Factitious disorders

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 medications to simulate disease.

Systematic evidence for directing treatment is lacking.

Factitious disorder is a syndrome in which signs and/or symptoms of disease are intentionally feigned, exaggerated, or self-induced by a patient when there is no clear principal external incentive for the behavior.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022. The psychiatric nomenclature distinguishes factitious disorder from several related disorders by both the intentionality of the behavior and its motivation. Symptoms produced without conscious intent are considered a somatic symptom disorder. Symptoms intentionally feigned or created for some external reward, such as getting out of jail or obtaining unneeded pain medication, are considered malingering.

Distinguishing factitious disorder from related conditions can be a difficult task, particularly because they can sometimes co-exist in the same patient.[Figure caption and citation for the preceding image starts]: Distinguishing factitious disorder from related conditionsFrom the personal collection of Christopher P. Kogut, Virginia Commonwealth University, VA [Citation ends].