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Factitious disorders

Last reviewed: 4 Sep 2023
Last updated: 11 Aug 2022



History and exam

Key diagnostic factors

  • history of unexplained complaints or inconsistency over time
  • unusual presentation relative to demographics
More key diagnostic factors

Other diagnostic factors

  • symptoms more exaggerated while aware of being observed
  • presentation for care at many different hospitals
  • eyewitness evidence of the patient manipulating findings
  • dramatic history of travel and acute illness (Munchausen subtype)
  • multiple abdominal scars (Munchausen subtype)
  • medications or medical paraphernalia found in an unusual location in a patient's room
Other diagnostic factors

Risk factors

  • female sex (factitious disorder)
  • medically related employment (factitious disorder)
  • cluster B personality characteristics (factitious disorder)
  • male sex (Munchausen subtype)
  • single marital status (Munchausen subtype)
  • age 40 to 50 years (Munchausen subtype)
  • antisocial personality traits (Munchausen subtype)
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical history and exam
More 1st investigations to order

Investigations to consider

  • cultures (e.g., blood or wound)
  • serum C-peptide
  • urine sulfonylureas
  • urine electrolytes
  • urine protein
  • serum thyroglobulin
More investigations to consider

Treatment algorithm


suspected factitious disorder



James L. Levenson, MD

Professor of Psychiatry

Internal Medicine and Surgery


Department of Psychiatry


Division of Consultation/Liaison Psychiatry

Virginia Commonwealth University




JLL is the author of a reference cited in this topic.


Prof Levenson would like to gratefully acknowledge Prof Christopher P. Kogut, a previous contributor to this topic.


CPK declares that he has no competing interests.

Peer reviewers

Tanveer Padder,

Consulting Psychiatrist

Padder Health Services




TP declares that he has no competing interests.

Marc Feldman,

Clinical Professor of Psychiatry

University of Alabama




MF receives royalties for two books on the subjects covered in this topic (Routledge publishing and American Psychiatric Publishing). He is also an author of references cited in this topic.

  • Differentials

    • Malingering
    • Somatic symptom and related disorders
    • Organic disease
    More Differentials
  • Guidelines

    • Assessment and management of adults and children in cases of fabricated or induced illness
    • Munchausen by proxy: clinical and case management guidance
    More Guidelines
  • Patient leaflets

    Factitious disorders

    More Patient leaflets
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