Highlights & Basics
- Factitious disorders are uncommon disorders in which the patient intentionally fabricates physical or psychological symptoms primarily for the purpose of deceiving healthcare providers and/or others.
- Patients are motivated primarily by a desire to assume the sick role rather than by the hope to achieve external rewards.
- Munchausen syndrome is an extreme form.
- Factitious disorder imposed on another (previously factitious disorder by proxy) describes the clinical scenario wherein the patient feigns or induces signs or symptoms of illness in another person who is under the patient's care, when there are no clear external incentives. It is a potentially lethal form of abuse, as patients may inadvertently induce coma or death by giving drugs to simulate disease.
- Systematic evidence for directing treatment is lacking.
Quick Reference
History & Exam
Key Factors
Other Factors
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Definition
Epidemiology
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Citations
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022.
Hausteiner-Wiehle C, Hungerer S. Factitious disorders in everyday clinical practice. Dtsch Arztebl Int. 2020 Jun 26;117(26):452-9.[Abstract][Full Text]
Bass C, Wade DT. Malingering and factitious disorder. Pract Neurol. 2019 Apr;19(2):96-105.[Abstract]
Eastwood S, Bisson JI. Management of factitious disorders: a systematic review. Psychother Psychosom. 2008;77(4):209-18.[Abstract]
1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022.
2. Asher R. Munchausen's syndrome. Lancet. 1951 Feb 10;1(6650):339-41.[Abstract]
3. Wise MG, Ford CV. Factitious disorders. Prim Care. 1999 Jun;26(2):315-26.[Abstract]
4. Sutherland AJ, Rodin GM. Factitious disorders in a general hospital setting: clinical features and a review of the literature. Psychosomatics. 1990 Fall;31(4):392-9.[Abstract]
5. Gault MH, Campbell NR, Aksu AE. Spurious stones. Nephron. 1988;48(4):274-9.[Abstract]
6. Yates GP, Feldman MD. Factitious disorder: a systematic review of 455 cases in the professional literature. Gen Hosp Psychiatry. 2016 May 12;41:20-8.[Abstract][Full Text]
7. Bérar A, Balusson F, Allain JS. Factitious disorder imposed on self: a retrospective study of 2232 cases from health insurance databases. Gen Hosp Psychiatry. 2023 Nov-Dec;85:114-9.[Abstract][Full Text]
8. Hausteiner-Wiehle C, Hungerer S. Factitious disorders in everyday clinical practice. Dtsch Arztebl Int. 2020 Jun 26;117(26):452-9.[Abstract][Full Text]
9. Tatu L, Aybek S, Bogousslavsky J. Munchausen syndrome and the wide spectrum of factitious disorders. Front Neurol Neurosci. 2018;42:81-6.[Abstract]
10. Dickerman AL, Jiménez XF. Psychosocial and psychodynamic considerations informing factitious disorder. Psychodyn Psychiatry. 2023 Mar;51(1):98-113.[Abstract][Full Text]
11. Pankratz L, Lezak MD. Cerebral dysfunction in the Munchausen syndrome. Hillside J Clin Psychiatry. 1987;9(2):195-206.[Abstract]
12. Fenelon G, Mahieux F, Roullet E, et al. Munchausen's syndrome and abnormalities on magnetic resonance imaging of the brain. BMJ. 1991 Apr 27;302(6783):996-7.[Abstract][Full Text]
13. Krahn LE, Li H, O'Connor MK. Patients who strive to be ill: factitious disorder with physical symptoms. Am J Psychiatry. 2003 Jun;160(6):1163-8.[Abstract]
14. Bérar A, Bouzillé G, Jego P, et al. A descriptive, retrospective case series of patients with factitious disorder imposed on self. BMC Psychiatry. 2021 Nov 23;21(1):588.[Abstract][Full Text]
15. Jimenez XF, Nkanginieme N, Dhand N, et al. Clinical, demographic, psychological, and behavioral features of factitious disorder: a retrospective analysis. Gen Hosp Psychiatry. 2020 Jan-Feb;62:93-5.[Abstract]
16. Abdurrachid N, Gama Marques J. Munchausen syndrome by proxy (MSBP): a review regarding perpetrators of factitious disorder imposed on another (FDIA). CNS Spectr. 2022 Feb;27(1):16-26.[Abstract]
17. Bass C, Wade DT. Malingering and factitious disorder. Pract Neurol. 2019 Apr;19(2):96-105.[Abstract]
18. Comacchio C, Misca DM, Bortoletto R, et al. Prevalence and risk factors for depression in factitious disorder: a systematic review. Front Psychiatry. 2024;15:1355243.[Abstract][Full Text]
19. Ameh V, Speak N. Factitious hypoglycaemia in a nondiabetic patient. Eur J Emerg Med. 2008 Feb;15(1):59-60.[Abstract]
20. Feldman MD, Miner ID. Factitious Usher syndrome: a new type of factitious disorder. Medscape J Med. 2008 Jun 30;10(6):153.[Abstract][Full Text]
21. Levenson JL, Valverde R, Olbrisch ME. Factitious wound infections in an altruistic living liver donor. Prog Transplant. 2008 Mar;18(1):22-4.[Abstract]
22. Nwaejike N, Archbold H, Wilson DS. Factitious lymphoedema as a psychiatric condition mimicking reflex sympathetic dystrophy: a case report. J Med Case Reports. 2008 Jun 24;2:216.[Abstract][Full Text]
23. Santangelo WC, Richey JE, Rivera L, et al. Surreptitious ipecac administration simulating intestinal pseudo-obstruction. Ann Intern Med. 1989 Jun 15;110(12):1031-2.[Abstract]
24. Shelton JH, Santa Ana CA, Thompson DR, et al. Factitious diarrhea induced by stimulant laxatives: accuracy of diagnosis by a clinical reference laboratory using thin layer chromatography. Clin Chem. 2007 Jan;53(1):85-90.[Abstract][Full Text]
25. Tojo A, Nanba S, Kimura K, et al. Factitious proteinuria in a young girl. Clin Nephrol. 1990 Jun;33(6):299-302.[Abstract]
26. Gregory RJ, Jindal S. Factitious disorder on an inpatient psychiatry ward. Am J Orthopsychiatry. 2006 Jan;76(1):31-6.[Abstract]
27. Parker PE. A case report of Munchausen syndrome with mixed psychological features. Psychosomatics. 1993 Jul-Aug;34(4):360-4.[Abstract]
28. Sigal MD, Altmark D, Carmel I. Munchausen syndrome by adult proxy: a perpetrator abusing two adults. J Nerv Ment Dis. 1986 Nov;174(11):696-8.[Abstract]
29. Giurgea I, Ulinski T, Touati G, et al. Factitious hyperinsulinism leading to pancreatectomy: severe forms of Munchausen syndrome by proxy. Pediatrics. 2005 Jul;116(1):e145-8.[Abstract][Full Text]
30. Astuto M, Minardi C, Rizzo G, et al. Unexplained seizures in an infant. Lancet. 2009 Jan 3;373(9657):94.[Abstract]
31. Meehan WP 3rd, Merschman KM, Chiang VW. An 18-month-old girl with recurrent apneic spells. Pediatr Emerg Care. 2008 Aug;24(8):546-9.[Abstract]
32. Goh WY, Chan MPC. Factitious disorder imposed on another in palliative care: a case report. J Palliat Med. 2023 Aug;26(8):1165-7.[Abstract][Full Text]
33. Wallach J. Laboratory diagnosis of factitious disorders. Arch Intern Med. 1994 Aug 8;154(15):1690-6.[Abstract]
34. Eastwood S, Bisson JI. Management of factitious disorders: a systematic review. Psychother Psychosom. 2008;77(4):209-18.[Abstract]
35. Sousa Filho D, Kanomata EY, Feldman RJ, et al. Munchausen syndrome and Munchausen syndrome by proxy: a narrative review. [in por]. Einstein (Sao Paulo). 2017 Oct-Dec;15(4):516-21.[Abstract][Full Text]
36. Olha KV, Vasyl YV, Vladyslav SA, et al. Fever in Munchausen syndrome. umj. 2024 Aug 19;8(166).[Full Text]
37. Royal College of Paediatrics and Child Health. Perplexing presentations (PP)/Fabricated or induced Iilness (FII) in children - guidance. Mar 2021 [internet publication].[Full Text]
38. Royal College of Psychiatrists. Assessment and management of adults and children in cases of fabricated or induced illness (FII). Mar 2020 [internet publication].[Full Text]
39. American Professional Society on the Abuse of Children (APSAC). Munchausen by proxy: clinical and case management guidance. 2017 [internet publication].[Full Text]
