Factitious Disorder Imposed on Self (Formerly Known as Munchausen Syndrome)

What is factitious disorder imposed on self?

Factitious disorder imposed on self, formerly known as Munchausen syndrome, is a mental health condition that occurs when you appear sick, pretend to feel symptoms or intentionally make yourself ill.

Most reported symptoms relate to physical illness, such as chest pain, upset stomach or fever, rather than those of a mental health condition. But if you have this factitious disorder, you may pretend to experience mental health symptoms, too, like hallucinations or hearing voices.

This condition can be dangerous because your behaviors may be a form of self-harm.

How common is factitious disorder imposed on self?

Factitious disorder imposed on self isn’t common. It’s difficult to determine exactly how many people experience it. Many people seek treatment from multiple healthcare providers, so the statistics are misleading.

Where did the term ‘Munchausen syndrome’ come from?

Factitious disorder was originally called Munchausen syndrome. It got its initial name after Baron Munchausen. He was an 18th-century German officer known for embellishing the stories of his life and experiences. The condition name reflects the embellishing aspect of the syndrome but not its complexity as a mental health condition.

Today, healthcare providers don’t use the term “Munchausen syndrome.” Instead, they refer to the condition as “factitious disorder imposed on self.”

What are the behaviors of factitious disorder imposed on self?

Behaviors of factitious disorder imposed on self include:

• Pretending to have physical symptoms (like a headache, stomachache or chest pain).
• Pretending to have psychological symptoms (like hallucinating or hearing voices).
• Making yourself ill or producing physical symptoms (like damaging a wound to prevent healing or eating contaminated food to make yourself vomit).

What are the signs of factitious disorder imposed on self?

If you have factitious disorder imposed on self, you make up or exaggerate symptoms to appear ill. You may:

• Falsify feeling symptoms that you don’t have.
• Show or pretend to have new or additional symptoms following test results or after treatment begins.
• Show symptoms only when alone.
• Alter diagnostic tests (like contaminating a urine sample).
• Pretend to take medications but hide them or spit them out.
• Intentionally harm yourself.

Other signs may include:

• Having an inconsistent medical history
• Changing or falsifying your identity
• Visiting many different healthcare facilities to receive care
• Not wanting to allow providers to meet with your family or friends or speak with other providers you’ve seen
• Wanting to undergo painful testing or procedures

What causes factitious disorder imposed on self?

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 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 an identifiable cause.

What motivates factitious disorder imposed on self behaviors?

People with this condition typically know they’re pretending. However, they’re not actively seeking tangible benefits by making things up or embellishing (like avoiding obligations or obtaining disability benefits). The benefits are typically unconscious and emotional in nature. They may not even be aware of the benefits they’re getting.

Is factitious disorder imposed on self hereditary?

There’s no known link between factitious disorder imposed on self and genetics. Research is ongoing to learn more about the cause.

What are the risk factors for factitious disorder imposed on self?

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

• Abuse or neglect
• Trauma
• Frequent illnesses that affected you or a loved one
• Family dysfunction
• A lot of time in a healthcare facility

How is factitious disorder imposed on self diagnosed?

It can be difficult for healthcare providers to diagnose factitious disorder imposed on self. A healthcare provider will rule out possible physical and mental health conditions and verify diagnostic criteria. There needs to be clear evidence that you’re falsifying or creating symptoms. A diagnosis usually happens after several diagnostic tests and procedures. A variety of healthcare providers work together to make a diagnosis.

Is there a factitious disorder imposed on self test?

There isn’t a specific test to diagnose factitious disorder imposed on self. Testing to rule out other conditions may include blood tests, urine tests, imaging tests and more.

Your provider bases their diagnosis on the exclusion of physical conditions or other psychiatric disorders and their observations of your attitude and behavior.

In some cases, your healthcare provider may refer you to a psychiatrist or psychologist (mental health professionals specially trained to diagnose and treat mental health conditions). Psychiatrists and psychologists use a thorough medical history, physical history, laboratory and/or imaging tests, and psychological assessment tools to make an evaluation.

Factitious disorder imposed on self in the DSM-5

Your healthcare provider(s) will refer to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to determine if your symptoms compare to the criteria for this condition. The DSM-5 is the standard reference book for recognized mental health conditions in the United States.

Diagnostic criteria for factitious disorder imposed on self include:

• Falsifying physical or psychological signs and symptoms, inducing injury or disease
• Presenting to others as ill, impaired or injured
• Deceptive behavior that happens without an external reward
• Another mental health condition doesn’t explain the behavior well

How is factitious disorder imposed on self (formerly known as Munchausen syndrome) treated?

The first goal of treatment for factitious disorder imposed on self is to modify harmful behaviors and reduce the misuse or overuse of medical resources. After you meet these goals, your care team will address any underlying causes of your behavior.

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 side effects if you don’t need them. Your providers may work with you closely to prevent harm based on your needs.

A form of psychotherapy that addresses your thinking and behavioral patterns (cognitive behavioral therapy) helps treat factitious disorder imposed on self. Family therapy may also help teach your family members more about this condition. Group therapy may reduce feelings of isolation or abandonment.

It can be difficult to treat factitious disorder imposed on self many people who experience this condition deny that they have it, making it difficult to treat. However, treatment is available when you’re ready.

You’ll likely only need care from one physician or the combined efforts of two caregivers with different specialties working closely together; for example, a psychiatrist and a primary care physician. Your caregiver(s) will focus on reducing self-harm and educating you on how to care for yourself and prevent complications.

Can factitious disorder imposed on self be prevented?

There’s no known way to prevent this condition. However, beginning treatment as soon as you notice symptoms may help you achieve the best outcome.

Factitious disorder imposed on self can be dangerous, even life-threatening. If you intentionally harm yourself or take medications for symptoms you don’t have, you may experience severe side effects that can affect how your body functions. Undergoing unnecessary tests or procedures can also do more harm to your body than good.

In addition, many people diagnosed with factitious disorder imposed on self experience substance use disorder and are at risk of suicide.

If you or a loved one are thinking about hurting yourself or have suicidal thoughts, contact a healthcare provider or call 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 disorder imposed on self?

Your prognosis varies based on your willingness to accept and follow a treatment plan. If you acknowledge the diagnosis and follow your healthcare provider’s instructions during treatment, you’ll likely have a positive outcome. If you deny or avoid treatment, your outcome may be poor, and your behavior could be very dangerous, even life-threatening.

While some people might have only one episode of this condition, most experience recurring episodes throughout their lives. Ongoing treatment is necessary.

How do I help someone with factitious disorder imposed on self?

Factitious disorder imposed on self is a serious mental health condition. It can be difficult for the person who experiences it to realize how harmful it is. If your loved one experiences this condition, it may feel easy to point out when they’re lying. But this can feel like a personal attack on them, and your words may be met with anger, avoidance or aggression.

Some providers recommend addressing factitious disorder imposed on self behaviors directly with the person, then asking them if they feel overwhelmed, stressed, anxious or depressed. Others might recommend a nonconfrontational approach by referring someone to see a psychologist without addressing the reason why.

If you’re not sure where to start, ask a healthcare provider or mental health professional for advice. They can educate you, your loved one and your family and friends about the condition. Working together, you can help keep your loved one accountable by making sure they follow their personalized treatment plan. Take them to see their psychologist and/or therapy appointments. Help dispense their medication (if applicable). Being available to support your loved one (not enabling their behavior) is the best way to help someone with factitious disorder imposed on self.

When should I see a healthcare provider?

Visit a healthcare provider if you or a loved one shows behaviors of factitious disorder imposed on self. Your prognosis may be better when you address the condition early to reduce the likelihood of harm.

What questions should I ask my healthcare provider?

• What treatment is best for me?
• Do I have a related mental health diagnosis, such as depression or a personality disorder?
• Can you recommend a psychiatrist or therapist?
• How often should I return to see you for treatment?
• How do I discuss this condition with my friends and family?

What’s the difference between malingering behavior and factitious disorder imposed on self?

If you practice malingering behaviors, you might pretend to be sick or ill to gain something tangible, like avoiding work or school or to get benefits. There isn’t a conscious gain when someone has factitious disorder imposed on self. The behaviors may instead provide a subconscious emotional benefit.

What’s the difference between Munchausen syndrome and Munchausen syndrome by proxy?

Both factitious disorder imposed on self (formerly known as Munchausen syndrome) and factitious disorder imposed on another (formerly known as Munchausen syndrome by proxy) are types of factitious disorders.

Factitious disorder imposed on self is pretending you have an illness.

Factitious disorder imposed on another is where you pretend that someone within your care (like a child or adult) experiences symptoms. You may also harm someone within your care so they show symptoms of a physical or mental illness that they don’t have. This is a form of abuse.