Factitious disorders involve patients intentionally producing or faking physical or psychological symptoms to convince others they are sick. The goal of the patient is simply to assume the “sick role,” often as a means of getting attention or sympathy. In this way, factitious disorders differ from malingering, which involves feigning illness for the purpose of material gain.

Patients with factitious disorders often complain of various physical symptoms (e.g., aches and pains) and/or mental symptoms (e.g., hallucinations). They may manipulate physical signs (e.g., by adding a foreign substance to a urine specimen) and even deliberately injure themselves.

Because these fictional symptoms are by nature hard to detect objectively, factitious disorders can be difficult to diagnose. This is especially 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.

At first, it may not be obvious to a physician that a patient is faking symptoms. During an initial visit, a physician is likely to perform a physical examination, compile a thorough medical history and conduct various tests to try to identify the source of the patient’s complaints. However, over time, it may become more obvious that the patient is faking the illness. Patient history of multiple procedures and hospitalizations may offer one clue. Eventually, a factitious disorder may be diagnosed.

Factitious disorders are often chronic, lifelong conditions that can be difficult to treat. Most patients deny that their problem is psychological and discontinue treatment when such a diagnosis is made. Treatment may vary depending on the type of factitious disorder that is diagnosed. In most cases, the chief form of treatment is psychotherapy.

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.

Four major categories of factitious disorders are generally recognized. They are:

• Factitious disorder with mostly psychological symptoms. People with this type of factitious disorder engage in behavior that that appears to indicate the presence of a mental illness. For example, they may report hallucinations or make strange statements. Ganser syndrome – in which people have short-term bursts of bizarre behavior – belongs to this class.
  
  
• Factitious disorder with mostly physical symptoms. People with this type of factitious disorder may report symptoms associated with physical illness. Common examples of symptoms reported include various types of pain, fever, infection, anemia (red blood cell deficiency), bleeding, rashes, vomiting, diarrhea and hypoglycemia (low blood sugar). The most chronic and severe form of factitious disorder with mostly physical symptoms is known as Münchausen syndrome, in which patients visit multiple physicians or hospitals and seek near continual treatment for their perceived problems.
  
  
• Factitious disorder with both psychological and physical symptoms. This type of factitious disorder involves both the psychological and physical symptoms mentioned above, with neither type predominating.
  
  
• Factitious disorder not otherwise specified (NOS). This involves disorders that include symptoms of factitious disorder, but not enough symptoms associated with any one form to warrant a specific diagnosis. A disorder called Münchausen syndrome by proxy (MSBP) – in which people induce symptoms in another person under their care – falls into this class. Münchausen syndrome by proxy usually involves mothers who intentionally harm their children in order to receive attention. This form of child abuse can seriously affect children who remain in the care of the person harming them.

Because patients with factitious disorders create their own symptoms, the condition affects all patients differently. However, there are warning signs that may indicate the presence of a factitious disorder to a physician. These include a patient history of dramatic symptoms that are not part of a consistent medical history. Symptoms also tend to resist treatment or may become more severe after treatment has begun.

Patients may also suffer predictable relapses following improvement of their condition or may complain of new symptoms that occur despite negative test results.

Other possible indicators of factitious disorders include:

• Dramatic but inconsistent medical history and symptoms
  
  
• Extensive patient knowledge of medical terminology
  
  
• Presence of numerous surgical scars
  
  
• Symptoms that consistently appear only when the patient is alone or unobserved
  
  
• Unusual level of comfort or lack of anxiety when faced with the possibility of painful or invasive procedures
  
  
• History of seeking treatment in numerous hospitals, clinics and physician’s offices
  
  
• Patient reluctance to allow healthcare professionals to consult with family members, friends and other healthcare providers

Patients with factitious disorders usually suffer from other mental disorders, particularly personality disorders. They are also at greater risk for depression, substance abuse and thoughts of suicide. They are particularly likely to be diagnosed with personality disorders. In many cases, patients with factitious disorders find it difficult to maintain employment or intimate personal relationships.

Factitious disorder is diagnosed when a patient falsely reports and/or portrays physical or mental signs or symptoms for the purpose of occupying a “sick role.” Also, the patient must not have other motives, such as those associated with malingering (e.g., financial gain or work avoidance).

At first, it may not be obvious to a physician that a patient is faking symptoms. During an initial visit, a physician is likely to perform a complete physical examination and to compile a thorough medical history. Various tests may be conducted to try to identify the source of the patient’s complaints.

However, over time, it may become more obvious that the patient is faking the illness. Patient history of multiple procedures and hospitalizations may offer one clue. Continual complaints of new symptoms and constant requests for analgesics (medications that eliminate pain) may offer other clues.

Factitious disorders may be diagnosed when it is clear that the patient is intentionally faking psychological or physical symptoms with the sole motivation of assuming the sick role.

When confronted, patients usually become hostile and deny that they are making up their symptoms. If hospitalized, the patient may suddenly leave against medical advice. It is common for patients to move on to various physicians and hospitals to continue the ruse. In some cases, patients may seek medical care in another city, state or even another country.

Factitious disorders are often chronic, lifelong conditions that can be difficult to treat. Treatment may vary depending on the type of factitious disorder that is diagnosed. In most cases, the chief form of treatment is psychotherapy. Cognitive behavioral therapy may be used to help patients change their behavior and thought patterns.

In the case of Münchausen syndrome by proxy (MSBP), the first method of treatment is to remove the child or other person from potential harm at the hands of the patient. Then, psychotherapy may commence.

Though there is no medication used specifically to treat factitious disorders, patients may be prescribed medication to treat related disorders, such as depression or anxiety disorders.

Preparing questions in advance can help patients and their families to have more meaningful discussions with physicians. The following questions may help if a factitious disorder is suspected or diagnosed in a friend or family member:

1. How can you be sure my loved one is faking symptoms? What tests have you done to rule out other causes?
   
   
2. My loved one becomes hostile whenever it is suggested that his/her symptoms are not real. How should I handle this?
   
   
3. Is my loved one aware that he/she is faking symptoms?
   
   
4. What type of therapy might benefit my loved one? Can you recommend a qualified therapist?
   
   
5. How can I encourage my loved on to participate in therapy?
   
   
6. Are there medications that may help my loved one? What are the options, their potential risks and benefits?
   
   
7. Is my loved on a danger to himself/herself or others? What steps should I take to prevent problems?
   
   
8. Might other members of the family benefit from counseling or therapy? Can you recommend a therapist or support group?