Factitious disorder imposed on self
Factitious disorder imposed on self, formerly Munchausen syndrome, is the conscious falsification, exaggeration, or induction of physical or psychological illness in oneself with no identifiable external reward, driven by an unconscious wish to assume the sick role. Diagnosis relies on objective evidence of deception, such as a suppressed C-peptide with exogenous insulin use or a low thyroglobulin with exogenous thyroid hormone; management is non-punitive disclosure, minimal further workup, and psychiatric referral.
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What this article covers
- Overview
Definition: deliberate falsification of physical or psychological signs or symptoms, or induction of injury or disease, in oneself, with identified deception and no clear external reward; the…
- Epidemiology
Sex and occupation skew: more common in females and in health care workers, who have the access and knowledge to fabricate a convincing presentation.
- Risk factors
Health care occupation: nursing or other clinical training and specimen access make fabrication credible.
- Pathophysiology
Behavioral mechanism, not organic disease: pathophysiology here is the mechanism of fabrication, not a bodily disease process.
- Clinical features
No fixed symptom count or duration: the disorder is recognized by the pattern of falsified, exaggerated, or induced findings plus identified deception without a clear external reward, not by a required symptom count or duration.
- Differential diagnosis
Malingering: symptoms and motivation are both conscious, driven by an external reward such as compensation or avoiding legal proceedings or work, and complaints stop once the reward is obtained, unlike the internally motivated pattern here.
- Diagnosis
Diagnostic basis: established clinically by identified deception, objective evidence the patient falsified, exaggerated, or induced the findings, without a clear external reward; genuine medical and psychiatric causes must first be excluded.
- Management
Stabilize any objective harm from the induced illness first: Severe or neuroglycopenic hypoglycemia: dextrose 50% injection (D50W) 25 g IV push, then a dextrose 5-10% infusion, rechecking glucose in…
- Complications
Iatrogenic harm from repeated invasive procedures: willingness to undergo unnecessary surgery, catheterization, or other invasive testing exposes the patient to procedural risk a true illness would not have required.
- Prognosis
Typically chronic and relapsing: repeated and long-term hospitalizations are a described pattern, and the course does not end after a single disclosure conversation.
- Prevention
Apply the same fasting protocol to any future unexplained hypoglycemic episode: the 60 mg/dL (3.3 mmol/L) trigger and the same stopping points, 45 mg/dL (2.5 mmol/L) with neuroglycopenia or 55 mg/dL…
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- Factitious disorder imposed on another
Factitious disorder imposed on another (FDIA), formerly Munchausen syndrome by proxy, is fabrication, exaggeration, or direct induction of illness in a dependent, usually a child, by a caregiver seeking the concerned-caregiver role; the psychiatric diagnosis attaches to the caregiver, while the dependent is the one harmed. It is a form of abuse, so management leads with separating the child from the perpetrator, mandatory reporting to child protective services, and evidence preservation, before any psychiatric treatment of the caregiver.
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- Functional neurologic symptom disorder
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- Insulinoma
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