A factitious disorder is a mental illness in which a person makes up an illness or injury. The Diagnostic and Statistical Manual (DSM-IV) identifies four types of factitious disorders:
Factitious disorder with mostly psychological symptoms—For example, the person may pretend to have
Factitious disorder with mostly physical symptoms—For example, the person acts as if they have chest pain or abdominal pain. The term "Munchausen syndrome" is sometimes used to refer to this type.Factitious disorder with both psychological and physical symptoms.
Factitious disorder not otherwise specified—Factitious disorder by proxy (or
Munchausen syndrome by proxy) fall into this category. This involves a parent using his or her child to get needless medical attention for the child.
A factitious disorder may be confused with another type of mental disorder called
disorder. If a person has somatoform disorder, then he or she is not pretending to be sick. The person really believes that there is something physically wrong. However, the symptoms are actually due to psychological issues.
is an example of a somatoform disorder. Someone who has hypochondria fears that a real or imagined minor physical symptom is a sign of serious illness.
A factitious disorder is also different from
malingering. Malingering occurs when a person is pretending to be sick for some kind of clear benefit, such as money, food, or housing.
Receiving Medical Treatment
People with factitious disorder seek unnecessary medical treatment.
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The exact cause of factitious disorder not known. However, it may be a mixture of biological and psychological factors. Some possible causes may include: Having frequent illnesses early in lifeBeing abused or rejected by a parentIdentifying with someone who had an illness
These risk factors increase your chance of factitious disorder:
Having a personality disorder (such as
borderline personality disorder)
Having severe problems during childhood (such as psychiatric problems)Being hospitalized or institutionalizedHaving a poor sense of identityHaving poor coping skillsWorking in the healthcare fieldAge: young or middle-aged
Symptoms may include: A lengthy, conflicting medical historyVague symptoms that cannot be managedA illness that returns after it is controlledStrong knowledge of hospitals and medical termsMultiple surgical scarsNew symptoms that appear after test results come back negativeA medical history at many hospitals, clinics, and doctors’ officesBlocking contact between previous and current doctors, and between doctors and family membersSymptoms that appear only when patient is not being observedDemanding medical tests or proceduresEagerness to have medical tests or proceduresSelf-inflicted or artificial symptoms of disease
It is difficult for a doctor to diagnosis a factitious disorder. People who have this disorder become very skillful in pretending to have illnesses. The doctor also has to rule out any real physical condition that the person may have.
If the doctor determines that there is no physical cause for the symptoms, then the person may be referred to a mental health expert. This expert can then rule out other psychological conditions, like somatoform disorder and malingering. The person may become hostile and not want to work with a psychologist. However, there are strategies that the doctor can use to act in a way that is more supportive and helpful. The patient can be encouraged to seek mental health treatment.
Factitious disorder is difficult to treat. The person may resist getting help. In some cases, though, the person may agree to work with a mental health expert. Psychotherapy or behavior therapy may be helpful. If the person has any other conditions, like
other mental health problems, these can be treated as well.
There is no known way to prevent this disorder.
Huffman JC, Stern TA. The diagnosis and treatment of Munchausen syndrome.
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Purcell TB. Factitious disorders and malingering.
Rosen’s Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, PA: Mosby; 2006.
Last reviewed March 2013 by Brian Randall, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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