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Factitious disorder

Factitious disorder is a serious mental disorder in which someone deceives others by appearing sick, by purposely getting sick, or by self-injury. Factitious disorder symptoms can range from mild (slight exaggeration of symptoms) to severe (previously called Munchausen syndrome). The person may make up symptoms or even tamper with medical tests to convince others that treatment, such as high-risk surgery, is needed.

A factitious disorder is not the same as inventing medical problems for practical benefit, such as getting out of work or winning a lawsuit. Although people with factitious disorder know they are causing their symptoms or illness, they may not understand the reasons for their behavior.

Factitious disorder is mysterious and hard to treat. However, medical and psychological help are critical for preventing serious injury and even death caused by the self-harm typical of this disorder.

Symptoms Causes Risk factors Complications Prevention

Factitious disorder symptoms involve mimicking or producing illness or injury. People go to great lengths to avoid discovery of their deception, so it may be difficult to realize that their symptoms are actually part of a serious mental disorder.

Factitious disorder imposed on another (previously called Munchausen syndrome by proxy) is when someone makes another person sick, requiring medical attention. Usually this involves a parent harming a child. This form of child abuse can put a child in serious danger of injury or unnecessary medical care.

Factitious disorder signs and symptoms may include:

  • Clever and convincing medical problems
  • Frequent hospitalizations
  • Vague or inconsistent symptoms
  • Conditions that get worse for no apparent reason
  • Conditions that don't respond as expected to standard therapies
  • Eagerness to have frequent testing or risky operations
  • Extensive knowledge of medical terms and diseases
  • Seeking treatment from many different doctors or hospitals, which may include using a fake name
  • Having few visitors when hospitalized
  • Reluctance to allow health professionals to talk to family or friends or to other health care providers
  • Arguing with hospital staff
  • Frequent requests for pain relievers or other medications

How those with factitious disorder fake illness

Because people with factitious disorder become experts at faking symptoms and diseases or inflicting real injuries upon themselves, it may be hard for medical professionals and loved ones to know if illnesses are real or not.

People with factitious disorder make up symptoms or cause illness in several ways, such as:

  • Exaggerating existing symptoms. Even when an actual medical condition exists, they may exaggerate symptoms to appear sicker or more impaired than is true.
  • Making up histories. They may give loved ones, health care providers or support groups a false medical history, such as claiming to have had cancer or AIDS. Or they may falsify medical records to indicate an illness.
  • Faking symptoms. They may fake symptoms, such as stomach pain, seizures or passing out.
  • Causing self-harm. They may make themselves sick, for example, by injecting themselves with bacteria, milk, gasoline or feces. They may injure, cut or burn themselves. They may take medications, such as blood thinners or diabetes drugs, to mimic diseases. They may also interfere with wound healing, such as reopening or infecting cuts.
  • Tampering. They may manipulate medical instruments to skew results, such as heating up thermometers. Or they may tamper with lab tests, such as contaminating their urine samples with blood or other substances.

When to see a doctor

People with factitious disorder may be well aware of the risk of injury or even death as a result of self-harm or the treatment they seek. Still, they are unable to control their compulsive behavior and are unlikely to seek help. Even when confronted with proof — such as a videotape — that they're causing their illness, they often deny it and refuse psychiatric help.

If you think a loved one may be exaggerating or faking health problems, it may help to attempt a gentle conversation about your concerns. Try to avoid anger, judgment or confrontation. Offer support and caring and, if possible, help in finding treatment.

If your loved one causes self-inflicted injury or tries to commit suicide, call 911 or emergency medical help or, if you can safely do so, take him or her to an emergency room immediately.

The cause of factitious disorder is unknown. However, people with this disorder may have experienced a severe illness when they were young or may have been emotionally or physically abused.

Several factors may increase the risk of developing factitious disorder, including:

  • Childhood trauma, such as emotional, physical or sexual abuse
  • A serious illness during childhood
  • A relative with a serious illness
  • A poor sense of identity or self-esteem
  • Loss of a loved one through death, illness or abandonment early in life
  • Unfulfilled desire to be a doctor or other health professional
  • Work in the health care field
  • Personality disorders

Factitious disorder is considered rare, but it's not known how many people have the disorder. Some people use fake names to avoid detection, some visit many different hospitals and doctors, and some are never found out — all of which make it difficult to make a reliable estimate.

People with factitious disorder are willing to risk their lives to be seen as sick. They frequently have other mental disorders as well. As a result, they face many possible complications, including:

  • Injury or death from self-inflicted medical conditions
  • Severe health problems from unnecessary surgery or other procedures
  • Loss of organs or limbs from unnecessary surgery
  • Alcohol or other substance abuse
  • Significant problems in daily life, relationships and work

Because the cause of factitious disorder is unknown, there's currently no known way to prevent it. Early recognition and treatment of factitious disorder may help avoid unnecessary and potentially dangerous tests and treatment.

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