Factitious Disorder

Factitious disorder imposed on another, formerly called Munchausen syndrome by proxy, may present with various signs and symptoms that can be unclear or hard to discern. Ultimately, the symptoms of factitious disorder can vary greatly depending on the person and their intentions. 

Somatic symptoms are commonly seen in those with factitious disorders – this entails the intentional fabrication or exaggeration of physical or psychological symptoms without genuine medical or psychological basis.

Signs of factitious disorder

Here are some common signs and symptoms that may help indicate the presence of factitious disorder:

• Repetitive hospitalizations or medical visits without a definitive diagnosis
• History of seeking treatment from multiple healthcare professionals
• Unusual or unexplained medical test results
• Inconsistencies in medical history
• Symptoms that worsen or change without a clear reason

Physical symptoms of factitious disorder

Physical and behavioral manifestations of factitious disorder may include:

• Inducing or feigning injuries or illnesses by engaging in self-harm, manipulating medical devices, or consuming substances
• Faking symptoms such as pain, fatigue, or dizziness
• Exaggerating the severity of genuine but minor symptoms
• Misrepresenting personal medical history to obtain unnecessary treatments
• Exhibiting overt attention-seeking behavior, often by exaggerating their health problems
• Having an unusual level of medical knowledge due to extensive research on their self-induced illnesses
• Refusing to accept the reality of their condition, despite being presented with proof of exaggerated symptoms
• Manipulating or deceiving doctors or other healthcare professionals to receive unnecessary treatment

Recognizing the symptoms of factitious disorder can be challenging for healthcare providers, as individuals may go to great lengths to maintain their deception. Healthcare providers often have to rule out other possible causes of the symptoms before being able to diagnose factitious disorder. Treatment may target the root psychological problems that lead the person to engage in manipulative behaviors. Types of treatment may include therapy, counseling, and other mental health interventions.

The exact causes of factitious disorder, or the psychiatric condition in which patients deliberately produce or falsify symptoms of a medical condition, remain unknown. However, researchers have identified several factors that may contribute to the development of factitious disorder. Some common risk factors for factitious disorder may include:

• History of trauma,² or neglect
• History of frequent or serious illnesses
• Knowledge or experience in medical professions
• Lack of a strong social support system
• Severe stress or loss of a loved one
• History of lying or deceptive behavior
• Unresolved challenges related to identity or self-image
• Presence of other mental disorders (e.g., anxiety, depression, or substance abuse)
• Personality disorders (e.g., borderline personality disorder or narcissistic personality disorder)

People who have experienced childhood abuse or trauma, including sexual, physical, or emotional abuse, may be more likely to develop factitious disorder in adulthood, possibly as a way to seek care and attention they lacked in their past. People diagnosed with factitious disorder characterized by falsified general medical or psychiatric symptoms often have other mental disorders. For example, individuals with personality disorders, such as borderline personality disorder or narcissistic personality disorder, may be at a higher risk of factitious disorder. Anxiety, depression, and substance use disorders have also been linked to factitious disorder.

These risk factors may potentially contribute to factitious disorder, but they don’t necessarily mean that a person will develop factitious disorder. The exact cause of factitious disorder is not well understood, and it may be due to a combination of biological, psychological, and environmental factors.

The main goal of treatment for factitious disorder is typically to help affected individuals understand and change their behavior. Common treatments may include various forms of therapy, such as cognitive behavioral therapy (CBT), and medications to address any co-occurring mental disorders.

Medication

While there are no specific medications designed to treat factitious disorder, medications may be prescribed to treat symptoms of co-occurring mental illnesses, such as depression or anxiety. Common medications prescribed for these conditions may include:

• Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), to help treat depression and anxiety
• Anti-anxiety medications, like benzodiazepines, for short-term relief of anxiety symptoms

Individuals may need to work closely with their healthcare providers to find the most suitable medication for their needs and to manage any potential side effects. It is important to consult with a doctor or medical professional before beginning or changing any medication plan.

Self-care for factitious disorder

Practicing self-care may be helpful for individuals with factitious disorder as they work toward changing their behavior and treating any conditions they may have inflicted on themselves. Some self-care strategies that can help factitious disorder may include:

• Having proper sleep hygiene, aiming for seven to nine hours of sleep each night
• Eating a balanced diet to support physical and mental health
• Engaging in regular physical activity as it may help alleviate stress and anxiety
• Developing a supportive network of friends, family, or support groups who understand the disorder and can provide encouragement

In many cases, treating factitious disorder may require a combination of therapy, medication, and self-care strategies. A healthcare provider can develop an individualized treatment plan to tackle the needs of each person and help them manage the disorder.

Learning about factitious disorder and finding support may be challenging to navigate. However, various resources are available to support and treat those affected. One option for individuals seeking therapy is BetterHelp, an online platform offering professional counseling services via phone, videoconferencing, or live chat.

In addition to therapy, numerous mental health organizations are dedicated to providing information, guidance, and support to individuals with mental health challenges. These organizations may include Mental Health America and the National Institute of Mental Health. These organizations often offer various resources, such as educational materials, hotlines, and support groups that may be beneficial in coping with the disorder.

When seeking additional resources, it may be helpful to verify that the information is reputable and evidence-based. Other than national mental health organizations, some reliable sources may include peer-reviewed research studies and mental health providers. These resources may help individuals better understand their condition and make the right decisions when it comes to treatment.

Please see our Get Help Now page for more immediate resources.

Research on factitious disorder has often focused on understanding its causes and potential treatments. A systematic review of 455 cases in the professional literature concluded, among other things, that while the disorder isn't typically linked to suicide, individuals may harm themselves to fake illnesses, potentially causing serious or even fatal injuries. The study also suggests that the disorder is more connected to depression than personality disorders, and treating depressive symptoms may be helpful.

One study from 2023 looked at factitious dermatitis, a disorder characterized by self-induced skin lesions, in children and adolescents. The retrospective study, which spanned seven years (2016-2022), examined how often psychiatric disorders occur in those under 19 years old who have factitious dermatitis. The study found that children and adolescents with factitious dermatitis were more likely to be diagnosed with psychiatric disorders, such as anxiety disorder, depression, and obsessive-compulsive disorder,⁴ within a year after diagnosis of factitious dermatitis.

60% of individuals with factitious disorder have experienced severe illness

Factitious  disorder may have its roots in early traumatic experiences with health. In a study of 20 cases of factitious disorder patients, 60% had experienced a case of serious illness in childhood.¹

¹The Journal of the American Academy of Psychiatry and the Law

Here are more key statistics on factitious disorder:

• Factitious disorder is considered a rare condition, with the incidence rate varying across different countries. For example, the incidence rate in Germany and Norway is about 3.71 and 3.18 per 100,000 people, respectively.
• Estimations suggest that factitious disorder accounts for around 0.6% to 3% of cases referred from general medicine to psychiatry.
• Approximately 90% of individuals with factitious disorder engage in behaviors where they intentionally create or exaggerate symptoms, often through methods that can cause self-harm. These actions might include taking harmful substances or medications, or causing physical injury to themselves.