(Formerly known as Munchausen syndrome)
It is a mental illness, in which a person repeatedly acts as if he or she has a physical, emotional or cognitive disorder when, in truth, he or she has caused the symptoms. People with factitious disorders act this way because of an inner need to be seen as ill or injured, not to achieve a concrete benefit, such as financial gain. They are even willing to undergo painful or risky tests and operations in order to get the sympathy and special attention given to people who are truly ill. Some will secretively injure themselves to cause signs like blood in the urine or cyanosis of a limb. Cyanosis is the condition occurring when the blood supply is cut off to a particular part of the body and the skin takes on a dusky blue color. Factitious disorder imposed on self is associated with severe emotional difficulties.
Originally called Munchausen syndrome, named for Baron von Munchausen, an 18th century German officer who was known for embellishing the stories of his life and experiences—is the most severe type of factitious disorder. Most symptoms in people with this disorder are related to physical illness—symptoms such as chest pain, stomach problems, or fever—rather than those of a mental disorder.
In DSM5, all self imposed factitious disorders are included under one heading.
What are the symptoms of factitious disorder imposed on self?
People with this syndrome deliberately produce or exaggerate symptoms in several ways. They might lie about or fake symptoms, hurt themselves to bring on symptoms, or alter diagnostic tests (such as contaminating a urine sample). Possible warning signs of Munchausen syndrome include the following:
- Dramatic but inconsistent medical history
- Unclear symptoms that are not controllable and that become more severe or change once treatment has begun
- Predictable relapses following improvement in the condition
- Extensive knowledge of hospitals and/or medical terminology, as well as the textbook descriptions of illnesses
- Presence of multiple surgical scars
- Appearance of new or additional symptoms following negative test results
- Presence of symptoms only when the patient is alone or not being observed (e.g. seizures or passing out)
- Willingness or eagerness to have medical tests, operations, or other procedures
- History of seeking treatment at numerous hospitals, clinics, and doctors' offices, possibly even in different cities
- Reluctance by the patient to allow health care professionals to meet with or talk to family, friends, or prior health care providers
- Problems with identity and self-esteem
- More comfortable being in the hospital than you might think
- Medical knowledge may be quite extensive from many hospitalizations or prior work
Some individuals may put blood in their urine, inject themselves with feces or put tight rubber bands around an arm or leg.
What causes factitious disorder imposed on self?
The exact cause is not known, but researchers believe both biological and psychological factors play a role in the development of this syndrome. Some theories suggest that a history of abuse or neglect as a child, or a history of frequent illnesses requiring hospitalization, might be factors associated with the development of this syndrome. Researchers also are studying the possible link with personality disorders, which are common in these individuals.
How common is it?
There are no reliable statistics regarding the number of people in the United States who suffer from this disorder, but it is considered to be rare. In hospital populations it is estimated that 1% will meet the criteria. Obtaining accurate statistics is difficult because of dishonesty in representation. In addition, people with this disorder tend to seek treatment at many different health care facilities, which causes misleading statistics.
While factitious disorder imposed on self can occur in children, it most often affects young adults.
How is factitious disorder imposed on self diagnosed?
Diagnosing is very difficult because of the dishonesty that is involved. Doctors must rule out any possible physical and mental illnesses, and often use a variety of diagnostic tests and procedures before considering this diagnosis.
If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist — mental health professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use a thorough medical history and physical, laboratory imagery, and psychological assessment tools to evaluate. The doctor bases his or her diagnosis on the exclusion of actual physical or other psychiatric disorders, and his or her observation of the patient's attitude and behavior. However, personality concerns are prominent and can make it that much more confusing to sort out organic from factitious etiologies.
Questions to be answered include:
- Do the patient's reported symptoms make sense in the context of all test results and assessments?
- Do we have collateral information from other sources that confirm the patient's information? (If the patient does not allow this, this is a helpful clue.)
- Is the patient willing to take the risk for more procedures and tests than you would expect?
- Are treatments working in a predictable way?
- If they claim severe mental symptoms are because of the death of a loved one, the doctor needs to confirm the facts of the loss.
The doctor then determines if the patient's symptoms compare to the criteria as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is the standard reference book for recognized mental illnesses in the United States: Falsification of psychological or physical symptoms or signs. They are intentionally trying to deceive and may harm or injure themselves purposely but deny having done so.
How is factitious disorder imposed on self treated?
Although a person with this syndrome actively seeks treatment for the various disorders he or she invents, the person often is unwilling to admit to and seek treatment for the syndrome itself. This makes treating people with this syndrome very challenging, and the outlook for recovery poor. If caretakers can protect the patient from self-harm and educate him or her about consequences that can occur, it may be helpful. Trying to reduce his or her care through only one physician, or two working closely together (psychiatrist and internist), is also suggested.
When treatment is sought, the first goal is to modify the person's behavior and reduce his or her misuse or overuse of medical resources. Once this goal is met, treatment aims to work out any underlying psychological issues that might be causing the person's behavior or help him or her find solutions to housing or other social needs.
The primary treatment for factitious disorder imposed on self is psychotherapy (a type of counseling). Treatment likely will focus on changing the thinking and behavior of the individual (cognitive-behavioral therapy). Family therapy also might be helpful in teaching family members not to reward or reinforce the behavior of the person with the disorder, but often the person is estranged from his or her family. Group therapy may reduce feelings of isolation or that no one cares for them.
There are no medicines to treat factitious disorders themselves. Medicine might be used, however, to treat any related disorder—such as depression, anxiety, or a personality disorder. The use of medicines must be carefully monitored in people with factitious disorders due to the risk that the drugs might never be picked up from the pharmacy or might be used in a harmful way.
What are the complications of factitious disorder imposed on self?
These individuals are at risk for health problems (or even death) associated with hurting themselves or otherwise causing symptoms. In addition, they might suffer from reactions or health problems associated with multiple tests, procedures, and treatments, and are at high risk for substance abuse and suicide attempts.
What is the prognosis (outlook) for people with factitious disorder imposed on self?
Some people will suffer only a single episode of symptoms. In most cases, however, the disorder is a recurring condition that can be very difficult to treat. Many will deny they are faking symptoms and will not seek or follow treatment. Even with treatment, it is more realistic to work toward managing the disorder rather than to try curing it. Avoiding unnecessary, inappropriate admissions to the hospital, testing, or treatment is important.
Can factitious disorder imposed on self be prevented?
There is no known way to prevent this disorder. However, it might be helpful to begin treatment in people as soon as they begin to have symptoms.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 12/7/2014…#9833