Factitious Disorder

Factitious disorder is deliberate falsification or induction of physical or psychological illness without obvious external reward, motivated by assuming the sick role.

• Imposed on self (Munchausen syndrome in severe form) or imposed on another (formerly by proxy, usually a mother harming a child, a form of child abuse).
• Prevalence 0.5 to 1% of hospital patients; health professionals overrepresented.
• Associated with personality disorders (borderline), childhood neglect or abuse, depression.
• Distinct from malingering (external incentive) and conversion disorder (unintentional).

• Dramatic, inconsistent history; symptoms mimic disease (fever from manipulated thermometers, infections from injections, hypoglycaemia from insulin, anaemia by blood letting).
• Multiple admissions, extensive previous records, willingness to undergo invasive procedures, inconsistent test results, improvement when unobserved.
• Imposed on another: unexplained recurrent illness in a child, resolves on separation from caregiver.

• Careful review of all records, collateral history, and evidence of deception (e.g., low C peptide with high insulin in factitious hypoglycaemia, unusual flora in infections, covert monitoring where legal).
• Exclude genuine disease, then confirm falsification.
• Screen for depression, personality disorder and suicidality.
• Imposed on another: immediate child protection involvement, multidisciplinary review, separation if necessary.

• Avoid confrontation that causes patient to leave; non punitive discussion, private offer of psychiatric help, collaborative approach with a single point of care.
• Psychotherapy (CBT, supportive, psychodynamic); treat comorbid depression and personality disorder.
• Avoid unnecessary procedures and medication; document clearly.
• Imposed on another: safeguard the child, notify child protection services and police as needed, legal process.
• Prognosis is poor; long term follow up.