Last reviewed: 26 Apr 2022
Last updated: 14 Jun 2019
Summary
Definition
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 (common-variety factitious disorder)
- medically related employment (common-variety factitious disorder)
- cluster B personality characteristics (common-variety 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
ACUTE
suspected factitious disorder
Contributors
Authors
Christopher P. Kogut, MD, MSW

Assistant Professor
Department of Psychiatry
Virginia Commonwealth University
Richmond
VA
Disclosures
CPK declares that he has no competing interests.
James L. Levenson, MD
Professor of Psychiatry
Internal Medicine and Surgery
Vice-Chair
Department of Psychiatry
Chair
Division of Consultation/Liaison Psychiatry
Virginia Commonwealth University
Richmond
VA
Disclosures
JLL is the author of a reference cited in this topic.
Peer reviewers
Joel Yager, MD
Professor
Department of Psychiatry
University of New Mexico School of Medicine
Albuquerque
NM
Disclosures
JY is an author of a reference cited in this topic.
Adrianne Reveley, MA, MB, BCh, FRCPsych
Consultant Psychiatrist
The London Medical Centre
London
UK
Disclosures
AR declares that she has no competing interests.
Differentials
- Malingering
- Somatoform disorders
- Organic disease
More DifferentialsGuidelines
- Munchausen by Proxy: Clinical and Case Management Guidance
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