Factitious Disorder

Often called Munchausen syndrome after Baron von Munchausen (1720-1797), an 18th-century German officer who was known for embellishing the stories of his life and experiences, factitious disorder involves the falsification of physical or psychological signs or symptoms with no obvious reward for doing so. In DSM-5, the condition falls under the Somatic Symptom and Related Disorders section and is divided into 2 subtypes: that imposed on one's self and that directed at someone else, or factitious disorder/Munchausen syndrome by proxy. The condition is different from hypochondriasis in that patients with Munchausen syndrome are aware that they are exaggerating, whereas sufferers of hypochondriasis believe they actually have a disease.

People affected by factitious disorder deliberately produce or exaggerate symptoms in several ways. They might lie about or fake symptoms, hurt themselves, or change diagnostic tests. Possible warning signs include dramatic but inconsistent medical history; seeking treatment at numerous hospitals; extensive knowledge of hospitals and/or medical terminology; eagerness to have medical interventions; new symptoms following negative test results; presence of symptoms only when the patient is alone or not being observed; and problems with identity and self-esteem. Patients often have a history of abuse or neglect as a child, while personality disorders are common in individuals with factitious disorder. Clinicians suspecting factitious disorder should rule out early-stage medical conditions. The first treatment goal is to modify the person's behavior and reduce misuse or overuse of medical resources. Also, any underlying psychiatric disorder should be identified and treated. Finally, the primary treatment for factitious disorder is psychotherapy, including cognitive-behavioral therapy and family therapy.

Those exhibiting Munchausen syndrome/factitious disorder by proxy act as if an individual that he or she is caring for has a physical or mental illness when the person — most often a young child — is not really sick. People with the condition might lie about symptoms; alter diagnostic tests; falsify medical records; or induce symptoms through various means, such as poisoning, suffocating, starving, and causing infection. People with factitious disorder by proxy are often parents or the adult children of an elderly patient; healthcare professionals; very friendly and cooperative with the healthcare providers; quite concerned (sometimes overly so) about the child or designated patient; and might also suffer from factitious disorder. The fabrication is not done to achieve a benefit, such as financial gain, other than perhaps sympathy and attention from others. Etiologic and treatment considerations are similar to those in factitious disorder, with the added concern about the safety of the potential victim. Management often requires a team that includes social workers, foster care organizations, and law enforcement in addition to the healthcare providers.

Comparison of Somatic Disorders

Somatic symptom disorder Excessive anxiety & preoccupation with > 1 unexplained symptoms
Illness anxiety disorder Fear of having a serious illness despite few or no symptoms and consistently negative investigations
Conversion disorder Neurologic symptom incompatible with any known neurologic disease; often acute onset associated with stress
Factitious disorder Intentional falsification or inducement of symptoms with goal to assume sick role
Malingering Falsification or exaggeration of symptoms to obtain external incentives (secondary gain)