The disorder has since been renamed and is now classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as “factitious disorder imposed on self.”
Symptoms
People with factitious disorder imposed on self (FDIS) will deliberately cause, misrepresent, and/or exaggerate their symptoms (physical or psychological). They may suddenly leave a hospital and move to another area when it is discovered that they are not being truthful. The following are some examples of behavior you may see in somebody with FDIS:
Complaining of neurological symptoms (such as seizures, dizziness, or blacking out), the presence of which are often difficult to determineDoing something to purposely injure themselves in order to cause illness (for example, drinking a poisonous substance to have a violent stomach reaction)Exaggeration of an actual injury that may lead to additional and unnecessary medical interventionFalsifying medical records to specify an illnessManipulating a laboratory test (for example, by adding blood to urine or ingesting a medication) to obtain a false abnormal resultPhysically hurting themselves to cause an injuryReporting being depressed and suicidal following an event (like a death of a child) even though there was no death and/or the person does not even have a child
Warning Signs
If you are concerned that someone you know may be affected by FDIS, there are some warning signs that you can look out for. The main sign is that the individual seems to always be complaining about and/or exaggerating symptoms of an illness. Additional warning signs can include:
Ambiguous symptoms that are not able to be controlled and become even more severe or change after beginning treatment Complaints of new or more symptoms following negative test results Extensive but inconsistent medical history Extensive knowledge of hospitals and/or medical terminology (including textbook descriptions of illnesses) History of obtaining treatment at several hospitals, clinics, and doctors’ offices (possibly in different cities or zip codes) Presence of symptoms only when the person is alone or not being observed Problems with identity and self-esteem Reluctance or unwillingness to allow medical professionals to meet with or talk to family, friends, or past medical providers Willingness or eagerness to go to the hospital as well as undergo medical tests, operations, and procedures
Diagnosis
Diagnosing FDIS can be very hard because of all of the dishonesty associated with the disorder. Doctors must first rule out any possible physical and mental illnesses before considering a diagnosis of Munchausen syndrome. Additionally, in order to be diagnosed with Munchausen syndrome/factitious disorder imposed on self, the following four criteria must be met:
Causes
The exact cause of this disorder is not known. Due to the deception surrounding Munchausen syndrome, it is also not known exactly how many people are affected by it (but the number is likely very low). The onset of symptoms usually occurs in early adulthood, often after hospitalization for a medical condition. Unfortunately, this is a complex and poorly understood condition.
Childhood Abuse or Neglect
One theory of what causes this mental disorder is a history of abuse, neglect, or abandonment as a child. A person may have unresolved parental issues because of this trauma. These issues may, in turn, cause the individual to fake being sick. People may do this because they:
Need to feel important and be the center of attentionHave a need to punish themselves by making themselves sick (because they feel unworthy)Need to pass responsibility for their welfare and care on to other people
Childhood Illness and Hospitalization
Another theory points to a history of frequent or prolonged illnesses that required hospitalization (especially if this took place during childhood or adolescence). The rationale behind this theory is that people with Munchausen syndrome may associate their childhood memories with a sense of being taken care of. After becoming adults, they may try to achieve the same feelings of comfort and reassurance by pretending to be ill.
Personality Disorders
There may also be a link between personality and factitious disorder imposed on self. This is because personality disorders are common in people with Munchausen syndrome. This disorder may stem from the person’s inner need to be seen as sick or disabled. It could also be due to the person having an insecure sense of their own identity. People affected by this disorder are willing to go through extreme measures, such as undergoing painful or risky tests or operations in an attempt to gain the sympathy and special attention given to people who are truly sick. So pretending to be sick allows them to assume an identity that elicits support and acceptance from others. Admission to the hospital can also provide a clearly defined place in a social network.
Types
Both Munchausen syndrome and Munchausen syndrome by proxy are categorized as factitious disorders. With Munchausen syndrome, the person presents themselves to others as being sick, whereas with Munchausen syndrome by proxy, the person presents another individual as being ill or injured. This other individual, who can be a child, another adult, or pet, is considered to be a victim. A person affected by Munchausen syndrome by proxy may also be guilty of criminal behavior if their actions consist of abuse and/or maltreatment.
Treatment
Although people with Munchausen syndrome may actively obtain treatment for the numerous disorders they create, they typically do not want to admit to and seek treatment for the actual syndrome. People affected with factitious disorder imposed on self deny they are faking or causing their own symptoms, so obtaining treatment tends to be dependent on somebody else suspecting that the person has this disorder, persuading the individual to receive treatment, and encouraging the person to stick to treatment goals.
Psychotherapy
The main treatment goal for Munchausen syndrome is to change the person’s behavior and lessen the misuse/overuse of medical resources. Treatment usually consists of psychotherapy (mental health counseling). During treatment sessions, the therapist may try to challenge and assist in changing the thinking and behavior of the person (this is known as cognitive behavioral therapy). Therapy sessions may also try to uncover and address any underlying psychological issues that may be causing the person’s behavior. In addition to individual therapy, treatment may also include family therapy. Teaching family members how to properly respond to a person diagnosed with Munchausen syndrome can be helpful. The therapist can teach family members not to reward or reinforce the behavior of the person with the disorder. This may make lower the person’s need to appear sick since they may no longer be receiving the attention they are seeking.
Medication
Medication is typically not used in the treatment of FDIS. If the person is also experiencing anxiety or depression, however, a doctor may prescribe medication, including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, and tricyclic antidepressants (TCAs). If this is the case, it is important that the person is closely monitored because of the higher likelihood of using these medications to purposely hurt themselves.
A Word From Verywell
If someone you love is living with FDIS, it’s important to seek help. Munchausen syndrome is associated with severe emotional difficulties, including an increased risk for substance use and suicide attempts. People with FDIS are also at risk for health problems or death because of their purposeful actions of trying to hurt themselves. They can suffer additional harm from complications associated with multiple tests, procedures, and treatments. For more mental health resources, see our National Helpline Database.
