Looking back at your life, have you or someone you know ever faked being sick to get out of an obligation? When it happens on a one-off occasion, we typically don’t find that behavior being anything out of the ordinary. Honestly, we have all probably seen it happen every once in a while. Whether it be a child who fakes a cough to stay at home from school, or a busy office worker who calls in ‘sick’ to actually go to a concert, using a fake or exaggerated illness for practical benefits or to get out of something you didn’t want to do is mostly harmless (but probably something you shouldn’t make a habit out of!). Although these ‘harmless’ examples might happen from time to time, there is a mental disorder in which diagnosed individuals purposely deceive those around them into believing they have serious injuries or impairments when they really do not. Affecting just about 0.1% of the population, factitious disorder is a secretive, hard-to-diagnose condition that can have serious negative effects when diagnosed individuals receive medical attention or resources that they do not actually need.1 In this blog, we will discuss the ins and outs of factitious disorder and how it affects those with the condition.
Signs and Symptoms of Factitious Disorder
Factitious disorder, also known as Munchausen syndrome, is a mental health disorder in which diagnosed individuals deceive others by convincing them that they are physically or mentally ill. Affected individuals attempt to mimic symptoms of various illnesses to gain sympathy, care, and medical attention from those around them. Those with the condition go to great lengths to hide their deceit, and this can make it especially difficult for providers to know when their symptoms are genuine or if they could potentially be suffering from factitious disorder. While many people may be able to relate to ‘faking’ an illness for practical benefits, those with factitious disorder do not seem to seek any type of benefit or reward from their behavior. Even when their ‘symptoms’ may be debunked by objective medical evidence, affected individuals continue to exaggerate their impairments and symptoms. Individuals with this condition go to great lengths to make their ‘illness’ believable, and are willing to undergo risky procedures, take unnecessary medication, or endure painful tests to continue getting special attention from those around them.
Because of the secretive, deceptive nature of factitious disorder, it can be difficult to know what its symptoms are. Some patients will present with simple, yet serious symptoms that demand immediate attention such as chest pain or breathing issues. Other patients may present with more confusing, complicated symptoms. However, there are some things that providers can look out for that raise suspicion. After an extensive work-up is done to outrule any other physical or mental illnesses, a provider may refer the patient to a mental health professional. Below are some examples of possible warning signs that an individual is suffering from factitious disorder:2,3
- Inconsistent and unclear medical symptoms
- Very extensive knowledge of medical terminology or processes
- ‘Textbook’ knowledge on various illnesses
- Suffers from conditions that do not respond to typical or standard therapies
- Conditions worsen without logical or apparent reason
- Dramatic medical history that is hard to follow
- Symptoms are inconsistent with exam findings, anatomy, or physiology
- Medical records do not match patient-provided information
- Extensive knowledge on hospitals
- Symptoms are hard to control or become more severe even after treatment
- Symptoms only present when patient is by themselves
- Relapse of symptoms are unpredictable after medical intervention
- New symptoms appear after test results come back negative
- Eager to have frequent medical testing or procedures
- Looks for treatment at multiple hospitals from multiple doctors, may even go to a different city
- Seeks treatment under false names
- Frequent stays at the hospital
- Unwilling to let medical providers speak to their friends, family, or prior medical providers
- Unwilling to release past medical records
- Refuses psychiatric or mental evaluations
- Presents with surgical scars
Other symptoms of factitious disorder include:
- Hurting oneself to mimic symptoms
- Lie about symptoms
- Lie or exaggerate medical histories
- Tampering with diagnostic tests to yield specific results (ex. Contaminating urine samples or heating up thermometers)
- Arguing with doctors and other medical staff
- Refusing visitors when they are hospitalized
How or why does factitious disorder develop?
A lot of the time, individuals who are suffering from factitious disorder are unaware they are suffering from a serious mental disorder. They may not understand that they are inducing their own symptoms or illness, and may even deny that they are suffering from a mental illness if told so. Currently, there are not many high-quality, extensive research studies that explain the etiology of factitious disorder, but many providers and researchers have agreed that factitious disorder is mostly a result of developmental factors.4
Researchers have shown that those with factitious disorder may have developed the mental disorder as a result of adverse childhood events or challenges. For example, patients with factitious disorder are more likely to have gone through a major illness in their childhood. A research review showed that among 20 patients with factitious disorder, 60% of the patients had personal histories with major childhood illness.4 Researchers supposed that this early exposure to medical intervention and hospital settings can trigger the development of factitious disorder. In addition, professionals agree that individuals with factitious disorder are more likely to have suffered from troublesome or traumatic childhoods. A study on 57 individuals with factitious disorder showed that only 3 of the 57 people felt that they had ‘good’ childhoods. The other individuals characterized their childhoods as more troubling with different forms or physical or emotional abuse.4
Patients with factitious disorder may display these behaviors due to a number of reasons. For one, individuals with factitious disorder may enjoy or even crave the affection that comes with the ‘sick role’. When you are sick, the more people care for you, are gentle with you, and act in ways to help you feel more comfortable and cared for. For those who lacked affection during childhood, perpetually staying in the sick role may alleviate some discomfort from that kind of upbringing. Those with factitious disorder may be seeking relationships or enjoy being cared for by other people. They may also be seeking to feel the same type of ‘special attention’ and sympathy that those who are truly sick receive. Or, on the other hand they may also find a certain kind of accomplishment or pride in being able to stump medical professionals.
Is Factitious Disorder the same thing as Munchausen by Proxy?
There are two types of factitious disorder. Above, we have explored the manifestations of factitious disorder imposed on self, also known as Munchausen syndrome. However, there is another type of factitious disorder known as factitious disorder imposed on another (FDIA), or Munchausen by proxy. With FDIA, individuals are not attempting to fabricate their own ‘illnesses’. Rather, individuals within a caregiver role act as if their child or dependent has a medical condition that requires medical intervention or attention. Typically, a person with FDIA is a mother (although fathers can have this mental illness as well) and the child under their care is typically under 6 years of age. Other times, the dependent person may even be an adult, disabled individual, or someone elderly. This condition is just as dangerous, or even more dangerous than factitious disorder, because an individual is subjecting others to medical procedures and treatments that are completely unnecessary.
An individual may be likely to develop FDIA due to an unfulfilled need to get sympathy or attention from other people about their parenting or caretaking skills. When individuals mimic medical symptoms in their young children, they may hope to be praised or acknowledged for taking such good care of their child. Individuals are not faking their dependents’ illnesses for financial gain, but are more so looking for the validation and sympathy that accompanies people who are actually sick. Some common characteristics in an individual with FDIA include:5,6
- Being a parental figure (typically a mother) with small children
- Being a healthcare professional themselves or having extensive medical knowledge
- They are able to explain the child’s symptoms with very incredible detail
- They are very involved with their child’s healthcare team, are typically very friendly and cooperative with medical staff
- May also suffer from factitious disorder imposed on self
Other signs to look for in children include:
- Having a history of many hospitalizations
- Having seen a lot of health care professionals
- Having an unusual set of symptoms that go away in medical settings but start up again at home
- The child or dependent does not have lab work that matches symptoms
- All the symptoms are solely reported by the caretaker
- Blood samples do not match their blood type
- Drugs, chemicals, or other tampering measures are taken on their urine, stool, and blood
Diagnosing FDIA can be especially difficult for healthcare professionals because of how much deception is involved, and the safety of a child or dependent is at stake. FDIA can cause vulnerable individuals to undergo risky procedures and tests when there is no objective evidence that it is necessary. Healthcare professionals must rule out any and all other possibilities for physical or mental illness in the child before considering an FDIA diagnosis in the caregiver. Social workers and other legal intervention is necessary if such a diagnosis is eventually made for the caregiver. Similarly to factitious disorder imposed on self, it can be very difficult to explain to patients that they have a serious mental disorder. They may be unaware of the thoughts and patterns that they exhibit, and early intervention is especially important when a dependent individual is involved.