Factitious Disorder

Self-induced symptoms or false physical and laboratory findings in an attempt to deceive clinicians

Unlike the somatic symptom disorders, symptom production is intentional

No apparent external motivation for the deceptive behaviors other than achieving the sick role

In factitious disorder imposed on self (formerly Munchausen syndrome), the deception is carried out by the patient

In factitious disorder imposed on another (formerly Munchausen by proxy), a parent creates an illness in a child so that the parent can maintain a relationship with clinicians

Patients are frequently connected in some way to the health professions and often are migratory

Deceptions may involve

• Fever

• Self-mutilation

• Hemorrhage

• Hypoglycemia

• Seizures

• Many other symptoms

• False physical and/or laboratory findings

Presentations are often dramatic and exaggerated, but the duplicity may also be complex and difficult to recognize

Determining that physical or laboratory findings are false

Early psychiatric consultation is indicated

Two main treatment strategies

• Conjoint confrontation of the patient by both the primary clinician and the psychiatrist

The patient's disorder is portrayed as a cry for help, and psychiatric treatment is recommended

• Avoidance of direct confrontation and attempt to provide a face-saving way to relinquish the symptom without overt disclosure of the disorder's origin