Factitious Disorder Imposed on Self (Munchausen’s Syndrome): Information, Symptoms, Treatment and More

Factitious Disorder Imposed on Self is a mental health condition which involves a person acting as if they have a physical or mental illness.

Factitious Disorder Imposed on Self is a type of Somatic Disorder. It can range in severity – dependent on who is involved and the circumstances.

The individual actively feigns their symptoms and will often intentionally hurt themselves to cause symptoms, or lie about their symptoms.

Overall, someone with this disorder will have an innate need to be viewed as ill, and to attain a role of patient. The condition is also known as Munchausen’s Syndrome.

It is very similar, although different, to Factitious Disorder Imposed on Another. This is where a person acts as if someone in their care, rather than themselves, has a physical or mental illness.

While it is controversial to suggest Factitious Disorder is a mental health condition, the disorder’s association with stress and emotional pain are key factors in its development. People with Factitious Disorder often have underlying mental health conditions, and/or will have been the victim of abuse in their childhood.

What are the symptoms of Factitious Disorder Imposed on Self?

The symptoms of Factitious Disorder Imposed on Self involves a person effectively making themselves, or acting like, they are ill.

The severity of the condition can range from person-to-person. Some people will go to extraordinary lengths in order to appear ill, such as taking illicit substances, injecting harmful materials, or moving house regularly in order to visit multiple hospitals.

Signs and symptoms of Factitious Disorder Imposed on Self

• Individual feigns symptoms of an illness
• Will have strong knowledge of the illness they are feigning
• Significantly exaggerate the severity of symptoms
• May claim to have psychological symptoms e.g. hallucinations
• May claim to have chronic pain
• Attention seeking behaviour
• May crave sympathy or reassurance
• Actively attempt to get ill – e.g. injecting themselves with harmful substances such as bacteria to induce fever, or deliberately infecting a wound
• Tampering with diagnostic tests or samples
• Will happily undergo risky surgeries to keep up the charade
• Recurrent hospitalisation
• Inconsistent medical history
• Reluctance for healthcare professionals to meet family members
• Vague or inconsistent symptoms
• Manipulative
• Normally quite intelligent
• May travel excessively from hospital to hospital
• Greatly overstate past experiences e.g. talking about miraculous, odds-defying recoveries
• Unstable relationships with others
• Low self-esteem
• Frequent relapses
• Sabotaging discharge plans or suddenly becoming ill again just before being released from hospital/clinic
• Will not have financial gain as motive

The individual involved won’t be feigning illness for monetary or disability reasons. Instead, they are obsessed with being a patient, and the centre of attention. They often won’t be aware themselves of why they are feigning illness.

Factitious Disorder very commonly runs comorbidly with another mental health condition. The above is is not an exhaustive list of symptoms.

What are the causes of Factitious Disorder Imposed on Self?

It isn’t entirely known what causes Factitious Disorder Imposed on Self. The disorder is complex. It appears that multiple factors can be involved in the condition appearing.

To begin with, it is important to note that the patient completes the acts consciously, they are often unaware of the motivations behind their behaviour.

It is widely believed that childhood abuse is a key factor [1]. Those that were abused as children may have become accustomed to receiving medical attention as they grew up. They may, especially if they haven’t had the chance to process the abuse, want to continue receiving help – something that they will go to great measures to achieve.

Moreover, they may also unfortunately believe they need to punish themselves. Any form of childhood trauma can result in similar cases.

In many cases, it has also been suggested that those with a Factitious Disorder may have an underlying Personality Disorder. This could be Dependent personality disorder, Histrionic personality disorder, Antisocial personality disorder or Narcissistic personality disorder.

This can range from needing others to help them (dependent), wanting attention (histrionic), taking pleasure in manipulating others (antisocial), or feeling they should be the centre of attention (narcissistic).

Anyone that enjoys manipulating others, or has a personal resentment against healthcare professionals, are likelier to develop this condition.

On the other hand, someone that may struggle to form a network may believe that admission to a hospital will provide them with a chance to build up their own network.

If a person failed to become a healthcare professional yet wanted to, they may believe that imposing illnesses upon themselves may offer the next best thing to working in a hospital.

It seems that many possible causes exist. It is difficult to pinpoint a singular factor. Certainly though, emotional pain from the past appears to be a key factor.

We have an article that explores the causes of this condition in more detail. You can read the article at this link.

Diagnosis of Factitious Disorder Imposed on Self

Diagnosing Factitious Disorder Imposed on Self is a very challenging process. Not only does the individual involved rarely realise anything is wrong, but they are also normally cunning and manipulative.

Consequently, it is usually left to a healthcare professional to suspect Factitious Disorder Imposed on Self is present and then launch an investigation.

If they suspect the disorder is present, they will normally look at the health history of the individual, and see if inconsistencies are present. They may also contact a patient’s past healthcare professionals to get enhanced information on the individual.

Contacting the family of a patient is another method that can be used, although this can be challenging in line with Data Protection regulations. Other areas of investigations may include checking tests for any anomalies, or running further tests under close supervision.

Factitious Disorder Imposed on Self is quite rare, and can be confused for Malingering. As a result, the healthcare professional will need to ensure the person isn’t feigning illness in order to take time off work, claim benefits, or because they want access to potent opioids for recreational purposes (examples of Malingering). The process of distinguishing Factitious Disorder from Malingering may only be possible by in-depth psychological evaluation.

In any case, it can be difficult to diagnose the disorder, as most people when caught out will deny feigning illness and refuse to partake in any suggested treatment.

The healthcare professional will normally tell the person they need psychiatric assistance, which ideally will lead the person to changing their mind and seeking treatment.

When the person admits they feigned symptoms, they can be referred for an assessment by a mental health professional. It is likely the reasons for the person acting in this way can be discovered and any underlying trauma spoken about. They will aim to make a diagnosis based on this assessment.

The patient would need to satisfy the below criteria:

• Either physical or psychological symptoms are either falsified by the individual, or purposefully induced
• The individual presents themselves to others as being of ill health, or impaired in some way
• This behaviour is conducted without the motive of attempting to extract money or some other benefit from position
• The behaviour is not better attributed to an alternative mental disorder

It is very common for a Personality Disorder to be diagnosed alongside Factitious Disorder Imposed on Self – although this may happen at a later date – often during talking therapy.

How is Factitious Disorder Imposed on Self treated?

Treatment is available for Factitious Disorder Imposed on Self. Treatment is generally only effective when an individual admits they have a problem that is in need of treatment. In many instances, with the right treatment plan, a full recovery can be made.

Treatment normally involves a form of talking therapy. It is also a possibility that those who are also suffering from either Depression or Anxiety receive medication. This is dependent of course on individual circumstances.

Talking Therapy

There are many different talking therapies that may help treat Factitious Disorder Imposed on Self. Therapy will typically require a long-term commitment.

If past trauma is involved, Psychoanalytical Psychotherapy is commonly used. But, as seen below, there are merits to many other types of therapy.

Psychoanalytical Psychotherapy: Psychoanalytical Psychotherapy is a talking therapy that aims to help uncover and resolve unconscious beliefs that cause psychiatric conditions. Traumatic experiences that may or may not be buried in the unconscious mind can be highlighted and processed. Psychoanalytical psychotherapy involves talking to a trained therapist. The therapist can show the individual how early memories and past traumas have affected their thinking, behaviour and attitude in the modern day. Psychoanalytical psychotherapy is especially useful for any condition that involves past trauma. Renowned neurologist Sigmund Freud developed this therapy, which is typically completed over a long-term basis.

Cognitive Behavioural Therapy (CBT): CBT is a type of therapy that is used to treat a range of mental health conditions. CBT involves an individual talking face-to-face with a therapist, although sometimes CBT can be conducted in a group setting. CBT attempts to improve an individual’s wellbeing and mood. The therapy focuses on the link between thoughts, feelings and actions. This can be useful for those with low self-esteem, anxiety, unhelpful personality traits or intrusive thoughts. CBT can help an individual understand their feelings more, and in the long run should lead to an improvement in quality of life.

There are a range of other types of talking therapies available. We have more information in our dedicated Therapy section.

Medication

If an individual also shows signs of low mood, anxiety, or poor self-esteem, they may be prescribed antidepressants to help them. This may result in some improvement, though is most effective when used in conjunction with therapy.

Antidepressants: Antidepressants can help to improve and regulate mood. They should improve motivation and restore energy. SSRI Antidepressants are the most commonly prescribed. They act on the brain chemical serotonin – which is thought to help in regulating mood and emotion. They may include side-effects such as a dry mouth, sexual problems and nausea, though these should hopefully be short-term. Other classes of antidepressants are available in the event of an inadequate reaction.

Summary

Factitious Disorder Imposed on Self is a challenging condition for all involved. But treatment is available and can result in a person getting their life back on track.

It is important that anyone suffering from ill mental health seeks help. Our website has plenty of information if needed!

See Also

• Somatic Disorders Section
• What is the Prognosis for Somatic Disorders?
• Therapy Homepage
• Medicine Homepage