How is factitious disorder imposed on self (Munchausne syndrome) 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.

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