What Is Factitious Disorder, Formerly Known as Munchausen Syndrome?

Factitious disorder, formerly known as Munchausen syndrome, is a mental illness in which a person or a caregiver acts as if they or their loved one has a critical illness when they’re not actually sick. It is different from malingering, which is motivated by personal gain. It is also unique from somatoform disorder, in which a person can have physical symptoms but they are due to psychological factors.

What Is Factitious Disorder?

There are two types of factitious disorder: factitious disorder imposed on self and factitious disorder imposed on another. With the latter, the individual creates or makes up symptoms of illness in people or animals they are caring for, such as children, the elderly or people with disabilities. When it happens to a child it is known as medical child abuse. One famous case is Gypsy Rose Blanchard, whose mother convinced others was sick when Blanchard wasn’t.

Factitious disorder is considered a difficult condition to treat because a person with it may be resistant to the idea they are fabricating or causing symptoms. It can be hard for people with factitious disorder to realize they have a mental health condition — they believe in their behaviors and it serves an emotional purpose. Those with the condition often seek care from another doctor or hospital rather than understanding they have a disorder.

It is not known how many people have factitious disorder but about 1% of people admitted to hospitals are estimated to have it, according to the Cleveland Clinic. The cause of factitious disorder has not been identified but there are several risk factors. These may include being frequently ill throughout childhood, abuse or neglect from a parent, and working in health care, among others.

Symptoms of Factitious Disorder

Symptoms of factitious disorder can be difficult for clinicians to differentiate from symptoms of actual illness. Some symptoms of factitious disorder include:

• Having a long, oftentimes confusing medical history
• Relapse after an illness is controlled
• Detailed knowledge of the medical field, hospitals and health care terminology
• An increase in symptoms when not under observation
• Requesting or demanding that tests or procedures be done
• A medical history with many different doctors or hospitals
• New symptoms that develop following negative test results

“Patients with factitious diseases are extremely difficult to recognize because they do not appear different from patients with authentic causes of similar symptoms,” Dr. Estaban Kosek noted, adding:

Since patients with factitious disease present a false medical history, their physicians prescribe unnecessary procedures and therapies that may result in iatrogenic disease. In many cases, damage to these patients from doctors’ actions exceeds the harm resulting from the patients’ self-induced illness.

It’s important to note that people with a real chronic illness can be dismissed as having factitious disorder or “making up” their symptoms. Those with an undiagnosed chronic illness may find themselves going to doctor after doctor who don’t believe their symptoms. If you’re living with an undiagnosed or difficult chronic illness, know your symptoms are valid and real. It may take some work but try to find a doctor who is willing to work with you to get to the root cause of your illness.

How Factitious Disorder Is Diagnosed

To diagnose factitious disorder, a medical professional will run tests to exclude any underlying physical cause of symptoms. Combined with a patient’s history and a physical examination, a diagnosis may be made when there is no obvious gain for being sick or injured.

“It is often tricky to diagnose because it can involve exaggeration of actual symptoms to appear sicker than someone actually is,” J. Lucy Boyd, RN, noted. “A person with diabetes may deliberately eat candy before their blood sugar is checked, while swearing they haven’t eaten in 8 hours. A stereotypical exaggerated ‘limp’ may be present when walking for the doctor’s benefit.”

How Factitious Disorder Is Treated

Factitious disorder can be difficult to treat and is best handled by a trained psychotherapist, according to Kosak. “Treatment likely will focus on changing the thinking and behavior of the individual with the disorder (cognitive-behavioral therapy). Family therapy also may help in teaching family members not to reward or reinforce the behavior of the person with the disorder.”

To date, no medications have been found that help with factitious disorder but they may be used to treat related conditions like depression.

What to Do If You’re a Survivor of Factitious Disorder

It’s important to note that factitious disorder imposed on another (sometimes still referred to as Munchausen syndrome by proxy), can be very traumatizing to the survivor. When a caregiver imposes illness and unnecessary treatment on a child or other vulnerable individual, it can cause physical illness as well as trauma-related symptoms like depression, anxiety, hypervigilance, intrusive memories or dreams, and dissociation. If you’re struggling as a survivor of factitious disorder, you’re not alone and help is available.

For more information on factitious disorder visit Munchausen.com, a site created by expert Dr. Mark Feldman. If you know someone you suspect may have factitious disorder you can speak with their primary physician or a therapist.