Do you suspect that a loved one is pretending to be ill? Understanding motives and potential causes behind self-inflicted illness may help.

In the sprawling landscape of mental health, certain conditions can be puzzling, even to the most seasoned experts. Factitious disorder is one such example.

It’s not just a portrayal in cinematic dramas, but a real-life concern that affects numerous individuals and places undue burden on the healthcare system.

You may even know a friend or family member affected by factitious disorder. It can be understandably difficult to navigate, and while this phenomenon may seem baffling, there is good sense to be made of it.

Factitious disorder, previously known as Munchausen syndrome, is a mental condition in which a person intentionally produces or falsifies symptoms of physical or mental illness.

They don’t do this for any apparent gain, like money or time off work. It’s done purely to assume the role of a patient.

Consequently, they may lie about symptoms, alter diagnostic tests, or even inflict harm upon themselves to bring about the appearance of illness.

What is the difference between factitious disorder and malingering?

The key difference between factitious disorder and malingering lies in the motive. In other words, the reasons a person has for pretending to be ill are different between these two disorders.

People living with factitious disorder create symptoms for no apparent external benefit, such as extended time off from work. Their motive seems to be more related to internal gains, such as desire for attention or a craving for sympathy and nurturing.

On the other hand, those who are malingering pretend to be ill or exaggerate their symptoms to achieve something specific, like avoiding work or obtaining financial compensation.

Factitious disorder vs. malingering:

If you know someone living with factitious disorder, they may:

  • report severe symptoms that don’t align with test results
  • experience disappointment if they’re not diagnosed with a serious condition
  • manipulate medical results to appear sicker
  • lack a clear external motive
  • try to keep medical visits a secret from family and friends

If you know someone who is malingering, they may:

  • report symptoms that prevent return to work but symptoms “disappear” during leisure activities
  • be more physically active when off work
  • have a clear external motive
  • have symptoms that disappear once the goal is achieved
  • exhibit no distress when medical tests come back normal
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The specific symptoms of factitious disorder are largely based on deception and fabrication of medical injury or illness. One key clue is that claims may be made about particular symptoms that seem confusing or conflicting.

If you know someone living with factitious disorder, they may also:

  • inflict self-harm to maintain the sick role
  • report symptoms that are inconsistent with lab results or physical exams
  • have a history of multiple hospital visits
  • be eager to have medical procedures done
  • be unwilling to participate in a psychiatric evaluation
  • appear unresponsive to treatments
  • be unwilling to show past medical records

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), factitious disorder is officially diagnosed when one or more of the following conditions are met:

  • making up physical and mental signs of being sick or hurt, or intentionally causing injury or illness
  • pretending to be unwell, impaired, or injured
  • engaging in deceitful behavior, even when there are no obvious rewards

Additionally, the behavior can’t be explained better by another mental disorder, like having fixed false beliefs or other psychotic disorders.

The causes of factitious disorder are unknown, but childhood traumas and personality disorders are thought to play a role, according to the National Health Service (NHS).

Traumas occurring in childhood that can lead to factitious disorder may include:

  • parental neglect or abandonment
  • loss of a loved one
  • extensive medical procedures or treatments

Personality disorders may also be linked to factitious disorder. Specifically, these may include:

Research from 2016 found that several other factors may be associated with factitious disorder. First, it was discovered that about 40% of the people living with factitious disorder were depressed.

Additionally, many had previously worked in a healthcare setting, and the average age of symptom onset was around age 34.

Treatment for factitious disorder can be tricky, often because many individuals may not view their behavior as problematic. In other words, they would never seek treatment because they don’t see a reason to.

If a healthcare professional suspects factitious disorder, 2020 research states that a supportive confrontation is suggested as a potential first step toward treatment.

This means that the provider would let the individual know they’re aware that intentional self-harm or illness fabrication could be the reason for their seeking medical care.

It’s also suggested that psychotherapy be offered as a first-line treatment option during the confrontation, although only about 50% of people pursue it. It’s not always the case that treatment offers will be well-received and may even be counter-productive.

It can be difficult to identify factitious disorder, which makes it challenging to prevent altogether. There are no significant predictive factors or early warning signs, so the focus is more so on preventing the behavior from worsening.

Worsening behavior might look like increased frequency of self-harm or greater visits to the hospital, among others. If a loved one seems to be claiming illness more often, it could be a sign that they’re behavior is worsening and intervention may be needed.

Helping a family member with factitious disorder

If you suspect a loved one is living with factitious disorder, directly challenging them about their behavior or accusing them of falsification may not be the best approach. It’s important that you begin by supporting and validating them, adopting a non-judgmental approach.

Remember that the cause of factitious disorder often involves unresolved childhood traumas and perhaps even uncontrollable personality disorders. As a result, your loved one’s behavior may stem from a place that feels totally out of their control.

With this in mind, it may be helpful to start a compassionate and heart-centered dialogue with them about the way they’re feeling. You can also use the opportunity to reassure them that they have your support, and encourage them to visit a mental health professional to help cope with their distress.

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Factitious disorder is a serious mental health condition that requires patience and understanding. Treating this disorder requires professional help, and may take significant time to resolve.

But with appropriate treatment and support, individuals with this disorder can learn healthier ways to cope with their feelings and needs.

If you or a loved one is living with this factitious disorder, remember that help is available, and recovery is possible.