Factitious Disorder - Anatomy of Psych

What is factitious disorder?

Factitious disorder, also known as Munchausen syndrome, is a falsification of physical or psychological signs or symptoms with no obvious reward. The individual is aware that they are exaggerating. Since this condition involves deception, the actual prevalence rate is unknown. However, it is estimated that 1% of individuals in hospital settings may meet the criteria for the disorder. In factitious disorder imposed on another, also known as Munchausen syndrome by proxy, almost all perpetrators are women, with over 95% being the mother.

The onset of factitious disorder is typically in early adulthood, often following hospitalization for medical or psychiatric reasons. Individuals with the disorder often have a history of multiple hospital admissions and are willing to undergo invasive procedures.

What does factitious disorder look like?

Signs & Symptoms

Taking surreptitious actions to deliberately misrepresent, stimulate, or cause signs or symptoms of illness or injury in the absence of obvious external rewards
Deceptive reports of neurological symptoms, manipulation of laboratory tests, falsification of medical records to indicate an illness, ingestion of a substance to induce an abnormal laboratory result or illness, physically injuring oneself to induce illness
Dramatic but inconsistent medical history, presenting to numerous hospitals, an eagerness to have medical interventions, new symptoms following negative test results, presence of symptoms only when the patient is alone or not being observed by a clinician, extensive knowledge of medical terminology
Struggling with problems of identity and self-esteem

DSM-5 Criteria

Factitious disorder imposed on self

Criterion A. Falsification (i.e. deliberately feigning) of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.

Criterion B. The individual presents himself or herself to others as ill, impaired, or injured.

Criterion C. The deceptive behavior is evident even in the absence of obvious external rewards.

Criterion D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Factitious disorder imposed on another

Criterion A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception.

Criterion B. The individual presents another individual (victim) to others as ill, impaired, or injured.

Criterion C. The deceptive behaviour is evident even in the absence of obvious external rewards.

Criterion D. The behaviour is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Note: The perpetrator, not the victim, receives this diagnosis.

Specifiers

Risk Factors

History of childhood abuse or neglect
History of a true medical treatment requiring extensive treatment as a child
Past important relationships with a physician
Underlying malicious intent toward the medical profession

Differential Diagnosis

Self-protection from liability
Early-stage medical conditions
Somatic symptom disorder
Malingering
Conversion disorder
Borderline personality disorder
Medical condition or mental disorder not associated with intentional symptom falsification

How is factitious disorder treated?

Psychoanalytic or psychodynamic therapy
Cognitive behavioral therapy (CBT)
Family therapy

References

[1] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.

[2] Boyd, M. A. (2019). Psychiatric & mental health nursing for Canadian practice. Wolters Kluwer.

[3] Townsend, M. C. (2015). Psychiatric mental health nursing. F.A. Davis.