Factitious disorders are conditions in which a patient consciously fakes symptoms of illness to fool others into believing that they are genuinely sick. The patient’s goal is to be viewed in the “sick role,” often as a means of getting attention or sympathy.  

Factitious disorders differ from several other mental health conditions. Malingering involves patients who fake illness for a specific goal, such as insurance payments or to obtain drugs or avoid work. Somatoform disorders include symptoms that are difficult to attribute to a physical condition, but they are not intentionally falsified.

Patients with factitious disorders may complain of symptoms, such as stomach pain or headaches. In addition, they may manipulate physical signs by warming a thermometer to falsely indicate fever or adding a foreign substance to a urine specimen. In some cases, they may even deliberately injure themselves.

In addition, patients with factitious disorders may complain of psychological symptoms such as depression, hallucinations, delusions, anxiety and suicidal thoughts.

Because these fictional symptoms are by nature hard to detect objectively, factitious disorders can be difficult to diagnose. This is particularly true in patients who have a sophisticated knowledge of diseases and medical terminology. Some patients are so deeply affected by a factitious disorder that they may be willing to undergo potentially painful and dangerous procedures.

Other patients may be hospitalized repeatedly for short stays or travel from place to place seeking care. This extreme form of factitious disorder is known as Münchausen syndrome and is named after Baron von Münchhausen, a famed teller of tall tales. It should be noted that some sources use the term Münchausen syndrome to refer to all types of factitious disorders. Another form of factitious disorder is Münchausen syndrome by proxy (MSBP), in which a patient intentionally harms another person in their care, commonly a parent inducing symptoms in a child. This form of factitious disorder is considered child abuse and may cause serious harm or death.

Factitious disorders tend to begin in childhood and are more common in females than males, although the most severe form – Münchhausen syndrome – is more common in males. Episodes of some factitious disorders may occur intermittently throughout adulthood. The exact cause of factitious disorders remains unknown. However, scientists believe that both biological and psychological factors play a role in the development of the disorder. Some experts maintain that a history of childhood abuse or neglect may be partially responsible. Some patients develop the condition in adulthood after experiencing legitimate hospitalizations as a child or young adult.

Patients with factitious disorders often undergo tests, invasive procedures, hospitalizations, and take numerous sick days from work. All of this can be extremely disruptive to a patient’s lifestyle.

The prevalence of factitious disorders is unclear for several reasons. Some cases may be underreported because the patients were treated for their fake symptoms and a factitious disorder was never diagnosed. Other cases may be over-reported when one patient visits numerous hospitals using different names. Dermatologists (skin doctors) and neurologists (physician who specializes in nervous system disorders) are especially likely to see patients with factitious disorders, according to a recent survey.