Definition

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 schizophrenia.
• 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 somatoform 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. Hypochondria 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.

Causes

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 life
• Being abused or rejected by a parent
• Identifying with someone who had an illness

Risk Factors

Factitious disorder is more common in people who are young or middle-aged.

Factors that may increase your risk of factitious disorder include:

• Having a personality disorder such as sociopathy or borderline personality disorder
• Having severe problems during childhood such as psychiatric problems
• Being hospitalized or institutionalized
• Having a poor sense of identity
• Having poor coping skills
• Working in the healthcare field

Symptoms

Symptoms may include:

• A lengthy, conflicting medical history
• Vague symptoms that cannot be managed
• A illness that returns after it is controlled
• Strong knowledge of hospitals and medical terms
• Multiple surgical scars
• New symptoms that appear after test results come back negative
• A medical history at many hospitals, clinics, and doctors’ offices
• Blocking contact between previous and current doctors, and between doctors and family members
• Symptoms that appear only when patient is not being observed
• Demanding medical tests or procedures
• Eagerness to have medical tests or procedures
• Self-inflicted or artificial symptoms of disease

Diagnosis

It is difficult for a doctor to diagnosis a factitious disorder. People who have this disorder become 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.

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 depression, anxiety, or other mental health problems, these can be treated as well.

Prevention

There is no known way to prevent this disorder.

American Psychological Association http://www.apa.org

Canadian Psychological Association http://www.cpa.ca

Huffman JC, Stern TA. The diagnosis and treatment of Munchausen syndrome. Gen Hosp Psychiatry. 2003;25:358-363.

Munchausen syndrome. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated April 28, 2014. Accessed September 24, 2014.

Munchausen syndrome. Patient UK website. Available at:
http://www.patient.co.uk/doctor/Munchausen’s-Syndrome.htm
Updated September 17, 2010. Accessed September 24, 2014.

Somatoform disorders. Family Doctor—American Academy of Family Physicians website. Available at:
http://familydoctor.org/familydoctor/en/diseases-conditions/somatoform-disorders.html
Updated April 2014. Accessed September 24, 2014.