Factitious Disorders

Factitious Disorders



Factitious disorders are a group of mental disturbances in which patients intentionally act physically or mentally ill without obvious benefits. The name factitious comes from a Latin word that means artificial. These disorders are not malingering, which is defined as pretending illness when the "patient" has a clear motive, such as financial gain.


Patients with factitious disorders produce or exaggerate the symptoms of a physical or mental illness by a variety of methods, including contaminating urine samples with blood, taking hallucinogens, injecting themselves with bacteria to produce infections, and other similar behaviors.
There are no reliable statistics on the frequency of factitious disorders, but they are more common in men than in women. The following conditions are sometimes classified as factitious disorders:

Munchausen syndrome

Munchausen syndrome refers to patients whose factitious symptoms are dramatized and exaggerated. Many persons with Munchausen go so far as to undergo major surgery repeatedly, and, to avoid detection, at several locations. Many have been employed in hospitals or in health care professions. The syndrome's onset is in early adulthood.

Munchausen by proxy

Munchausen by proxy is the name given to factitious disorders in children produced by parents or other caregivers. The parent may falsify the child's medical history or tamper with laboratory tests in order to make the child appear sick. Occasionally, they may actually injure the child to assure that the child will be treated.

Ganser's syndrome

Ganser's syndrome is an unusual dissociative reaction to extreme stress in which the patient gives absurd or silly answers to simple questions. It has sometimes been labeled as psychiatric malingering, but is more often classified as a factitious disorder.

Causes and symptoms

No single explanation of factitious disorders covers all cases. These disorders are variously attributed to underlying personality disorders; child abuse; the wish to repeat a satisfying childhood relationship with a doctor; and the desire to deceive or test authority figures. Also, the wish to assume the role of patient and be cared for is involved. In many cases, the suffering of a major personal loss has been implicated.
The following are regarded as indications of a factitious disorder:
  • dramatic but inconsistent medical history
  • extensive knowledge of medicine and/or hospitals
  • negative test results followed by further symptom development
  • symptoms that occur only when the patient is not being observed
  • few visitors
  • arguments with hospital staff or similar acting-out behaviors
  • eagerness to undergo operations and other procedures
When patients with factitious disorders are confronted, they usually deny that their symptoms are intentional. They may become angry and leave the hospital. In many cases they enter another hospital, which has led to the nickname "hospital hoboes."


Diagnosis of factitious disorders is usually based on the exclusion of bona fide medical or psychiatric conditions, together with a combination of the signs listed earlier. In some cases, the diagnosis is made on the basis of records from other hospitals.


Treatment of factitious disorders is usually limited to prompt recognition of the condition and the refusal to give unnecessary medications or to perform unneeded procedures. Factitious disorder patients do not usually remain in the hospital long enough for effective psychiatric treatment. Some clinicians have tried psychotherapeutic treatment for factitious disorder patients, and there are anecdotal reports that antidepressant or antipsychotic medications are helpful in certain cases.


Some patients have only one or two episodes of factitious disorders; others develop a chronic form that may be lifelong. Successful treatment of the chronic form appears to be rare.



Eisendrath, Stuart J. "Psychiatric Disorders." In Current Medical Diagnosis & Treatment, 1998, edited by Stephen J. McPhee, et al., 37th ed. Stamford: Appleton & Lange, 1997.

Key terms

Ganser's syndrome — An unusual factitious disorder characterized by dissociative symptoms and absurd answers to direct questions.
Malingering — Pretending to be sick in order to be relieved of an unwanted duty or obtain some other obvious benefit.
Munchausen by proxy — A factitious disorder in children produced by a parent or other caregiver.
Munchausen syndrome — A factitious disorder in which the patient's symptoms are dramatized and exaggerated.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.
References in periodicals archive ?
Functional visual disorders (malingering and factitious disorders) constituted the next common condition for the referral (27.6% of the patients).
In fact, the authors have found that BPD tends to be comorbid with factitious disorders and depression (Tripolar syndrome) with a tendency to overuse hospital and medical facilities, inclusive of Accident and Emergency (A&E) departments, family doctors and General Practitioner (GP) surgeries (2).
They address response styles, detection strategies organized by response styles and domains, and cultural and transnational perspectives; disorders and syndromes associated with dissimulation, including feigned psychosis, denied psychopathy, malingered traumatic brain injury, denial and misreporting of substance abuse, malingering of posttraumatic disorders, factitious disorders in medical and psychiatric practices, and feigned medical presentations; psychometric methods; specialized methods, such as polygraph techniques, methods for the recovery of memories of childhood sexual abuse, methods for deception in sex offenders, structured interviews, and brief measures; and specialized applications, such as deception in children and adolescents and assessment of law enforcement personnel.
Gayle braids together her own narration of the charged weeks surrounding her mother's suicide, transcripts of her mother's documentary, research into delusional and factitious disorders, and Gayle's own experience with misdiagnosis and illness (both fabricated and real).
The neuropsychiatrist is frequently called upon to diagnose and treat patients with neurological symptoms that do not have an identifiable physiological cause, such as in conversion, dissociation and factitious disorders. She/he should be able to work with colleagues in other disciplines to determine which further tests and investigations are necessary or not as the case may and to competently handle such cases.
Central to understanding factitious disorders and malingering are the explanatory models and beliefs used to provide meaning for both patients and doctors.
Munchausen's syndrome and factitious disorders in children-case series and literature review.
Dermatitis artefacta is considered to be a disease from the group of factitious disorders, which rule out other medical conditions like escoriative injuries, delusional disorders or simulation.
Factitious disorders are characterized by intentionally abnormal physical and/or psychological behavior, and affected patients often make up their symptoms and clinical histories.
Although there are no medicines to treat factitious disorders, they may be used to treat any related condition such as depression, anxiety, or a personality disorder.
In differential diagnosis of the abnormal illness behaviors of malingering, factitious disorders, and somatoform disorders, counselors must evaluate how much the client's deceptive behavior is conscious and intentional (Wiley, 1998).
Factitious disorders (FDs), also known as dermatitis artefacta or pathomimia, describe a set of faked of self-inflicted skin lesions created without a clear external incentive.