Textbook of Psychiatry
H12.2 Factitious disorders
Patients with factitious disorders do not have an actual illness but allow others to believe
that they do by feigning one: they pretend they have an illness.
It is regarded as pathological if there are no understandable external motives for it,
such as obtaining compensation or avoiding a court case.
2 subtypes of factitious disorder:
Factitious disorder imposed on self (“Münchhausen syndrome”)
Factitious disorder imposed on another (“Münchhausen syndrome by proxy”)
Development, course and impact:
If the pretence produces benefits and if the response of others is unexpectedly pleasant, it
may be reinforced and become a routine, degenerating into a pseudo-reality that is
increasingly difficult to escape from.
most often a regular pattern
usually starts in adolescence
more common in girls
The pretence is usually confined to falsifying a serious illness in a subgroup of the patients’
social circle, eliciting compassion and respect. It is accompanied by embarrassment, worry
and fear that the truth will be discovered.
Chosen symptoms are based on the patient’s own experience with disease or
encounter with a particular illness in the patient’s circle or in the media.
GP’s and psychologist often do not suspect a factitious disorder. The illusion is refined by
falsifying diagnostic tests, covert non-compliance, or inducing actual symptoms. They also
win respect from the clinician by not whining, staying strong even in the face of worrying
symptoms and taking responsibility and continuing to meet their commitments.
An episode of falsification is ended by a chance event in the patients’ life or by being
unmasked as a fraud. The patient is ‘cured’.
At a later stage in life, a different symptom may be chosen and the history is repeated.
If the feigned illness is psychiatric, the course will be different, as a connection will always be
made with previous episode of a psychiatric disorder.
Diagnosis:
Falsified symptoms can sometimes be recognized by a doctor. A suspicion may arise during
the course of treatment from indirect clues. It is only possible to diagnose more complex
H12.2 Factitious disorders
Patients with factitious disorders do not have an actual illness but allow others to believe
that they do by feigning one: they pretend they have an illness.
It is regarded as pathological if there are no understandable external motives for it,
such as obtaining compensation or avoiding a court case.
2 subtypes of factitious disorder:
Factitious disorder imposed on self (“Münchhausen syndrome”)
Factitious disorder imposed on another (“Münchhausen syndrome by proxy”)
Development, course and impact:
If the pretence produces benefits and if the response of others is unexpectedly pleasant, it
may be reinforced and become a routine, degenerating into a pseudo-reality that is
increasingly difficult to escape from.
most often a regular pattern
usually starts in adolescence
more common in girls
The pretence is usually confined to falsifying a serious illness in a subgroup of the patients’
social circle, eliciting compassion and respect. It is accompanied by embarrassment, worry
and fear that the truth will be discovered.
Chosen symptoms are based on the patient’s own experience with disease or
encounter with a particular illness in the patient’s circle or in the media.
GP’s and psychologist often do not suspect a factitious disorder. The illusion is refined by
falsifying diagnostic tests, covert non-compliance, or inducing actual symptoms. They also
win respect from the clinician by not whining, staying strong even in the face of worrying
symptoms and taking responsibility and continuing to meet their commitments.
An episode of falsification is ended by a chance event in the patients’ life or by being
unmasked as a fraud. The patient is ‘cured’.
At a later stage in life, a different symptom may be chosen and the history is repeated.
If the feigned illness is psychiatric, the course will be different, as a connection will always be
made with previous episode of a psychiatric disorder.
Diagnosis:
Falsified symptoms can sometimes be recognized by a doctor. A suspicion may arise during
the course of treatment from indirect clues. It is only possible to diagnose more complex
