Last reviewed: 29 Oct 2022
Last updated: 11 Aug 2022
Summary
Factitious disorders are uncommon disorders in which the patient intentionally fabricates physical or psychological symptoms primarily for the purpose of deceiving healthcare providers and/or others.
Patients are motivated primarily by a desire to assume the sick role rather than by the hope to achieve external rewards.
Munchausen syndrome is an extreme form.
Factitious disorder imposed on another [previously factitious disorder by proxy] describes the clinical scenario wherein the patient feigns or induces signs or symptoms of illness in another person who is under the patient's care, when there are no clear external incentives. It is a potentially lethal form of abuse, as patients may inadvertently induce coma or death by giving medications to simulate disease.
Systematic evidence for directing treatment is lacking.
Definition
Factitious disorder is a syndrome in which signs and/or symptoms of disease are intentionally feigned, exaggerated, or self-induced by a patient when there is no clear principal external incentive for the behavior.[1] The psychiatric nomenclature distinguishes factitious disorder from several related disorders by both the intentionality of the behavior and its motivation. Symptoms produced without conscious intent are considered a somatic symptom disorder. Symptoms intentionally feigned or created for some external reward, such as getting out of jail or obtaining unneeded pain medication, are considered malingering.
Distinguishing factitious disorder from related conditions can be a difficult task, particularly because they can sometimes co-exist in the same patient.[Figure caption and citation for the
preceding image starts]: Distinguishing factitious disorder from related conditionsFrom the personal collection of Christopher P. Kogut, Virginia Commonwealth University, VA [Citation ends].
History and exam
Key diagnostic factors
- history of unexplained complaints or inconsistency over time
- unusual presentation relative to demographics
More key diagnostic factors
Other diagnostic factors
- symptoms more exaggerated while aware of being observed
- presentation for care at many different hospitals
- eyewitness evidence of the patient manipulating findings
- dramatic history of travel and acute illness [Munchausen subtype]
- multiple abdominal scars [Munchausen subtype]
- medications or medical paraphernalia found in an unusual location in a patient's room
Other diagnostic factors
Risk factors
- female sex [factitious disorder]
- medically related employment [factitious disorder]
- cluster B personality characteristics [factitious disorder]
- male sex [Munchausen subtype]
- single marital status [Munchausen subtype]
- age 40 to 50 years [Munchausen subtype]
- antisocial personality traits [Munchausen subtype]
More risk factors
Diagnostic investigations
1st investigations to order
- clinical history and exam
More 1st investigations to order
Investigations to consider
- cultures [e.g., blood or wound]
- serum C-peptide
- urine sulfonylureas
- urine electrolytes
- urine protein
- serum thyroglobulin
More investigations to consider
Treatment algorithm
suspected factitious disorder
Contributors
Authors
James L. Levenson, MD
Professor of Psychiatry
Internal Medicine and Surgery
Vice-Chair
Department of Psychiatry
Chair
Division of Consultation/Liaison Psychiatry
Virginia Commonwealth University
Richmond
VA
DisclosuresJLL is the author of a reference cited in this topic.
Acknowledgements
Prof Levenson would like to gratefully acknowledge Prof Christopher P. Kogut, a previous contributor to this topic.
DisclosuresCPK declares that he has no competing interests.
Peer reviewers
Tanveer Padder,
Consulting Psychiatrist
Padder Health Services
Laurel
MD
DisclosuresTP declares that he has no competing interests.
Marc Feldman,
Clinical Professor of Psychiatry
University of Alabama
Tuscaloosa
AL
DisclosuresMF receives royalties for two books on the subjects covered in this topic [Routledge publishing and American Psychiatric Publishing]. He is also an author of references cited in this topic.
Differentials
- Malingering
- Somatic symptom and related disorders
- Organic disease
More Differentials
Guidelines
- Assessment and management of adults and children in cases of fabricated or induced illness
- Munchausen by proxy: clinical and case management guidance
More Guidelines
Patient leaflets
Factitious disorders
More Patient leaflets
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