Factitious disorder

Overview

Factitious disorder, previously called Munchausen syndrome, is a serious mental health condition in which people deceive others by pretending to be sick. They do this by faking symptoms, getting sick on purpose or hurting themselves. Factitious disorder also can happen when family members or caregivers falsely present others, such as children, as being ill, hurt or having a hard time functioning.

Factitious disorder symptoms can range from mild to severe. People may make up symptoms or even tamper with medical tests to convince others that they need treatment, such as high-risk surgery.

Factitious disorder isn't the same as making up medical issues for a benefit or reward, 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 know why they do what they do or see themselves as having mental health issues.

Factitious disorder is a rare condition that can be hard to diagnose and treat. Help from medical and mental health professionals is critical to prevent serious injury and even death when people with factitious disorder hurt themselves.

Symptoms

Factitious disorder symptoms involve people trying to look ill, making themselves ill or hurting themselves. They also may fake symptoms, make symptoms seem worse than they are or pretend they can't do certain things because of their symptoms so they can deceive others. People with the condition work hard to hide their lies. It may be hard to know that their symptoms are part of a serious mental health condition. People with this condition continue with the lies, even without any benefit or reward, or when faced with evidence that doesn't support their claims.

Factitious disorder symptoms may include:

• Clever and convincing medical or mental health problems.
• Deep knowledge of medical terms and diseases.
• Vague symptoms or symptoms that aren't consistent.
• Conditions that get worse for no clear reason.
• Conditions that don't respond as expected to standard treatments.
• Seeking treatment from many healthcare professionals or hospitals, which may include using a fake name.
• Not wanting healthcare professionals to talk to family or friends or other healthcare professionals.
• Staying in the hospital a lot.
• Desire for frequent testing or risky surgeries and procedures.
• Many surgical scars or evidence of many procedures.
• Having few visitors when in the hospital.
• Arguing with healthcare professionals 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 mental symptoms of illness or causes injury or disease in another person to deceive others.

People with this condition present another person as sick, hurt or having a hard time functioning, claiming they need medical help. Usually this involves a parent harming a child. This form of abuse can put a child in danger of being hurt or getting medical care that isn't needed.

How those with factitious disorder fake illness

Because people with factitious disorder become experts at faking symptoms and diseases or hurting themselves, it may be hard for healthcare professionals and loved ones to know whether symptoms and illnesses are real.

People with factitious disorder make up symptoms or cause illnesses in several ways. For example, they may:

• Make symptoms seem worse than they are. Even when there is an actual medical or mental health condition, they may exaggerate symptoms. They may try to look sicker or make themselves look like they're having a harder time functioning than they actually are.
• Make up histories. They may give loved ones, healthcare professionals or support groups false medical histories, such as claiming to have had cancer or AIDS. Or they may create false health records to make it look like they're ill.
• Fake symptoms. They may fake symptoms, such as stomach pain, seizures or passing out.
• Hurt themselves. They may make themselves sick. For example, they may inject themselves with bacteria, milk, gasoline or feces. They may hurt, cut or burn themselves. They may take medicines, such as blood thinners or medicines for diabetes, to mimic diseases. They also may hinder wound healing, such as by reopening or infecting cuts.
• Tamper. They may tamper with medical instruments so results aren't correct. For example, they may heat up thermometers. Or they may tamper with lab tests, such as spoiling their urine samples with blood or other substances.

When to see a doctor

People with factitious disorder may know the risk of injury or even death when they hurt themselves or seek treatment that's not needed. But they have a hard time managing their behaviors. They also aren't likely to seek help. Even when they see proof that they're causing their illness, such as a video, they often deny it and refuse mental health help.

If you think that a loved one may be exaggerating or faking health problems, it may help to try to talk to that person about your concerns. Try not to be angry or to judge or confront the person. Also try to reinforce and urge healthier, more productive activities rather than focus on beliefs and behaviors that aren't healthy. Offer support and care. If possible, help find treatment for the person.

If your loved one causes self-harm or attempts suicide, contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential. The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).

If you suspect that a child is being harmed or abused by a caregiver as part of factitious disorder, you can contact the Childhelp National Child Abuse Hotline at 1-800-422-4453 (toll-free). This hotline is available 24 hours a day, seven days a week. There also may be local and state child protective services agencies in your area.

Causes

The cause of factitious disorder isn't known. But a mix of mental health issues and stressful life experiences may cause the condition.

Risk factors

Several factors may raise 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 or illness, or feeling abandoned.
• Past experiences while sick and the attention it brought.
• A poor sense of identity or low self-esteem.
• Personality disorders.
• Depression.
• Desire to be linked with healthcare professionals or medical centers.
• Working in the healthcare field.

Factitious disorder is thought to be rare, but it isn't known how many people have the condition. Some people use fake names. Some visit many hospitals and healthcare professionals. And some are never identified. This makes it hard to get a reliable estimate.

Complications

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

• Injury or death from medical conditions that they cause themselves.
• Severe health issues from infections or from surgeries or other procedures that aren't needed.
• Loss of organs or limbs from surgeries that aren't needed.
• Misuse of alcohol or other substances.
• Major problems in daily life, including having trouble getting along with others and working.
• Abuse, when the behavior is imposed on another.

Prevention

Because the cause of factitious disorder isn't known, there's no way to prevent it. Recognizing and treating factitious disorder may help avoid potentially dangerous tests and treatments that aren't needed.