What is factitious disorder?
Factitious disorder is a mental disorder in which a person acts as if he or she has a physical or mental illness. People with factitious disorder deliberately create or exaggerate symptoms of an illness. They have an inner need to be seen as ill or injured.
Factitious disorder is considered a mental illness because it is associated with severe emotional difficulties and stressful situations.
How common is factitious disorder?
Factitious disorder is considered rare, but it’s not known how many people have the disorder. Please discuss with your doctor for further information.
What are the symptoms of factitious disorder?
The common symptoms of factitious disorder are:
- 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
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.
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.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my 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 emergency medical help or, if you can safely do so, take him or her to an emergency room immediately.
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes factitious disorder?
The cause of factitious disorder is unknown. However, the disorder may be caused by a combination of psychological factors and stressful life experiences.
What increases my risk for factitious disorder?
There are many risk factors for factitious disorder, such as:
- 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
- Desire to be associated with doctors or medical centers
- Work in the health care field
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is factitious disorder diagnosed?
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
- 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
How is factitious disorder treated?
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.
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 often focuses on managing the condition, rather than trying to cure it. Treatment generally includes:
- Having a primary care doctor. Using one doctor or 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.
- 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.
- Medications may be used to treat additional mental health disorders, such as depression or anxiety.
- 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 changes & home remedies
What are some lifestyle changes or home remedies that can help me manage factitious disorder?
The following lifestyles and home remedies might help you cope with 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 doctor 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.
If you have any questions, please consult with your doctor to better understand the best solution for you.
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