Understanding Factitious Disorder (Also Known As Munchausen Syndrome)

Factitious disorder may sound more like something you’d see in a TV medical drama than a real-life problem. This condition typically involves an individual faking or deliberately creating symptoms of medical problems to receive sympathy, attention, and care. Previously called Munchausen syndrome, factitious disorder can be seen as a rare but genuine mental health disorder that can lead to serious consequences if left unaddressed.

Factitious disorder may stem from a pathological need for attention, external support, and a sense of belonging. The apparent symptoms can vary quite a bit since they usually depend on which physical or mental illness the person is attempting to falsify. In some cases, individuals with factitious disorder may try to create or simulate a health problem in another person rather than in themselves. Therapy can be beneficial for those living with factitious disorder, as well as their loved ones, who may also be impacted.

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What is factitious disorder, and what are its symptoms?

The key feature of factitious disorder, as defined by the American Psychological Association (APA), is usually the intentional faking or induction of illness symptoms to take on the role of a patient.

Falsifying medical history and other symptoms of a person with factitious disorder

This may sometimes involve exaggerating minor illnesses or difficulties. Patients may also claim to have symptoms that can be difficult to verify, such as the following:

• Pain (especially in the head, stomach, or chest)
• Fatigue
• Dizziness
• Weakness
• Loss of vision or hearing
• Seizures

Other individuals may falsify medical records or tests — for example, adding blood to a urine sample or lying about past illnesses. They might purposely injure or poison themselves to induce medical symptoms or crises. Common tactics can include the following:

• Injecting insulin or other medications they haven’t been prescribed
• Deliberately overdosing on prescribed or over-the-counter medicine
• Swallowing noxious substances, such as rancid food
• Picking at their skin to cause bleeding
• Taking laxatives to induce diarrhea

Factitious disorder is also known as Munchausen syndrome

Due to the deceptions and exaggerations often involved in factitious disorder, it’s sometimes called Munchausen syndrome. The name is believed to have come from a 19th-century German baron who became famous for telling tall tales about his adventures. 

Despite the deceptive nature of this disorder, it can cause genuine and lasting harm. Patients may seriously injure themselves or even die because of their efforts to induce symptoms. They can cause substantial distress to the people close to them while also wasting medical resources.

The two types of factitious disorder

Factitious disorder can present in many ways, depending on the person’s methods for faking illness. However, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) normally recognizes two main subtypes:

1. Factitious disorder imposed on the self

This generally refers to the form of factitious disorder described above, in which an individual fabricates or causes symptoms of health problems in themself. 

2. Factitious disorder imposed on another

A person with this mental health disorder (sometimes referred to as “Munchausen syndrome by proxy”) usually reports or produces symptoms in someone else. In many cases, the other person is someone dependent on them, such as a child or an elderly relative. This can be a serious form of abuse, as it can involve creating health problems in someone who’s otherwise healthy and subjecting them to potentially stressful or invasive medical procedures. 

Factitious disorder vs. hypochondria

Though they might seem similar, factitious disorder and hypochondria tend to be two very different mental health disorders. 

The crucial distinction may be that in cases of hypochondria, the patient sincerely believes or is sincerely worried that they’re ill. A person with factitious disorder is normally aware that they’re deceiving people, often including their own friends and family members, as well as health care professionals. 

Factitious disorder vs. malingering

Some people may fake illness or injury to achieve tangible benefits, such as time off from work or monetary compensation. This is often known as malingering, not factitious disorder. 

In this case, the difference is usually that people with factitious disorder aren’t trying to gain external benefits. Instead, they’re typically seeking the care and attention that can accompany medical treatment. Their behavior may be at least partly compulsive.

Signs of factitious disorder

Identifying factitious disorder is rarely easy because a person with this condition tends to be trying to trick the people around them. They may research the physical or psychological signs of specific medical conditions so that they can recreate them convincingly, often intentionally choosing diseases that can be hard to definitively rule out.

Some possible clues can alert healthcare professionals to the possibility of a factitious disorder:

• Inconsistent or vague details
• Unusual enthusiasm about receiving extensive diagnostic tests or invasive surgeries
• The details of physical symptoms don’t seem to match what the patient is reporting
• Pushing for a specific diagnosis for which there’s no evidence
• Medical records don’t match what the patient is saying
• A long medical history with few clear diagnoses
• Reported symptoms seem overly severe or dramatic
• The patient’s personality seems grandiose or dramatic, especially when discussing their illness
• Disparaging remarks toward past treatment providers
• The patient has been examined and tested extensively with no conclusive diagnosis
• Disappointment or anger when they’re not diagnosed with something serious
• The patient’s condition seems to get worse when they’re about to be sent home

Even with indicators like these, it can be hard for doctors to be certain that someone has factitious disorder unless they observe the person doing something to create symptoms, such as taking medication they’re not supposed to have.

Recognizing factitious disorder in a friend or loved one

If you think that someone you know might have factitious disorder, the best indicators may be their history and behavior.

Someone with this condition may constantly complain of illnesses that never seem to get better or worse. Though they may receive frequent medical attention, they might rarely seem to receive a diagnosis. They may change between treatment facilities frequently as care providers become suspicious, sometimes traveling great distances to be seen by new doctors. 

An individual with factitious disorder is likely to resist or dismiss psychological explanations for their symptoms. Although they may be happy to undergo intensive medical treatment, they’ll typically be opposed to mental health screenings or therapy.

In cases of factitious disorder imposed on another, the person may seem highly emotionally invested in the idea that their child or relative has a serious illness. They may report symptoms or behaviors that contradict the perspective of the supposedly sick individual, such as falsely reporting suicidal statements from a teenager. The patient may seem to be healthier when separated from the person who is claiming that they’re sick.

What causes factitious disorder?

There’s currently no clear understanding of exactly how factitious disorder develops. However, certain biological and psychological factors seem to lead to an increased risk of this condition, possibly offering some clues as to its origin. 

Other mental health disorders

Having another serious mental health disorder can be a risk factor for factitious disorder. In particular, this condition can be commonly associated with personality disorders like borderline personality disorder (BPD). 

Some researchers have also reported a strong apparent link between factitious disorder and depression. It’s not clear whether this could be due to shared causal factors or whether faking illness may arise as an attempt to cope with depressive symptoms.

History of trauma

Individuals with factitious disorder tend to be significantly more likely to have experienced childhood trauma, deprivation, or instability. An unusually high proportion also seem to have experienced a major illness or medical intervention as children.

Medical background

Some reports suggest that people who are involved in the medical field or have a longstanding interest in medical careers may be more likely to display factitious disorder. A fascination with illness, healthcare, and medical settings may sometimes play a role in the development of this mental disorder.

Factitious disorder may represent an attempt to meet emotional needs

How is factitious disorder treated?

Treating factitious disorder successfully can be extremely difficult, particularly because people with this condition are not usually motivated to get better or cooperate with psychological professionals. That said, psychotherapies like cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT) are likely to be the most effective approaches.

Clinical guidelines suggest that the most productive method for getting a person with factitious disorder to cooperate in psychological treatment may be to confront them in a supportive way rather than with a hostile or demanding demeanor. Emphasizing that the individual does indeed need help, companionship, and support, but that healing will require them to change their behavior, may persuade them to work with mental health professionals.

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Therapy for those affected by factitious disorder

Getting mental health care could also be important if you’ve experienced mental and emotional strain due to a loved one’s factitious disorder. If you’re unsure how to fit therapy into your schedule alongside your other responsibilities, you might want to consider seeking treatment online. 

Finding time for remote counseling is often easier since there’s usually no need to travel, and you can chat with a licensed mental health professional from anywhere with an internet connection. Connecting with a therapist via an online therapy platform often makes it easier to find a professional who has experience helping others who have gone through similar situations, which can be a challenge when you’re limited to practitioners in your local area.

Online therapy can be highly effective in addressing a wide range of mental health challenges and concerns. While there aren’t yet studies investigating the efficacy of online therapy for treating those impacted by factitious disorder, researchers reviewing clinical evidence report that internet therapy often produces results equivalent to face-to-face treatment. Consulting with a therapist online may help you better manage the emotional burden of factitious disorder, whether it’s you or someone you know who lives with this condition.

Takeaway

Factitious disorder is a serious mental health disorder that can cause severe harm. Because it usually involves a deliberate attempt to deceive healthcare providers, it can be difficult to recognize and treat. This condition may result from an individual’s need to feel secure and cared for as a result of a challenging, traumatic past. It may be best treated with cognitive behavioral therapy or dialectical behavior therapy. Those living with factitious disorder, as well as those impacted by others who have this disorder, may benefit from working with a licensed therapist in person or online.