Factitious Disorder (Munchausen Syndrome)

Basics

A mental disorder characterized by the intentional falsification or self-induction of illness, without external rewards, to assume the sick role
The nature of the disorder resists rigorous study
Psychological factors, such as a history of trauma, abuse, or neglect during childhood, are often associated with the disorder
No definitive biologic markers have been identified
Prevalence is unknown and felt to be relatively rare
Risk factors:
- Females
- Onset in the thirties/forties
- Personality disorder
- A history of chronic childhood illness
- A history of employment in the medical field
Subcategories:
- Factitious Disorder Imposed on Self:
  - Individuals fabricate or induce symptoms in themselves to assume the patient role
- Factitious Disorder Imposed on Another (Munchausen Syndrome by Proxy):
  - A caregiver, often a parent, deliberately produces or falsifies symptoms in someone under their care, such as a child, to gain attention or sympathy
- Munchausen syndrome:
  - Severe, chronic form of factitious disorder involving dramatic deception and self-harm

DSM-5-TR diagnostic criteria:
- Intentional production of physical or psychological signs associated with deception
- Patients presents as ill, impaired, or injured
- Absence of external incentives
- The behavior is not better explained by another mental disorder
Onset is usually early adulthood often after hospitalization for a mental disorder or medical condition
Course is often intermittent
Clinical clusters:
- Self-induced infection
- Simulated specific illnesses with no actual disorder
- Chronic wounds
- Self-medication

Factitious Disorder Imposed on Another (Munchausen by Proxy):
- The patient’s illness is caused by the caregiver, not the patient
- The motivation for the caregiver’s behavior is to assume the sick role by proxy
- The caregiver inflicts injury or induces illness in their charge, usually a child
- Commonly parents (mostly mothers)
May simulate injury and disease in several ways:
- Inflicts injury
- Induces Illness
- Fabricates symptoms
- Exaggerates symptoms of the child’s illness causing overaggressive medical interventions
The perpetrator usually refuses to acknowledge the deception
Cessation of the symptoms when the patient and caregiver are separated
Some caregivers may use online forums to mislead public regarding factitious illness in a child

Caregivers of elderly patients may also be perpetrators in Factitious Disorder Imposed on Another

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