Factitious disorder

Factitious disorder, previously called Munchausen syndrome, is a serious mental health condition in which people deceive others by pretending to be sick. They do this by faking symptoms, getting sick on purpose or hurting themselves. Factitious disorder also can happen when family members or caregivers falsely present others, such as children, as being ill, hurt or having a hard time functioning.

Factitious disorder symptoms can range from mild to severe. People may make up symptoms or even tamper with medical tests to convince others that they need treatment, such as high-risk surgery.

Factitious disorder isn't the same as making up medical issues for a benefit or reward, such as getting out of work or winning a lawsuit. Although people with factitious disorder know they are causing their symptoms or illnesses, they may not know why they do what they do or see themselves as having mental health issues.

Factitious disorder is a rare condition that can be hard to diagnose and treat. Help from medical and mental health professionals is critical to prevent serious injury and even death when people with factitious disorder hurt themselves.

Factitious disorder symptoms involve people trying to look ill, making themselves ill or hurting themselves. They also may fake symptoms, make symptoms seem worse than they are or pretend they can't do certain things because of their symptoms so they can deceive others. People with the condition work hard to hide their lies. It may be hard to know that their symptoms are part of a serious mental health condition. People with this condition continue with the lies, even without any benefit or reward, or when faced with evidence that doesn't support their claims.

Factitious disorder symptoms may include:

• Clever and convincing medical or mental health problems.
• Deep knowledge of medical terms and diseases.
• Vague symptoms or symptoms that aren't consistent.
• Conditions that get worse for no clear reason.
• Conditions that don't respond as expected to standard treatments.
• Seeking treatment from many healthcare professionals or hospitals, which may include using a fake name.
• Not wanting healthcare professionals to talk to family or friends or other healthcare professionals.
• Staying in the hospital a lot.
• Desire for frequent testing or risky surgeries and procedures.
• Many surgical scars or evidence of many procedures.
• Having few visitors when in the hospital.
• Arguing with healthcare professionals and staff.

Factious disorder imposed on another

Factitious disorder imposed on another, previously called Munchausen syndrome by proxy, is when someone falsely claims that another person has physical or mental symptoms of illness or causes injury or disease in another person to deceive others.

People with this condition present another person as sick, hurt or having a hard time functioning, claiming they need medical help. Usually this involves a parent harming a child. This form of abuse can put a child in danger of being hurt or getting medical care that isn't needed.

How those with factitious disorder fake illness

Because people with factitious disorder become experts at faking symptoms and diseases or hurting themselves, it may be hard for healthcare professionals and loved ones to know whether symptoms and illnesses are real.

People with factitious disorder make up symptoms or cause illnesses in several ways. For example, they may:

• Make symptoms seem worse than they are. Even when there is an actual medical or mental health condition, they may exaggerate symptoms. They may try to look sicker or make themselves look like they're having a harder time functioning than they actually are.
• Make up histories. They may give loved ones, healthcare professionals or support groups false medical histories, such as claiming to have had cancer or AIDS. Or they may create false health records to make it look like they're ill.
• Fake symptoms. They may fake symptoms, such as stomach pain, seizures or passing out.
• Hurt themselves. They may make themselves sick. For example, they may inject themselves with bacteria, milk, gasoline or feces. They may hurt, cut or burn themselves. They may take medicines, such as blood thinners or medicines for diabetes, to mimic diseases. They also may hinder wound healing, such as by reopening or infecting cuts.
• Tamper. They may tamper with medical instruments so results aren't correct. For example, they may heat up thermometers. Or they may tamper with lab tests, such as spoiling their urine samples with blood or other substances.

When to see a doctor

People with factitious disorder may know the risk of injury or even death when they hurt themselves or seek treatment that's not needed. But they have a hard time managing their behaviors. They also aren't likely to seek help. Even when they see proof that they're causing their illness, such as a video, they often deny it and refuse mental health help.

If you think that a loved one may be exaggerating or faking health problems, it may help to try to talk to that person about your concerns. Try not to be angry or to judge or confront the person. Also try to reinforce and urge healthier, more productive activities rather than focus on beliefs and behaviors that aren't healthy. Offer support and care. If possible, help find treatment for the person.

If your loved one causes self-harm or attempts suicide, contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential. The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).

If you suspect that a child is being harmed or abused by a caregiver as part of factitious disorder, you can contact the Childhelp National Child Abuse Hotline at 1-800-422-4453 (toll-free). This hotline is available 24 hours a day, seven days a week. There also may be local and state child protective services agencies in your area.

The cause of factitious disorder isn't known. But a mix of mental health issues and stressful life experiences may cause the condition.

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

• Childhood trauma, such as emotional, physical or sexual abuse.
• A serious illness during childhood.
• Loss of a loved one through death or illness, or feeling abandoned.
• Past experiences while sick and the attention it brought.
• A poor sense of identity or low self-esteem.
• Personality disorders.
• Depression.
• Desire to be linked with healthcare professionals or medical centers.
• Working in the healthcare field.

Factitious disorder is thought to be rare, but it isn't known how many people have the condition. Some people use fake names. Some visit many hospitals and healthcare professionals. And some are never identified. This makes it hard to get a reliable estimate.

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

• Injury or death from medical conditions that they cause themselves.
• Severe health issues from infections or from surgeries or other procedures that aren't needed.
• Loss of organs or limbs from surgeries that aren't needed.
• Misuse of alcohol or other substances.
• Major problems in daily life, including having trouble getting along with others and working.
• Abuse, when the behavior is imposed on another.

Because the cause of factitious disorder isn't known, there's no way to prevent it. Recognizing and treating factitious disorder may help avoid potentially dangerous tests and treatments that aren't needed.

Diagnosing factitious disorder is often very hard. People with factitious disorder are experts at faking many diseases and conditions. And while these people often look like they have real and even life-threatening medical conditions, they may have brought those conditions on themselves.

The use of many healthcare professionals and hospitals, the use of fake names, and privacy and confidentiality laws may make it hard or even impossible to gather information about previous medical experiences.

Diagnosis is based on objectively identifying symptoms that are made up, rather than the person's intent or motivation for doing so. A healthcare professional may suspect that people have factitious disorder when:

• Their medical history doesn't make sense.
• No believable reason exists for an illness or injury.
• The illness doesn't follow the usual course.
• There's no clear reason why they're not getting better, despite the right treatment.
• There are contradictory or inconsistent symptoms or lab test results.
• They don't want to give information from previous health records, other healthcare professionals or family members.
• They're caught lying or harming themselves.

To help figure out if a person has factitious disorder, healthcare professionals:

• Do a detailed interview.
• Require past health records.
• Work with family members to get more information — if the person being examined gives permission.
• Run only tests needed to look at possible physical issues.

Treatment of factitious disorder is often hard, and there are no standard therapies. Because people with factitious disorder want to be in the sick role, they often aren't willing to seek or accept treatment for the condition. But if approached in a way that doesn't judge, people with factitious disorder may agree to have a mental health professional assess and treat them.

An approach without judgment

Directly accusing people of having factitious disorder usually makes them angry and defensive. This can cause them to suddenly end a relationship with a healthcare professional or hospital and seek treatment elsewhere. So healthcare professionals may try to create an "out" that spares people the humiliation of admitting to faking symptoms and instead offer information and help.

For example, healthcare professionals may reassure people that not having an explanation for medical symptoms is stressful and suggest that the stress may be responsible for some physical complaints. Or the healthcare professional may ask people with factitious order to agree that if the next medical treatment doesn't work, they'll explore together the idea of a possible mental health reason for the illness. The healthcare professional also may suggest that the focus of treatment be on making them better able to function and making their quality of life better rather than treating symptoms.

Either way, the healthcare professionals try to steer people with factitious disorder toward care with a mental health professional. And both healthcare professionals and loved ones can reinforce healthy, productive behaviors and not give too much attention to symptoms.

Treatment options

Treatment often focuses on managing the condition and making people better able to function, rather than trying to cure it. Treatment generally includes:

• Having a primary healthcare professional. Using one healthcare professional to oversee medical care can help manage needed care and the treatment plan. This can reduce or stop visits to many healthcare professionals that aren't needed.
• Talk therapy. Talk therapy, also known as psychotherapy, and behavior therapy may help control stress and build coping skills. Family therapy also may be suggested. Other mental health conditions, such as depression, also may be addressed.
• Medicine. Medicines may be used to treat other mental health conditions, such as depression or anxiety.
• In-hospital treatment. If factitious disorder symptoms are severe, a short stay in a mental health hospital may be needed for safety and to create a treatment plan.

Treatment may not be accepted or may not help, especially for people with severe factitious disorder. In these cases, the goal may be to stop further invasive or risky treatments. When factitious disorder is imposed on others, healthcare professionals assess for abuse and need to report the abuse to authorities.

Along with professional treatment, these tips may help people who have factitious disorder:

• Stay with your treatment plan. Attend therapy appointments and take any medicines as directed. If you feel an urge to hurt yourself or cause yourself to become ill, talk honestly to your therapist or primary healthcare professional about better ways to cope with emotions.
• Have a medical gatekeeper. Rather than visiting many healthcare professionals, specialists and surgeons, have one trusted primary health professional to manage your medical care.
• Remember the risks. Remind yourself that you could be hurt for life or even die when you have a risky test or surgery that isn't needed.
• Don't run. Resist urges to find a new healthcare professional or flee to a new town where medical professionals don't know your background. Your therapist can help you overcome these powerful urges.
• Connect with someone. Many people with factitious disorder have no friends or close relationships. Try to find someone you can confide in, share enjoyable times with and offer your own support to.

People with factitious disorder are likely to first get care for this condition when healthcare professionals raise concerns that mental health issues may play a part in an illness. If people have symptoms of factitious disorder, healthcare professionals may get permission to contact family members in advance to talk about their loved one's health history.

Here's some information to help you get ready for that talk.

What you can do

To get prepared, make a list of:

• Your loved one's health history in as much detail as possible. Include health complaints, diagnoses, medical treatments and procedures. If possible, bring the names and contact information of healthcare professionals or facilities that provided care. Help your loved one sign releases of information to get records and allow for talks with other healthcare professionals.
• Any current behaviors or things you observe that make you think that your loved one may have factitious disorder. Note anything your loved one has been avoiding because of symptoms.
• Key points from your loved one's personal history, including childhood abuse or other trauma and any recent major losses.
• Medicines your loved one takes, including supplements, medicines bought without a prescription and prescription medicines, and the doses.
• Misuse of substances, including alcohol, drugs and prescription medicines.
• Questions for the healthcare professional to make the most of your discussion.

For factitious disorder, some questions to ask the healthcare professional include:

• What is likely causing my loved one's symptoms or condition?
• Are there other possible causes?
• How will you make the diagnosis?
• Is this condition likely to last for a short time or a long time?
• What treatments do you recommend for this disorder?
• How much do you expect treatment could improve the symptoms?
• How will you monitor my loved one's well-being over time?
• Do you think family therapy will help?
• What next steps should be taken?

What to expect from the doctor

The doctor or other healthcare professional will likely ask you several questions, including:

• What injuries or illnesses has your loved one recently complained of or been treated for in the past?
• Has your loved one ever been diagnosed with any specific medical issue?
• What treatments has your loved one had, including medicines and surgery?
• How often has your loved one changed healthcare professionals or hospitals in the past?
• Have any healthcare professionals, friends or family members had concerns that your loved one may be causing or contributing to an illness?
• Have any healthcare professionals, friends or family members had concerns that your loved one may be causing or contributing to illness in another person?
• How have your loved one's symptoms affected work, school and personal relationships?
• Do you know if your loved one has caused self-harm or hurt others, or attempted suicide?
• Did your loved one experience any trauma during childhood, such as a serious illness, loss of a parent or abuse?
• Have you talked with your loved one about your concerns?