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Key Findings

  • 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

Clinical Findings

  • 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

Diagnosis

  • Determining that physical or laboratory findings are false

Treatment

  • 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

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