Diagnosis

Diagnosing factitious disorder is often extremely difficult. People with factitious disorder are experts at faking many different diseases and conditions. And often they do have real and even life-threatening medical conditions, even though these conditions may be self-inflicted.

The person's use of multiple doctors and hospitals, the use of a fake name, and privacy and confidentiality regulations may make gathering information about previous medical experiences difficult or even impossible.

Diagnosis is based on objectively identifying symptoms that are made up, rather than the person's intent or motivation for doing so. A doctor may suspect factitious disorder when:

  • The person's medical history doesn't make sense
  • No believable reason exists for an illness or injury
  • The illness does not follow the usual course
  • There is a lack of healing for no apparent reason, despite appropriate treatment
  • There are contradictory or inconsistent symptoms or lab test results
  • The person resists getting information from previous medical records, other health care professionals or family members
  • The person is caught in the act of lying or causing an injury

To help determine if someone has factitious disorder, doctors:

  • Conduct a detailed interview
  • Require past medical records
  • Work with family members for more information
  • Run only tests required to address possible physical problems
  • May use the criteria for factitious disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association
May 31, 2017
References
  1. Factitious disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed Jan. 31, 2017.
  2. Factitious disorder imposed on self. Merck Manual Professional Version. http://www.merckmanuals.com/professional/psychiatric-disorders/somatic-symptom-and-related-disorders/factitious-disorder-imposed-on-self. Accessed Jan. 31, 2017.
  3. Yates GP, et al. Factitious disorder: A systematic review of 455 cases in the professional literature. General Hospital Psychiatry. 2016;41:20.
  4. Irwin MR, et al. Factitious disorder imposed on self (Munchausen syndrome). http://www.uptodate.com/home. Accessed Jan. 31, 2107.
  5. Ferri FF. Factitious disorder (including Munchausen syndrome). In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Elsevier; 2017. http://www.clinicalkey.com. Accessed Jan. 31, 2017.
  6. Marx JA, et al., eds. Factitious disorders and malingering. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2014. http://www.clinicalkey.com. Accessed Jan. 31, 2017.
  7. Kahn A, et al. Factitious disorder in Crohn's disease: Recurrent pancytopenia caused by surreptitious ingestion of 6-mercaptopurine. Case Reports in Gastroenterology. 2015;9:137.
  8. Jones TW, et al. Factitious disorder-by-proxy simulating fetal growth restriction. Obstetrics and Gynecology. 2015;125:732.
  9. Burton MC, et al. Munchausen syndrome by adult proxy: A review of the literature. Journal of Hospital Medicine. 2015;10:32.
  10. Sawchuk CN (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 28, 2017.