick role
3. There are no external motivating factors, such as a desire to improve their health, avoid work or obtain financial compensation

In a similar fashion, according to the ICD 10, factitious disorder is identified as the intentional production or feigning of symptoms or disabilities, either physical or psychological.

Factitious Disorder and Co-Occurring Conditions

As seen with other significant mental health conditions, factitious disorder is not typically a stand-alone condition. There is usually another disorder present, especially a personality disorder. One study found that 40% of patients with factitious disorder presented with one or more psychiatric disorders. The most frequent psychiatric problems found with factitious disorder were personality disorders, occurring in over 43.1% of patients. Depression occurred in 37.7% of patients.

Several case studies have revealed that borderline personality disorder and factitious disorder often occur together in a clinical setting, though more research is needed to understand the relationship between the two disorders. Histrionic personality disorder and factitious disorder can also occur together and would require the help of a mental health expert to treat the personality disorder in conjunction with factitious disorder.

Treatment for Factitious Disorder

Factitious disorder treatment is challenging for many physicians who must carefully rule out other possibilities of a rare sickness or other disorders such as malingering or conversion disorder. The patient’s own thought patterns and actions are not personally viewed as wrong, adding to the difficulty of an accurate diagnosis. This fact should guide any physician to be as supportive as possible, instead of confrontational. A multidisciplinary approach is necessary, including adding a mental health expert to the team to aid in treatment.

For treatment to be most successful, the person with factitious disorder must agree to work with a health care team and the outlined factitious disorder treatment plan. Some common forms of treatment or therapy for factitious disorder can include:

• Psychotherapy
• Cognitive-behavioral therapy
• Pharmacotherapy
• Treatment of co-occurring conditions
• Individual therapy
• Patient education

Prognosis and Outlook

The earlier that factitious disorder is identified and treated, the better the prognosis and outlook for the individual. As with other mental health conditions, the person who suffers from factitious disorder must adhere to a treatment plan for it to truly have a beneficial effect. In this instance, it is important for those involved with medical care to be as non-judgmental and supportive as possible. This may mean providing care for supposed physical ailments while encouraging mental health care as well.

If you or someone you know is struggling with symptoms similar to factitious disorder along with a substance use disorder, reach out to The Recovery Village. One of our representatives can discuss a treatment plan appropriate for you.

Editor – Megan Hull

Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more

Medically Reviewed By – Dr. Karen Vieira, PhD

Dr. Karen Vieira has a PhD in Biomedical Sciences from the University of Florida College of Medicine Department of Biochemistry and Molecular Biology. Read more