By: Catherine Joachin
What is factitious disorder?
Factitious disorder, commonly known as Munchausen syndrome, is a mental disorder in which a person purposefully feigns or exaggerates an illness without clear external motivation to do so (Cleveland Clinic, 2024). This behavior is motivated by a psychological need to assume the role of a sick person. By perpetuating this “sick” persona, patients risk not receiving an appropriate diagnosis or effective treatment (Mayo Clinic, 2019).
Symptoms and causes
People with factitious disorder engage in various forms of deception, going as far as to cause physical harm to themselves to maintain their ruse (Mayo Clinic, 2019). Even when evidence points to fabricated or self-inflicted symptoms, these individuals continue to pretend to have some form of illness (Mayo Clinic, 2019). Factitious disorder imposed on another (Munchausen syndrome by proxy), in which a person falsely claims or induces symptoms to someone in their care, typically a child or an elderly dependent, is a related condition (National Health Service, 2024).
Signs of factitious disorder may include:
- Vague, dramatic and inconsistent symptoms
- Unexplainable worsening of the condition
- Failure to respond to treatment
- Evidence of numerous surgical procedures
- Seeking treatment from different professionals and hospitals, maybe even under an alias
- Extensive knowledge of medical conditions and terminology
(Mayo Clinic, 2019).
People with this disorder often refuse psychiatric treatment; therefore, the cause of the condition remains unclear (NHS, 2024). Researchers believe that psychological factors, such as childhood neglect, emotional trauma, or a history of hospitalization, may contribute to the development of factitious disorder (Cleveland Clinic, 2024). Others propose that a potential link to personality disorders may play a role in enabling this condition (Cleveland Clinic, 2024; NHS, 2024).
Factitious seizures
Factitious seizures are non-epileptic convulsions over which a patient has conscious control. Unlike the nonepileptic seizures observed in conversion disorder, which are psychogenic by nature, these seizures are intentionally caused by the patients (Huff, Lui & Murr, 2024). Factitious paroxysmal episodes may be more difficult to differentiate from epilepsy than psychogenic nonepileptic seizures (PNES) are (Romano et al., 2014). This raises the risk of a misdiagnosis, which results in the administration of inappropriate treatment, higher mortality risk, and excessive medical expenses (Romano et al., 2014).
Diagnosis and Treatment
Due to the patient’s dishonesty, gathering information on previous medical records may be difficult. Given that the symptoms reported by patients are often false or widely exaggerated, physicians must rely on other signs that could lead them to a factitious syndrome diagnosis.
These include:
- Ambiguous medical history
- Unusual illness trajectory
- Symptoms inconsistent with lab test results
- Patient’s reluctance to reach out to previous medical professionals or family members for information
(Mayo Clinic, 2019)
Since people with this syndrome are often unwilling to admit that they need help, experts recommend adopting a non-judgmental approach to suggesting a consultation with a mental health professional (NHS, 2024). Psychotherapeutic interventions such as cognitive behavior therapy (CBT) may help address underlying psychiatric conditions such as depression (Mayo Clinic, 2019). Severe cases of factitious disorder may warrant hospitalization in a mental health facility in hopes that a psychiatric hold prevents patients from undertaking invasive and dangerous interventions on themselves (Mayo Clinic, 2019).
Conclusion
Factitious disorder is a mental health condition characterized by a deliberate exaggeration or feigning of physical or psychological symptoms to assume the sick role, often without obvious external incentives. Because the clinical features of the condition do not match the ones reported or exhibited by patients, it is difficult to diagnose and manage this disorder.
References
Cleveland Clinic (2024). Munchausen Syndrome (Factitious disorder imposed on self). Cleveland Clinic. Retrieved from: https://my.clevelandclinic.org/health/diseases/9833-munchausen-syndrome-factitious-disorder-imposed-on-self#symptoms-and-causes
Huff, J. S., Lui, F., & Murr, N. I. (2024). Psychogenic Nonepileptic Seizures. StatPearls – NCBI Bookshelf. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK441871/
Mayo Clinic. (2019). Factitious disorder – Symptoms and causes. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/diseases-conditions/factitious-disorder/symptoms-causes/syc-20356028
National Health Service (2024). Overview – Munchausen syndrome. NHS. Retrieved from: https://www.nhs.uk/mental-health/conditions/munchausen-syndrome/overview/
Romano, A., Alqahtani, S., Griffith, J., & Koubeissi, M. Z. (2014). Factitious psychogenic nonepileptic paroxysmal episodes. Epilepsy & Behavior Case Reports, 2(C), 184–185. Retrieved from: https://doi.org/10.1016/j.ebcr.2014.08.006
