Factitious Disorder

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