Factitious Disorder (Munchausen Syndrome)
Factitious disorder, previously referred to as Munchausen syndrome, is a condition in which an individual deceives others by appearing ill, impaired, or injured. This can involve faking, purposely getting sick, or self-injury. People with factitious disorder have a desire to be seen as ill or injured without any obvious external reward, such as personal or financial gain. They are aware of the deception they are engaging in, but they may not see themselves as having a problem.
Factitious disorder imposed on another (FDIA), also known as Munchausen by proxy, is diagnosed when a person fakes (or causes) illness in an individual who is in their care, also for attention-seeking purposes.
More women than men suffer factitious disorder, and they are often unmarried. People with borderline or histrionic personality traits may also present with signs of factitious disorder.
Factitious disorder is considered a mental illness because it is associated with severe psychological distress. People with factitious disorder may:
- Lie about or fake symptoms
- Hurt themselves to cause symptoms
- Falsify medical records
- Alter tests (such as contaminating a urine sample with blood) to make it look like they are sick
- Not want health providers to speak with family and friends
- Relapse after improvement
While the person may have a medical condition, they may exaggerate or intentionally worsen symptoms to cause others to view them as more ill or impaired than they really are. People with factitious disorder may seek excessive medical treatment at various hospitals or clinics and eagerly agree to or request medical procedures.
Individuals with factitious disorder have the potential to cause great physical and mental harm to themselves and others as a result of their deception.
Munchausen by proxy is factitious disorder imposed on another person, whereby an individual falsely presents another person as ill, impaired, or injured. For example, a mother medicates her child when the child is perfectly healthy. Factitious disorder imposed on another person is not its own disorder in the DSM.
The cause of factitious disorder is not known. Risk factors for developing this include childhood trauma, depression, personality disorders, among others.
Factitious disorder usually presents as recurrent episodes of deceptive behavior. The onset of factitious disorder is typically in early adulthood, often after a person has been hospitalized for a medical or psychiatric condition. Factitious disorder imposed on another person, or also known as Munchausen by proxy, may become apparent after the hospitalization of the individual’s victim.
The prevalence of factitious disorder is unknown because the involvement of deception makes it difficult to diagnose. It is estimated that 1 percent of patients in hospital settings meet the criteria for factitious disorder. In a hospital discharge survey, according to the National Institutes of Health, the incident rate of factitious disorder is 6.8 cases per 100,000 patients.
People with histrionic personalities often overreact, are seductive, and are overly dramatic. People with factitious disorder may or may not exhibit these traits. However, both histrionic personality disorder and factitious disorder have an attention-seeking element.
A malingerer feigns illness, perhaps for personal gain in the form of disability status, absence from work, the procurement of drugs, or other incentives. Factitious disorder is not based on such personal exploitation. Malingering is not a disorder.
Hypochondriasis, now known as illness anxiety disorder, is not related to factitious disorder. The hypochondriac is always worried and anxious about being sick; he might think that a common headache is cancer, for example. People with factitious disorder always want to be sick.
Treatment for factitious disorder is difficult, and there are no standard treatment strategies for this condition. Successful treatment of factitious disorder requires the patient to agree with their diagnosis and actively engage in treatment, which may be difficult for patients who want to be seen as sick.
Treatment options for factitious disorder include psychotherapy to manage stress and develop effective coping skills. Additionally, medications can be used to treat co-morbid psychiatric conditions, such as depression and anxiety. Temporary hospitalization may be necessary in severe cases to reduce the risk of harm to the individual or others.
Many people will drop out of treatment once a diagnosis of factitious disorder has been raised as a possibility because they feel defensive or embarrassed. To prevent this from happening, any confrontation should be gentle and supportive in nature and emphasize that the individual is someone who needs help and that their care will continue.