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 by faking, purposely getting sick, or self-injury. An individual falsely presenting another person as ill, impaired, or injured is factitious disorder imposed on another. 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. 

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. 

Symptoms

People with factitious disorder may lie about or fake symptoms, hurt themselves to cause symptoms, falsify medical records, or alter tests (such as contaminating a urine sample with blood) to make it look like they or another person are sick. While the person may have a medical condition, they may exaggerate or intentionally worsen symptoms to cause others to view them (or another) 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.

Factitious disorder is considered a mental illness because it is associated with severe psychological distress. Individuals with factitious disorder have the potential to cause great harm to themselves and others as a result of their deception. 

Causes

The cause of factitious disorder is not known. Risk factors for developing this include childhood trauma, depression, personality disorders, and working in the healthcare field, among others.

Factitious disorder usually presents as recurrent episodes of deceptive behavior. Onset of factitious disorder is typically in early adulthood, often after a person has been hospitalized for a medical or psychiatric condition. When imposed on another person, factitious disorder may present after hospitalization of the individual’s victim. 

Treatment

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. 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.

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. 

References

  • Ali, S., Jabeen, S., Pate, R. J., Shahid, M., Chinala, S., Nathani, M., & Shah, R. (2015). Conversion Disorder—Mind versus Body: A Review. Innovations in clinical neuroscience, 12(5-6), 27.
  • Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
  • Bass, C., & Halligan, P. (2014). Factitious disorders and malingering: challenges for clinical assessment and management. The Lancet, 383(9926), 1422-1432.

Last reviewed 11/09/2017