Factitious Disorder

Aka: Factitious Disorder, Secondary Gain, Munchausen Syndrome, Malingering

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II. Definitions

  1. Factitious Disorder
    1. Adoption of physical or psychologogical symptoms (simulated or created)
    2. Not motivated by material gain
      1. Motivated instead by desire to play the sick role
      2. Contrast with Malingering with secondary material gain
  2. Munchausen Syndrome
    1. Factitious Disorder characterized by habitual hospital presentations for apparent acute illness
    2. Patient gives a false, dramatic, but somewhat plausible history
  3. Munchausen Syndrome by Proxy
    1. Parent fabricates childhood illness resulting in unnecessary medical evaluation and treatment
  4. Malingering
    1. Purposeful feigning of physical symptoms for material gain (e.g. Substance Abuse, worker's comp)

III. Epidemiology

  1. Mean Age: 30-50 years
  2. Gender: Women represent two thirds of cases
  3. Occupation is frequently in healthcare or laboratory sciences

IV. Diagnosis: Factitious Disorder DSM-5

  1. Patient intentionally falsifies physical or psychological signs and symptoms or induces injury or illness
  2. Presents themselves to others as ill, impaired or injured
  3. Deceptive behavior is not connected to external incentive or reward
  4. Behavior not explained by other mental disorder

V. Findings

  1. Common Presentations
    1. Cardiovascular symptoms (e.g. Chest Pain, Dizziness, Shortness of Breath, Hypertension)
    2. Endocrine symptoms (e.g. Hypoglycemia, Thyrotoxicosis, Cushing Syndrome)
    3. Dermatologic symptoms (e.g. generalized skin lesions, or lesions localized to Breast, face, legs)
    4. Unusual results (e.g. vey low Body Temperature) in an otherwise healthy appearing patient
  2. Course
    1. Protracted illness with episodes of spontaneous remission, or unexplainable worsening
    2. When hospitalized, patients may suddenly worsen or develop new symptoms before intended discharge

VI. Differential Diagnosis

  1. Somatic Symptom Disorder
    1. Unintentional perceived organic symptoms
    2. Accepts painful or dangerous procedures
  2. Malingering
    1. Purposeful feigning of physical symptoms for material gain (e.g. Substance Abuse, worker's comp)
    2. Avoids painful or dangerous procedures
  3. Borderline Personality Disorder
    1. Impulsive, self-created injury or illness (intended self harm)
    2. Avoids painful or dangerous procedures
  4. Histrionic Personality Disorder
    1. Impulsive, simulated injury or illness (with grandiose or theatrical presentation)
    2. Avoids painful or dangerous procedures
  5. Illness Anxiety Disorder (Delusional Disorder, Hypochondriasis)
    1. Preoccupation with either contracting or having a serious medical disorder
    2. Accepts painful or dangerous procedures
  6. Factitious Disorder
    1. Adoption of physical or psychologogical symptoms (simulated or created) and not motivated by material gain
    2. Seeks painful or dangerous procedures

VII. Management

  1. Approach acute symptom presentations with the same thoroughness for all patients
    1. Focus on stabilization of the acute condition and a search for underlying causes
    2. Do not let suspicion for Factitious Disorder dissuade appropriate medical care for the given presentation
  2. Factitious Disorder is typically identified after a recurrent pattern of presentations
    1. Document in the medical record if suspicious of Factitious Disorder
    2. Use non-judgemental terms (in contrast to lying, pretending, malignering)
    3. Laboratory testing may be considered to support diagnosis (e.g. Insulin to C-Peptide ratio in Hypoglycemia)
  3. Avoid confronting patients about Factitious Disorder during acute presentations
    1. May worsen psychological stress and in some cases precipitate Suicidality
  4. Mental Health referral
    1. As with Somatic Symptom Disorder, refer Factitious Disorder to mental health

VIII. Prognosis

  1. Factitious Disorder is high risk for increased morbidity and mortality

IX. References

  1. Williams and Mehta (2025) Crit Dec Emerg Med 39(1): 4-12
  2. Hausteiner-Wiehle (2020) Dtsch Arztebl Int 117(26):452-9 +PMID: 32897184 [PubMed]

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Related Studies

Ontology: Factitious Disorders (C0015480)

Definition (NCI) A category of psychiatric disorders which are characterized by physical or psychological symptoms that are intentionally produced in order to assume the sick role; there is no external incentive for the behavior, such as economic gain or avoiding legal responsibility, and the person is unaware of any self-motivating factors.
Definition (MSH) Disorders characterized by physical or psychological symptoms that are not real, genuine, or natural.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D005162
ICD10 F68.1 , F68.10
SnomedCT 192528009, 50705009
DSM4 300.19
English Factitious disorder NOS, Disorders, Factitious, Factitious Disorders, Factitious Disorder NOS, Intentional production or feigning of symptoms or disabilities, either physical or psychological [factitious disorder], FACTITIOUS DIS, [X]Intent product/feign of symptom/disab eith physical/psych, [X]Intentional production or feigning of symptoms or disabilities, either physical or psychological [factitious disorder], [X]Int prd/fgn sym/dsb phy/psy, Intent product/feign of symptom/disab eith physical/psych, Int prd/fgn sym/dsb phy/psy, factitious disorder (diagnosis), factitious disorder, Factitious disorders, Factitious disorder, unspecified, Factitious Disorders [Disease/Finding], factitious disorders, factitious illness, disorder factitious, Factitious Disorder, [X]Intentional production or feigning of symptoms or disabilities, either physical or psychological [factitious disorder] (disorder), Factitious disorder, Factitious illness, Factitious disorder (disorder), disease (or disorder); artificial, factitious, disease (or disorder); feigned, without obvious motivation, disease (or disorder); feigning, disorder; factitious, disorder; feigned, without obvious motivation, disorder; intentional produced, disturbance; factitious, factitious; disorder, feigned; disease, without obvious motivation, feigned; disorder, without obvious motivation, intentional production; symptoms, intentional; produced disorder, symptoms; intentional production, Factitious disorder, NOS
Italian Disturbo fittizio, Disturbo fittizio NAS, Malattia fittizia, Disturbi fittizi
Dutch nagebootste stoornis NAO, nagebootste ziekte, aandoening; kunstmatig, zelf-toegebracht, aandoening; nagebootst, aandoening; voorgewend, zonder duidelijke reden, opzettelijk veroorzaakt; symptomen, opzettelijk; veroorzaakte aandoening, stoornis; opzettelijk veroorzaakt, stoornis; voorgewend, zonder duidelijke motivatie, stoornis; zelf-toegebracht, symptomen; opzettelijk veroorzaakt, voorgewend; aandoening, zonder duidelijke reden, voorgewend; stoornis, zonder duidelijke motivatie, zelf-toegebracht; stoornis, Opzettelijk veroorzaken of voorwenden van lichamelijke of psychische symptomen of beperkingen [nagebootste stoornis], nagebootste stoornissen, nagebootste stoornis, Nagebootste stoornis, Nagebootste stoornissen
French Trouble factice SAI, Trouble factice, Troubles factices
German vorgetaeuschte Krankheit, Simulierte Krankheiten NNB, Artifizielle Stoerung [absichtliches Erzeugen oder Vortaeuschen von koerperlichen oder psychischen Symptomen oder Behinderungen], Vorgetaeuschte Stoerungen, simulierte Krankheiten, Vorgetäuschte Störungen
Portuguese Doença factícia, Perturbação factícia NE, Transtornos Autoinduzidos, Perturbação factícia, Perturbações factícias
Spanish Enfermedad facticia, Trastorno facticio NEOM, [X]producción intencional o simulación de síntomas o de incapacidades, tanto físicas como psicológicas (trastorno facticio) (trastorno), [X]producción intencional o simulación de síntomas o de incapacidades, tanto físicas como psicológicas (trastorno facticio), Pseudodemencia, Pseudopsicosis, Trastornos Autoinducidos, trastorno facticio (trastorno), trastorno facticio, Trastornos facticios, Trastorno facticio, Trastornos Fingidos
Japanese 虚偽性障害ＮＯＳ, 虚偽性障害, ｷｮｷﾞｾｲｼｮｳｶﾞｲNOS, ｷｮｷﾞｾｲｼｮｳｶﾞｲ
Swedish Simulerade sjukdomar
Czech chování strojené, Předstírané onemocnění, Předstírané poruchy, Předstíraná porucha, Předstíraná porucha NOS, předstírané poruchy, faktitivní poruchy, nepřirozené chování
Finnish Itseaiheutetut häiriöt
Russian PSEVDODEMENTSIIA, IMITIRUEMYE RASSTROISTVA, VYMYSHLENNYE RASSTROISTVA, PSEVDOPSIKHOZ, GANZERA SINDROM, ВЫМЫШЛЕННЫЕ РАССТРОЙСТВА, ГАНЗЕРА СИНДРОМ, ИМИТИРУЕМЫЕ РАССТРОЙСТВА, ПСЕВДОДЕМЕНЦИЯ, ПСЕВДОПСИХОЗ
Korean 신체적 혹은 심리학적인 증상 또는 불구의 가장이나 고의성 유발.[인위적 장애]
Polish Zaburzenia pozorowane, Pseudopsychozy, Zaburzenia imitowane, Zespół Gansera, Otępienie rzekome
Hungarian Factitious zavar, Színleléses zavar k.m.n., Színleléses betegség, Factitiosus betegségek
Norwegian Ytre motivert simulering, Doctor shopper
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Malingering (C0024630)

Definition (MSHCZE) Předstírání (chorobných příznaků). Simulant je zdravý člověk, který předstírá příznaky nemoci. Úmysly mohou přitom být různé – pracovní neschopnost, získání náhrady za údajné poškození, vynucení pozornosti apod. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (MSH) Simulation of symptoms of illness or injury with intent to deceive in order to obtain a goal, e.g., a claim of physical illness to avoid jury duty.
Definition (PSY) Feigning or exaggerating illness or symptoms, usually in order to escape work, evoke sympathy, or gain compensation.
Concepts Individual Behavior (T055)
MSH D008306
SnomedCT 123086002, 23268009
DSM4 V65.2
Dutch simuleren, Simulatie
German Simulation, Simulieren
Italian Fingersi malato, Patomimia
Portuguese Sinulação, Simulação de Doença
Spanish Fingimiento de enfermedad, patomimia - RETIRADO -, simulación, patomimia - RETIRADO - (concepto no activo), simulación de enfermedad (hallazgo), simulación de enfermedad, Simulación de Enfermedad
French Sinistrose, Pathomimie, Simulation
Swedish Simulering
Czech simulování, Simulování, simulace
Finnish Sairaaksi tekeytyminen
Russian SIMULIATSIIA, СИМУЛЯЦИЯ
English malingering (diagnosis), malingering, Malingering, malinger, malingers, Feigning illness, Malingering (finding), Malingering -RETIRED-
Japanese 詐病, ｻﾋﾞｮｳ
Polish Symulacja choroby
Hungarian Szimulálás
Norwegian Malingering, Indre motivert simulering
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Munchausen Syndrome (C0026785)

Definition (MSH) A factitious disorder characterized by habitual presentation for hospital treatment of an apparent acute illness, the patient giving a plausible and dramatic history, all of which is false.
Definition (PSY) A disorder characterized by plausible presentations of physical symptoms or an acute illness that are under the individual's control, and often resulting in multiple, unnecessary hospitalizations.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D009110
ICD10 F68.1
SnomedCT 21586000, 268758001, 154900000
English Hospital-Addiction Syndrome, Hospital-Addiction Syndromes, Munchausen Syndrome, Munchhausen Syndrome, Syndrome, Hospital-Addiction, Syndrome, Munchausen, Syndrome, Munchhausen, Syndromes, Hospital-Addiction, Syndrome, Hospital Addiction, SYNDROME HOSP ADDICTION, HOSP ADDICTION SYNDROME, Munchhausen syndrome, Munchausen's syndrome (diagnosis), Münchausen syndrome, Munchausen Syndrome [Disease/Finding], Munchausen's syndrome (disorder), Munchausen's syndrome, Münchausen's syndrome (disorder), Münchausen's syndrome, munchausen's syndrome, munchausen syndrome, hospital addiction syndrome, munchhausen's syndrome, Munchhausens syndrome, munchhausen syndrome, munchausens syndrome, Munchausen syndrome, Hospital hopper syndrome, Peregrinating patient, Münchhausen, hospital hopper syndrome, Hospital Addiction Syndrome, Hospital addiction syndrome, munchhausens syndrome
Japanese ﾐｭﾝﾋﾊｳｾﾞﾝｼｮｳｺｳｸﾞﾝ, Munchausen症候群, Muenchausen症候群, ミュンヒハウゼン症候群, 病院常用症候群
Czech Münchhausenův syndrom, Munchhausenův syndrom
Finnish Münchausen-oireyhtymä
Russian SINDROM SKLONNOSTI K GOSPITALIZATSII, MIUNKHAUZENA SINDROM, GOSPITALIZM, ГОСПИТАЛИЗМ, МЮНХАУЗЕНА СИНДРОМ, СИНДРОМ СКЛОННОСТИ К ГОСПИТАЛИЗАЦИИ
Swedish Münchhausens syndrom
Polish Zespół Munchausena
Hungarian Münchausen-syndroma
Norwegian Münchhausens syndrom
Portuguese Síndrome de Münchausen, Hospitalismo, Síndrome de Munchausen
Dutch Münchausen-syndroom, Hospitaalverslavingssyndroom, Munchhausen-syndroom, Ziekenhuisverslavingssyndroom
German Muenchhausen Syndrom, Hospital-Addiction-Syndrom, Münchhausen-Syndrom
Spanish síndrome de Münchhausen (trastorno), síndrome de Münchhausen, Síndrome de Adicción al Hospital, Síndrome de Munchausen
French Syndrome de Münchhausen
Italian Sindrome di Munchausen
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Somatization Disorders

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