Factitious disorder

Overview

Factitious disorder is a serious mental disorder in which someone deceives others by appearing sick, by purposely getting sick or by self-injury. Factitious disorder also can happen when family members or caregivers falsely present others, such as children, as being ill, injured or impaired.

Factitious disorder symptoms can range from mild (slight exaggeration of symptoms) to severe (previously called Munchausen syndrome). The person may make up symptoms or even tamper with medical tests to convince others that treatment, such as high-risk surgery, is needed.

Factitious disorder is not the same as inventing medical problems for practical benefit, such as getting out of work or winning a lawsuit. Although people with factitious disorder know they are causing their symptoms or illnesses, they may not understand the reasons for their behaviors or recognize themselves as having a problem.

Factitious disorder is challenging to identify and hard to treat. However, medical and psychiatric help are critical for preventing serious injury and even death caused by the self-harm typical of this disorder.

Symptoms

Factitious disorder symptoms involve mimicking or producing illness or injury or exaggerating symptoms or impairment to deceive others. People with the disorder go to great lengths to hide their deception, so it may be difficult to realize that their symptoms are actually part of a serious mental health disorder. They continue with the deception, even without receiving any visible benefit or reward or when faced with objective evidence that doesn't support their claims.

Factitious disorder signs and symptoms may include:

Clever and convincing medical or psychological problems

• Extensive knowledge of medical terms and diseases
• Vague or inconsistent symptoms
• Conditions that get worse for no apparent reason
• Conditions that don't respond as expected to standard therapies
• Seeking treatment from many different doctors or hospitals, which may include using a fake name
• Reluctance to allow doctors to talk to family or friends or to other health care professionals
• Frequent stays in the hospital
• Eagerness to have frequent testing or risky operations
• Many surgical scars or evidence of numerous procedures
• Having few visitors when hospitalized
• Arguing with doctors and staff

Factious disorder imposed on another

Factitious disorder imposed on another (previously called Munchausen syndrome by proxy) is when someone falsely claims that another person has physical or psychological signs or symptoms of illness, or causes injury or disease in another person with the intention of deceiving others.

People with this disorder present another person as sick, injured or having problems functioning, claiming that medical attention is needed. Usually this involves a parent harming a child. This form of abuse can put a child in serious danger of injury or unnecessary medical care.

How those with factitious disorder fake illness

Because people with factitious disorder become experts at faking symptoms and diseases or inflicting real injuries upon themselves, it may be hard for health care professionals and loved ones to know if illnesses are real or not.

People with factitious disorder make up symptoms or cause illnesses in several ways, such as:

• Exaggerating existing symptoms. Even when an actual medical or psychological condition exists, they may exaggerate symptoms to appear sicker or more impaired than is true.
• Making up histories. They may give loved ones, health care professionals or support groups a false medical history, such as claiming to have had cancer or AIDS. Or they may falsify medical records to indicate an illness.
• Faking symptoms. They may fake symptoms, such as stomach pain, seizures or passing out.
• Causing self-harm. They may make themselves sick, for example, by injecting themselves with bacteria, milk, gasoline or feces. They may injure, cut or burn themselves. They may take medications, such as blood thinners or drugs for diabetes, to mimic diseases. They may also interfere with wound healing, such as reopening or infecting cuts.
• Tampering. They may manipulate medical instruments to skew results, such as heating up thermometers. Or they may tamper with lab tests, such as contaminating their urine samples with blood or other substances.

When to see a doctor

People with factitious disorder may be well aware of the risk of injury or even death as a result of self-harm or the treatment they seek, but they can't control their behaviors and they're unlikely to seek help. Even when confronted with objective proof — such as a videotape — that they're causing their illness, they often deny it and refuse psychiatric help.

If you think a loved one may be exaggerating or faking health problems, it may help to attempt a gentle conversation about your concerns. Try to avoid anger, judgment or confrontation. Also try to reinforce and encourage more healthy, productive activities rather than focusing on dysfunctional beliefs and behaviors. Offer support and caring and, if possible, help in finding treatment.

If your loved one causes self-inflicted injury or attempts suicide, call 911 or emergency medical help or, if you can safely do so, take him or her to an emergency room immediately.

Causes

The cause of factitious disorder is unknown. However, the disorder may be caused by a combination of psychological factors and stressful life experiences.

Risk factors

Several factors may increase the risk of developing factitious disorder, including:

• Childhood trauma, such as emotional, physical or sexual abuse
• A serious illness during childhood
• Loss of a loved one through death, illness or abandonment
• Past experiences during a time of sickness and the attention it brought
• A poor sense of identity or self-esteem
• Personality disorders
• Depression
• Desire to be associated with doctors or medical centers
• Work in the health care field

Factitious disorder is considered rare, but it's not known how many people have the disorder. Some people use fake names to avoid detection, some visit many different hospitals and doctors, and some are never identified — all of which make it difficult to get a reliable estimate.

Complications

People with factitious disorder are willing to risk their lives to be seen as sick. They frequently have other mental health disorders as well. As a result, they face many possible complications, including:

• Injury or death from self-inflicted medical conditions
• Severe health problems from infections or unnecessary surgery or other procedures
• Loss of organs or limbs from unnecessary surgery
• Alcohol or other substance abuse
• Significant problems in daily life, relationships and work
• Abuse when the behavior is inflicted on another

Prevention

Because the cause of factitious disorder is unknown, there's currently no known way to prevent it. Early recognition and treatment of factitious disorder may help avoid unnecessary and potentially dangerous tests and treatment.

Diagnosis

Diagnosing factitious disorder is often extremely difficult. People with factitious disorder are experts at faking many different diseases and conditions. And often they do have real and even life-threatening medical conditions, even though these conditions may be self-inflicted.

The person's use of multiple doctors and hospitals, the use of a fake name, and privacy and confidentiality regulations may make gathering information about previous medical experiences difficult or even impossible.

Diagnosis is based on objectively identifying symptoms that are made up, rather than the person's intent or motivation for doing so. A doctor may suspect factitious disorder when:

• The person's medical history doesn't make sense
• No believable reason exists for an illness or injury
• The illness does not follow the usual course
• There is a lack of healing for no apparent reason, despite appropriate treatment
• There are contradictory or inconsistent symptoms or lab test results
• The person resists getting information from previous medical records, other health care professionals or family members
• The person is caught in the act of lying or causing an injury

To help determine if someone has factitious disorder, doctors:

• Conduct a detailed interview
• Require past medical records
• Work with family members for more information — if the patient gives permission
• Run only tests required to address possible physical problems
• May use the criteria for factitious disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Treatment

Treatment of factitious disorder is often difficult, and there are no standard therapies. Because people with factitious disorder want to be in the sick role, they're often unwilling to seek or accept treatment for the disorder. However, if approached in a gentle, nonjudgmental way, a person with factitious disorder may agree to be treated by a mental health professional.

Nonjudgmental approach

Direct accusations of factitious disorder typically make the affected person angry and defensive, causing him or her to abruptly end a relationship with a doctor or hospital and seek treatment elsewhere. So the doctor may try to create an "out" that spares your loved one the humiliation of admitting to faking symptoms and offer information and help.

For example, the doctor may reassure your loved one that not having an explanation for medical symptoms is stressful and suggest that the stress may be responsible for some physical complaints. Or the doctor may ask your loved one to agree that, if the next medical treatment doesn't work, they'll explore together the idea of a possible psychological cause for the illness.

Either way, the doctor will try to steer your loved one toward care with a mental health professional. And both doctors and loved ones can reinforce healthy productive behaviors without giving undo attention to symptoms and impairments.

Treatment options

Treatment often focuses on managing the condition, rather than trying to cure it. Treatment generally includes:

• Having a primary care doctor. Using one doctor or other gatekeeper to oversee medical care can help manage needed care and the treatment plan and reduce or eliminate visits to numerous doctors, specialists and surgeons.
• Psychotherapy. Talk therapy (psychotherapy) and behavior therapy may help control stress and develop coping skills. If possible, family therapy also may be suggested. Other mental health disorders, such as depression, also may be addressed.
• Medication. Medications may be used to treat additional mental health disorders, such as depression or anxiety.
• Hospitalization. In severe cases, a temporary stay in a psychiatric hospital may be necessary for safety and treatment.

Treatment may not be accepted or may not be helpful, especially for people with severe factitious disorder. In these cases, the goal may be to avoid further invasive or risky treatments. In cases where the factitious disorder is imposed on others, the doctor assesses for abuse and reports the abuse to the appropriate authorities, if indicated.

Lifestyle and home remedies

Along with professional treatment, these tips may help people who have factitious disorder:

• Stick to your treatment plan. Attend therapy appointments and take any medications as directed. If you feel an urge to harm yourself or cause yourself to become ill, talk honestly to your therapist or primary care doctor for better ways to cope with emotions.
• Have a medical gatekeeper. Have one trusted primary provider to manage your medical care, rather than visiting numerous doctors, specialists and surgeons.
• Remember the risks. Remind yourself that you could face permanent injury or even death each time you hurt yourself or have a risky test or surgery needlessly.
• Don't run. Resist urges to find a new doctor or to flee to a new town where medical professionals aren't aware of your background. Your therapist can help you overcome these powerful urges.
• Connect with someone. Many people with factitious disorder lack friendships and other relationships. Try to find someone you're able to confide in, share enjoyable times with and offer your own support to.

Preparing for an appointment

A person with factitious disorder is likely to first receive care for this condition when a doctor raises concerns that psychological problems may be a factor in the illness. If your loved one has symptoms that suggest factitious disorder, his or her doctor may contact you in advance — with the patient's permission — to talk about your loved one's health history.

Here's some information to help you get ready for that talk.

What you can do

If your loved one gives permission for his or her doctor to contact you or meet with you, take steps to get prepared. Make a list of:

• Your loved one's health history in as much detail as possible. Include health complaints, diagnoses, medical treatments and procedures. If possible, bring the names and contact information of health care professionals or facilities that provided care. Be prepared to help your loved one sign releases of information to get records and allow for conversations with other health care professionals.
• Any current behaviors or circumstances you observe that cause you to be concerned that your loved one may have factitious disorder.
• Key points from your loved one's personal history, including abuse or other trauma that occurred during childhood and any significant recent losses.
• Medications your loved one currently takes, including supplements and over-the-counter and prescription drugs, and the dosages.
• Your questions for the doctor so that you can make the most of your discussion.

For factitious disorder, some questions to ask the doctor include:

• What is likely causing my loved one's symptoms or condition?
• Are there other possible causes?
• How will you determine the diagnosis?
• Is this condition likely temporary or long lasting?
• What treatments are recommended for this disorder?
• How much do you expect treatment could improve the symptoms?
• How will you monitor my loved one's well-being over time?
• Do you think family therapy will be helpful in this case?
• What next steps should we take?

What to expect from the doctor

The doctor is likely to ask you a number of questions, including:

• What injuries or illnesses has your loved one recently complained of or been treated for in the past?
• Has your loved one been diagnosed with any specific medical problem?
• What treatments has he or she had, including drugs and surgery?
• How often has your loved one changed doctors or hospitals in the past?
• Have any doctors, friends or family had concerns that your loved one may be causing or contributing to his or her illness?
• Have any doctors, friends or family had concerns that your loved one may be causing or contributing to illness in another person?
• How have your loved one's symptoms affected his or her career and personal relationships?
• Do you know if he or she ever had a self-inflicted injury or attempted suicide?
• Did he or she suffer any other trauma during childhood, such as a serious illness, loss of a parent or abuse?
• Have you talked to your loved one about your concerns?