What is Factitious Disorder?

Have you heard of factitious disorder before? Most people are probably more familiar with Munchausen syndrome which is another name for this mental health disorder.

Factitious disorder is a mental disorder where a patient presents themselves to medical professionals with either falsified physical or mental symptoms, exaggerated symptoms, or even symptoms they have caused. This disorder can also be imposed on another person, often a parent presenting a child to medical professionals with false symptoms or induced symptoms. This form of the condition was known as Munchausen syndrome by proxy

Read on to learn more about this mental disorder and the reason why some people develop it and crave medical attention. Learn about the signs that could mean someone has this disorder and how it can be diagnosed and treated.

Overview

Factitious disorder is a complicated and rare condition involving a person presenting themselves as unwell by falsifying symptoms and seeking medical attention and investigations. The reasons behind the development of this disorder often relate to traumatic childhood experiences and the person may adopt the ‘sick role’ in order to gain attention. The diagnosis and treatment of the disorder can be difficult as the sufferer may act in a deceptive way that is difficult to identify and visit many different doctors or hospitals. Even more distressing is when the person experiencing factitious disorder uses another person (usually a child in their care) to present as unwell, this is seen as a form of child abuse.Whether the person is faking illness in themselves or another, the condition does carry some risk in that they, or the child, may undergo unnecessary investigations and procedures with the risk of damaging their health.

Types of factitious disorder

This rare mental disorder shares some features with other psychological disorders such as personality disorders including antisocial personality disorder, borderline personality disorder, and narcissistic personality disorder. Another disorder that involves focus on physical symptoms is somatic disorder. 

Two types of factitious disorder have been identified, the first is imposed on oneself and was known as ‘Munchhausens disorder¹, and the second form is known as ‘factitious disorder imposed on another.²

Factitious disorder imposed on self or Munchausen syndrome is a syndrome where the patient intentionally presents with symptoms that can either be caused deliberately or entirely made up. The motivation for this behaviour is to gain attention, cope with stress, or because they enjoy the interaction with the healthcare system and professionals.¹

The second form of factitious disorder is very rare and considered to be a form of abuse, usually of a child by their carer but can be an older person being cared for. The person caring for the child or adult seeks to convince doctors that the child or adult is ill. The symptoms that they present can be false, exaggerated, or even deliberately caused.

Causes of factitious disorder

Often, as discussed previously, factitious disorder is the result of childhood experiences but any of the following may be relevant to its development.¹

• Childhood trauma or abuse 
• Significant childhood illness
• Witnessing illness in another person during childhood
• Healthcare work and knowledge
• Psychological distress
• Mental health disorders including personality disorders
• Grudges held against the medical establishment

Signs and symptoms of factitious disorder

The following are some of the signs that may alert a medical professional to the possibility of factitious disorder.¹

• Self-induced, feigned, or exaggerated symptoms
• Simple but serious symptoms that are likely to require hospital admission
• Inconsistent information 
• Dramatic and out-of-proportion symptoms
• Inconsistencies between symptoms and examination findings
• Symptoms inconsistent with anatomy or physiology
• Inconsistencies with patient-provided information and medical records
• Patient resists the release of medical records
• Extensive past medical history and numerous ailments 
• Extensive workup with no definite diagnosis. Even invasive procedures and surgeries 
• Exam findings that contradict patient-provided information

In the case of factitious disorder imposed on another, the following signs and symptoms may cause concern.

• Symptoms that are only present when the parent or carer is there
• The parent or carer is the only one who notices the symptoms
• The parent or carer speaks on behalf of the child
• Treatments or medicines do not work
• In the case of one health problem improving, another may appear
• The symptoms are very implausible
• The medical history shows a habit of frequently changing GPs and using different hospitals
• The child is limited in their abilities and activities unnecessarily
• The parent or carer is not reassured and pushes for further investigations and treatments

In extreme cases, the parent or carer may have resorted to the following:

• Falsifying documents
• Contaminating or manipulating clinical tests
• Poisoning the child
• Infecting the child
• Inducing unconsciousness in the child
• Allowing genuine illnesses to worsen
• Withholding food 

Management and treatment for factitious disorder

A general approach taken to manage factitious disorder will involve the following:³

• Regular appointments to monitor the condition and avoid false complaints and symptoms
• Psychiatric consultation 
• Assess the risk of suicide
• Treatment of other related psychiatric disorders 
• Psychotherapy 
• Cognitive Behavioural Therapy

If factitious disorder is suspected it would be important not to overlook or ignore any symptoms presented and dismiss the patient as faking symptoms or malingering in case of genuine health problems. Discussing the diagnosis of factitious disorder would be done in a supportive manner as with any other mental health disorder.

Diagnosis

To arrive at a diagnosis of factitious disorder, the following may be considered:³

• The falsification of physical or psychological symptoms
• The individual presents themselves as ill
• The individual is displaying deceptive behaviour not explained by any other mental illness

Asides from these observations of a person's behaviour the following will aid a diagnosis of factitious disorder:

• Analysis of medical records
• Laboratory tests

Risk factors

The origins of developing this disorder seem to come from childhood associations around illness ,attention and care. The behaviour is learnt as a way to get attention and perhaps at times of stress so the following may make this disorder more likely:⁴

• Emotional deprivation or abuse as a child
• Training or vocation as a health worker
• Experience of significant illness as a child
• Family history of factitious disorder

Complications

Complications of factitious disorder could be psychological, physical, or social. Physically an individual could suffer injury or even death from trying to cause symptoms or having risky medical procedures. Substance and alcohol abuse could also be present and lead to physical harm. Psychological impacts from the condition such as worsening mental health problems and wider social problems of work, social life, and relationship impact as well as strain and cost to the health system. 

FAQs

How can I prevent factitious disorder

It may not be possible to prevent factitious disorder as often the cause is unknown. Recognising the signs and symptoms early will aid recovery and prevent further complications. As well as seeking treatment for mood disorders, personality disorders, or any other mental health condition.

How common is factitious disorder

It is hard to know how many people actually have factitious disorders. The sufferers can go to great lengths to avoid being identified, but It is thought to be a relatively rare condition.

When should I see a doctor

It is important to see your doctor if you are suffering from mental health problems and are struggling with these. If you have a history of trauma and abuse that is having an impact on your life then a medical professional would recommend where you can find further help.

Summary

Factitious disorder is a rare mental health disorder that could significantly impact a sufferer's life and interfere with daily activities. It is important to understand how and why this condition may develop and the lengths a sufferer may go to gain the attention they crave. 

References

1. Carnahan, Kevin T., and Anupam Jha. ‘Factitious Disorder’. StatPearls, StatPearls Publishing, 2023. PubMed, http://www.ncbi.nlm.nih.gov/books/NBK557547/.
2. Factitious Disorders - Symptoms, Diagnosis and Treatment | BMJ Best Practice. https://bestpractice.bmj.com/topics/en-gb/695#:~:text=Factitious%20disorder%20is%20a%20syndrome,external%20incentive%20for%20the%20behaviour. Accessed 19 June 2023.
3. UpToDate. https://www.uptodate.com/contents/factitious-disorder-imposed-on-self-munchausen-syndrome#:~:text=Factitious%20disorder%20imposed%20on%20self%20is%20characterized%20by%20falsified%20general,gain%2C%20housing%2C%20or%20medications. Accessed 19 June 2023.
4. Caselli, Ivano, et al. ‘A Systematic Review on Factitious Disorders: Psychopathology and Diagnostic Classification’. Neuropsychiatry, vol. 8, no. 1, Feb. 2018, pp. 281–92. www.jneuropsychiatry.org, https://doi.org/10.4172/Neuropsychiatry.1000349.

This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Victoria Ward

BSc, Herbal Medicine,University of Lincoln

Experienced Medical Herbalist BSc (Hons) and former nurse, highly knowledgeable about healthcare and medicinal plants. I’m especially interested in skin care and gut health. Regular blogger for my own website and freelance article writer. I enjoy writing both creative, ghostwriting and medical writing. Passionate about country life, have two horses and a collie dog.

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