What is factitious disorder imposed on self (formerly Munchausen syndrome)?

Factitious disorder imposed on self (formerly known as Munchausen syndrome) 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.

How common is factitious disorder imposed on self?

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.

What are the symptoms of factitious disorder imposed on self (Munchausen syndrome)?

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.

There are many forms this disorder may take: feigning cancer, cardiac disease, skin disorders, infections, bleeding disorders, metabolic disorders, chronic diarrhea, and many more.

What causes factitious disorder imposed on self (Munchausen syndrome)?

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.