Factitious disorder

Overview

Factitious disorder is a serious mental disorder in which someone deceives others by appearing sick, by purposely getting sick or by self-injury. Factitious disorder also can happen when family members or caregivers falsely present others, such as children, as being ill, injured or impaired.

Factitious disorder symptoms can range from mild (slight exaggeration of symptoms) to severe (previously called Munchausen syndrome). The person may make up symptoms or even tamper with medical tests to convince others that treatment, such as high-risk surgery, is needed.

Factitious disorder is not the same as inventing medical problems for practical benefit, such as getting out of work or winning a lawsuit. Although people with factitious disorder know they are causing their symptoms or illnesses, they may not understand the reasons for their behaviors or recognize themselves as having a problem.

Factitious disorder is challenging to identify and hard to treat. However, medical and psychiatric help are critical for preventing serious injury and even death caused by the self-harm typical of this disorder.

Symptoms

Factitious disorder symptoms involve mimicking or producing illness or injury or exaggerating symptoms or impairment to deceive others. People with the disorder go to great lengths to hide their deception, so it may be difficult to realize that their symptoms are actually part of a serious mental health disorder. They continue with the deception, even without receiving any visible benefit or reward or when faced with objective evidence that doesn't support their claims.

Factitious disorder signs and symptoms may include:

Clever and convincing medical or psychological problems

• Extensive knowledge of medical terms and diseases
• Vague or inconsistent symptoms
• Conditions that get worse for no apparent reason
• Conditions that don't respond as expected to standard therapies
• Seeking treatment from many different doctors or hospitals, which may include using a fake name
• Reluctance to allow doctors to talk to family or friends or to other health care professionals
• Frequent stays in the hospital
• Eagerness to have frequent testing or risky operations
• Many surgical scars or evidence of numerous procedures
• Having few visitors when hospitalized
• Arguing with doctors and staff

Factious disorder imposed on another

Factitious disorder imposed on another (previously called Munchausen syndrome by proxy) is when someone falsely claims that another person has physical or psychological signs or symptoms of illness, or causes injury or disease in another person with the intention of deceiving others.

People with this disorder present another person as sick, injured or having problems functioning, claiming that medical attention is needed. Usually this involves a parent harming a child. This form of abuse can put a child in serious danger of injury or unnecessary medical care.

How those with factitious disorder fake illness

Because people with factitious disorder become experts at faking symptoms and diseases or inflicting real injuries upon themselves, it may be hard for health care professionals and loved ones to know if illnesses are real or not.

People with factitious disorder make up symptoms or cause illnesses in several ways, such as:

• Exaggerating existing symptoms. Even when an actual medical or psychological condition exists, they may exaggerate symptoms to appear sicker or more impaired than is true.
• Making up histories. They may give loved ones, health care professionals or support groups a false medical history, such as claiming to have had cancer or AIDS. Or they may falsify medical records to indicate an illness.
• Faking symptoms. They may fake symptoms, such as stomach pain, seizures or passing out.
• Causing self-harm. They may make themselves sick, for example, by injecting themselves with bacteria, milk, gasoline or feces. They may injure, cut or burn themselves. They may take medications, such as blood thinners or drugs for diabetes, to mimic diseases. They may also interfere with wound healing, such as reopening or infecting cuts.
• Tampering. They may manipulate medical instruments to skew results, such as heating up thermometers. Or they may tamper with lab tests, such as contaminating their urine samples with blood or other substances.

When to see a doctor

People with factitious disorder may be well aware of the risk of injury or even death as a result of self-harm or the treatment they seek, but they can't control their behaviors and they're unlikely to seek help. Even when confronted with objective proof — such as a videotape — that they're causing their illness, they often deny it and refuse psychiatric help.

If you think a loved one may be exaggerating or faking health problems, it may help to attempt a gentle conversation about your concerns. Try to avoid anger, judgment or confrontation. Also try to reinforce and encourage more healthy, productive activities rather than focusing on dysfunctional beliefs and behaviors. Offer support and caring and, if possible, help in finding treatment.

If your loved one causes self-inflicted injury or attempts suicide, call 911 or emergency medical help or, if you can safely do so, take him or her to an emergency room immediately.

Causes

The cause of factitious disorder is unknown. However, the disorder may be caused by a combination of psychological factors and stressful life experiences.

Risk factors

Several factors may increase the risk of developing factitious disorder, including:

• Childhood trauma, such as emotional, physical or sexual abuse
• A serious illness during childhood
• Loss of a loved one through death, illness or abandonment
• Past experiences during a time of sickness and the attention it brought
• A poor sense of identity or self-esteem
• Personality disorders
• Depression
• Desire to be associated with doctors or medical centers
• Work in the health care field

Factitious disorder is considered rare, but it's not known how many people have the disorder. Some people use fake names to avoid detection, some visit many different hospitals and doctors, and some are never identified — all of which make it difficult to get a reliable estimate.

Complications

People with factitious disorder are willing to risk their lives to be seen as sick. They frequently have other mental health disorders as well. As a result, they face many possible complications, including:

• Injury or death from self-inflicted medical conditions
• Severe health problems from infections or unnecessary surgery or other procedures
• Loss of organs or limbs from unnecessary surgery
• Alcohol or other substance abuse
• Significant problems in daily life, relationships and work
• Abuse when the behavior is inflicted on another

Prevention

Because the cause of factitious disorder is unknown, there's currently no known way to prevent it. Early recognition and treatment of factitious disorder may help avoid unnecessary and potentially dangerous tests and treatment.