Factitious Disorder (Munchausen Syndrome)

Factitious disorder is a chronic psychiatric condition in which an individual intentionally produces, exaggerates, or fabricates physical or psychological symptoms in themselves (Munchausen syndrome) or another person under their care (Munchausen by proxy, formally factitious disorder imposed on another). The motivation is internal — the desire to be seen as ill — rather than for monetary gain or other external reward, distinguishing it from malingering.

Patients often present with dramatic, atypical, or inconsistent histories, repeated hospitalizations across different facilities, eagerness to undergo invasive procedures, and reluctance to allow access to prior records. Self-induced symptoms may include the use of insulin, anticoagulants, infectious materials, or self-harm. Munchausen by proxy involves a caregiver (typically a parent) inducing or fabricating illness in a dependent and is recognized as a form of child abuse with significant mortality.

Diagnosis requires careful documentation, multidisciplinary collaboration, and often consultation-liaison psychiatry. Confrontation alone is rarely effective; supportive, non-punitive engagement and long-term psychotherapy yield better outcomes. Comorbid personality disorders (especially borderline), depression, and substance use are common. Treatment is challenging, with frequent denial, doctor-shopping, and high relapse rates.