Factitious Disorders

What are factitious disorders?

Factitious disorders are a group of mental health conditions where you appear sick, make someone else appear sick or purposefully create symptoms of a condition to receive care. You might do this for personal and psychological reasons like wanting attention, coping with stress or deceiving healthcare professionals.

This condition can be very dangerous. You may harm yourself and others by producing symptoms or undergoing unnecessary testing, treatments, procedures and surgeries. If you or a loved one feel the urge to hurt yourself or others, contact a healthcare provider or a mental health professional.

What are the two types of factitious disorders?

The types include:

• Factitious disorder imposed on self (formerly known as Munchausen syndrome): This type includes making up psychological or physical signs or symptoms that aren’t actually affecting you. You may fabricate a mental health condition such as schizophrenia by reporting that you hear voices. Alternatively, you may make up physical symptoms like a stomach ache or chest pain.
• Factitious disorder imposed on another: This type of factitious disorder happens when you report made-up symptoms for people within your care (like a parent falsely stating that their child is experiencing symptoms). In many cases, this can involve intentionally harming someone else so they can receive care. This diagnosis isn’t given to the victim but rather to the person who causes harm. Factitious disorder imposed on another is considered a form of abuse.

What are the signs and symptoms of factitious disorders?

If you have a factitious disorder, you may:

• Lie about or mimic symptoms
• Hurt yourself or someone else to cause symptoms
• Intentionally change diagnostic tests or treatment plans (like contaminating a urine sample or damaging a wound to prevent healing)
• Desire sympathy and special attention

Signs of a factitious disorder may include reporting symptoms that are perplexing to healthcare providers, like:

• Symptoms that change or increase in unexpected ways after treatment or after returning home from a healthcare facility
• Symptoms that recur unpredictably
• Symptoms that occur only when you’re alone
• New or additional symptoms after a healthcare provider tells you there’s nothing wrong

Other signs may include:

• Visiting many hospitals, clinics and providers’ offices, even in different cities from where you live
• An inconsistent medical history when reported at different times or to different healthcare providers
• Changing names when visiting a new healthcare provider
• Extensive knowledge of hospitals, medical terminology and/or textbook descriptions of illnesses
• A desire or eagerness to undergo painful medical testing or procedures
• Refusing to receive a psychological evaluation or have a healthcare professional meet or speak with family members, friends or previous providers

What causes factitious disorders?

Healthcare providers don’t know exactly what causes a factitious disorder. Studies suggest it could involve psychological factors (parts of your personality that influence your thoughts and actions) and biological factors (your brain chemistry and genetic makeup).

Research also suggests that you might have a motivation to deceive healthcare providers for the following reasons:

• Wanting someone else to take care of your physical or emotional needs
• Looking for power and superiority over others
• Reducing anxiety around a fear of abandonment
• Creating a new personal identity

It’s possible to develop a factitious disorder without a clear cause.

What are the risk factors for factitious disorders?

Factitious disorders are rare but you may have a higher risk of developing this condition if you experience:

• Abuse or neglect
• Trauma
• Frequent illnesses that affected you or a loved one
• Family dysfunction
• A lot of time in a healthcare facility (due to illness, career training, volunteering, etc.)

How are factitious disorders diagnosed?

A factitious disorder is difficult to diagnose due to deceptive behaviors.

A provider will make a diagnosis by learning more about you through:

• A thorough medical history
• A physical examination
• Laboratory testing
• Imaging tests

In some cases, your provider may recommend a psychiatric or psychological evaluation. Psychiatrists and psychologists are specially trained to diagnose and treat mental health conditions.

How are factitious disorders treated?

The first goal of treatment for factitious disorders is to modify harmful behaviors and reduce the misuse or overuse of medical resources. Once you meet these goals, your care team will focus on addressing any underlying causes of your behavior and help you find solutions to meet your needs.

The main focus of factitious disorders management is decreasing harm. Healthcare providers might work together to make sure you don’t undergo unnecessary medical testing or treatment. Many medical tests and treatments can cause harmful effects (like side effects or organ damage from antibiotics you don’t need).

Sometimes, healthcare providers may try to prevent you from harming yourself (like reducing your access to direct lines into your blood vessels to decrease the risk of self-induced infection).

A provider may also treat factitious disorders by addressing any underlying psychological motivations that cause deceptive behaviors. Everyone’s treatment plan is unique.

The most common treatment for factitious disorder is psychotherapy (a type of counseling). You’ll likely focus on changing your thinking and behaviors (cognitive-behavioral therapy) and learn healthier coping mechanisms. Family therapy also may teach your loved ones not to reward or reinforce certain behaviors.

There aren’t medications available to treat this condition. However, you may need medications to treat associated conditions, such as depression or anxiety.

Can factitious disorders be prevented?

There’s no known way to prevent a factitious disorder. But seeking treatment sooner can prevent complications such as:

• Substance use disorder
• Abusing someone else
• Organ loss (unnecessary removal of internal organs, limbs, etc.)
• Harm or side effects from unnecessary medical testing or treatments
• Bodily harm from attempts to fabricate illness
• Suicide

If you’re thinking about hurting yourself or someone else or have suicidal thoughts, contact a healthcare provider, call 911 or call or text 988 (Suicide & Crisis Lifeline). If you feel like you or a loved one are in immediate danger, contact 911 or your local emergency services number.

What’s the prognosis (outlook) for factitious disorders?

Each person with a factitious disorder has a different prognosis. In some cases, the condition can last for years or decades. Other cases get better within months of the first signs. Studies have found that this condition can stop suddenly, usually after loved ones or healthcare providers recognize what’s happening.

Unfortunately, many people with a factitious disorder avoid seeking treatment for it or following a treatment plan.

There’s a risk of life-threatening complications that can abruptly affect a person’s life expectancy.

Long-term mental health conditions can affect people who experienced abuse, but treatment is available. If you experienced abuse, know that you’re not alone.

What can I expect if my loved one has a factitious disorder?

A factitious disorder is a challenging mental health condition to diagnose and treat. Many people diagnosed with the condition may deny, refuse or ignore a healthcare provider’s official diagnosis because it isn’t the one they are expecting or hoping to hear.

You can help your loved one by listening to them. Avoid denying or belittling their deceptive behaviors and instead, offer gentle encouragement to seek care from a mental health professional. If you’re unsure how to support your loved one, contact a mental health provider for advice.

When should I see a healthcare provider?

Contact a provider if you feel like you need to hurt yourself or others to receive care.

Often, the person who experiences factitious disorder isn’t aware of how their behavior affects themselves or the people around them. A loved one may need to call for help if they notice signs of a factitious disorder. Call emergency services immediately if you or a loved one are in immediate danger.

What questions should I ask my healthcare provider?

• What type of treatment do you recommend?
• How often should I speak to a mental health professional?
• Can my loved ones participate in therapy?