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- Date Published | November 27, 2017
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An Overview of Factitious Disorders
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.
What are the types of factitious disorder?
Factitious disorders are of two types:
- Factitious disorder imposed on self includes the falsifying of psychological or physical signs or symptoms, as described above. An example of a psychological factitious disorder is mimicking behavior that is typical of a mental illness, such as schizophrenia. The person may appear confused, make absurd statements, and report hallucinations (the experience of sensing things that are not there; for example, hearing voices).
- Factitious disorder imposed on another: People with this disorder produce or fabricate symptoms of illness in others under their care: children, elderly adults, disabled persons, or pets. It most often occurs in mothers (although it can occur in fathers) who intentionally harm their children in order to receive attention. The diagnosis is not given to the victim, but rather to the perpetrator.
What are the warning signs of factitious disorder?
Possible warning signs of factitious disorder include:
- Dramatic but inconsistent medical history
- Unclear symptoms that are not controllable, 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 illness
- Presence of many 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
- Willingness or eagerness to have medical tests, operations, or other procedures
- History of seeking treatment at many hospitals, clinics, and doctors’ offices, possibly even in different cities
- Reluctance by the patient to allow healthcare professionals to meet with or talk to family members, friends, and prior healthcare providers
- Refusal of psychiatric or psychological evaluation
- Forecasting negative medical outcomes despite no evidence of this
- Sabotaging discharge plans or suddenly becoming more ill as one is about to be discharged from the hospital setting
How common is factitious disorder?
There are no reliable statistics regarding the number of people in the United States who suffer from factitious disorder. Obtaining accurate statistics is difficult because patients do not typically acknowledge their disorder. In addition, people with factitious disorders tend to seek treatment at many different healthcare facilities, resulting in statistics that are misleading. It is estimated that about 1% of those admitted to hospitals are believed to have factitious disorder, but this is likely under-reported.
What causes factitious disorder?
The exact cause of factitious disorder is not known, but researchers believe both biological and psychological factors play a role in the development of this disorder. Some theories suggest that a history of abuse or neglect as a child, or a history of frequent illnesses in themselves or family members that required hospitalization, may be factors in the development of the disorder.
Most patients with factitious disorder have histories of abuse, trauma, family dysfunction, social isolation, early chronic medical illness, or professional experience in healthcare (training in nursing, health aid work, etc.).
What are the symptoms of factitious disorder?
People with factitious disorder may:
- Lie about or mimic symptoms
- Hurt themselves to bring on symptoms
- Alter diagnostic tests (such as contaminating a urine sample or tampering with a wound to prevent healing)
- Be willing to undergo painful or risky tests and operations in order to obtain the sympathy and special attention given to people who are truly medically ill
Most people with this condition do not believe they have factitious disorder. They may not be entirely aware of why they are inducing their own illness. Many people with factitious disorder may also suffer from other mental disorders, particularly personality or identity disorders.
Diagnosis and Tests
How is factitious disorder diagnosed?
Due to the deceptive behaviors involved, diagnosing factitious disorder is very difficult. In addition, doctors must rule out any possible physical and mental illnesses, and often use a variety of diagnostic tests and procedures before considering a diagnosis of factitious disorder.
If the healthcare provider finds no physical reason for the symptoms, he or she may 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 thorough history, physical examinations, laboratory tests, imagery, and psychological testing to evaluate a person for physical and mental conditions.
The doctor bases his or her diagnosis on the exclusion of actual physical or mental illness, and his or her observation of the patient’s attitude and behavior.
Management and Treatment
How is factitious disorder treated?
The first goal of treatment is to change the person’s behavior and reduce his or her misuse of medical resources. In the case of factitious disorder imposed on another, the main goal is to ensure the safety and protection of any real or potential victims.
Once the initial goal is met, treatment aims to resolve any underlying psychological issues that may be causing the person’s behavior.
The primary treatment for factitious disorder is psychotherapy (a type of counseling). Treatment likely will focus on changing the thinking and behavior of the individual with the disorder (cognitive-behavioral therapy). Family therapy also may help in teaching family members not to reward or reinforce the behavior of the person with the disorder.
There are no medications to actually treat factitious disorder. Medication may be used, however, to treat any related disorder, such as depression or anxiety.
What are the complications of factitious disorder?
People with factitious disorder are at risk for health problems associated with hurting themselves by causing symptoms. In addition, they may suffer health problems related to multiple tests, procedures, and treatments, and are at high risk for substance abuse and suicide attempts. A complication of factitious disorder imposed on another is the abuse and potential death of the victims.
Can factitious disorder be prevented?
There is no known way to prevent factitious disorder. However, it may be helpful to start treatment in people as soon as they begin to have symptoms.
Outlook / Prognosis
What is the prognosis (outlook) for people with factitious disorder?
Some people with factitious disorder suffer one or two brief episodes of symptoms. In most cases, however, factitious disorder is a chronic, or long-term, condition that can be very difficult to treat. Additionally, many people with factitious disorder will not seek or follow treatment due to their low self-awareness.
- American Psychiatric Association. Highlights of Changes from DSM-IV-TR to DSM-5 Accessed 5/2/2017.
- Bass C, Halligan P. Factitious disorders and malingering: challenges for clinical assessment and management. Lancet. 2014; 383:1422-1432.
- Elder WG, Bennett K. Chapter 55. In: South-Paul JE, Matheny SC, Lewis EL, eds. CURRENT Diagnosis & Treatment in Family Medicine. 3rd ed. New York: McGraw-Hill; 2011.
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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 healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 03/28/2017