Munchausen syndrome, or factitious disorder imposed on self
Factitious disorder imposed on self (FDIS), is one of a group of factitious disorders that are either invented or self-inflicted.
It is difficult to know how common it is, but a study in Germany has suggested that it may affect 1.3 percent of hospital patients.
It can affect both adults and children. It is more common in men.
What is FDIS?
People with Munchausen syndrome invent illnesses to get medical attention.
An individual with FDIS may go from one hospital to another, pretending to have a disease that needs medical or surgical treatment, and giving invented information about their medical history and social background.
Occasionally, a patient will persuade a doctor that they need an unnecessary surgical procedure.
They may ingest substances or inject themselves with a chemical or other substance, or injure themselves to induce illness.
The exact prevalence of FDIS is hard to know, because patients use false names, visit different hospitals and doctors, and they can become adept at avoiding detection.
FDIS does not include faking an illness or injury to obtain drugs or to win a lawsuit, or hypochondria. A person with hypochondria believes they are ill, but a person with FDIS knows they are faking illness.
A person with this condition will usually have severe emotional difficulties.
Signs of FDIS may include:
- Telling dramatic stories about several medical problems, often with little documentary evidence
- Frequent hospitalization
- Multiple scars
- Symptoms that are inconsistent or vague and that do not match the results of tests
- Symptoms that unexpectedly get worse, for no logical or medically explicable reason
- A desire to undergo medical tests and surgical procedures
- A surprisingly good textbook knowledge of diseases and conditions
- Visiting many different doctors and hospitals
- Unwillingness to allow the health care provider to talk to friends or family
- Frequently asking for painkillers and other drugs
- Having very few or no visitors when in hospital
If the person is challenged about their story, they may become defensive or aggressive, or they may leave the hospital or health care provider and never return.
How does the patient fake illness?
It can be difficult for health professionals and family to know whether the signs and symptoms are made up or deliberately induced.
A person with FDIS may take pills to make themselves ill.
The patient may invent signs and symptoms or cause illness or injury by:
- Reporting a fictitious medical history. They may claim to have had cancer or some other major disease
- Feigning symptoms, for example, pain, seizures, headaches, or fainting. Symptoms may be carefully selected carefully and difficult to disprove.
- Hurting themselves. This could include injecting themselves with bacteria, feces, or some other substance, or burn or cutting the skin.
- Taking medicines to provoke symptoms of diseases, such drugs as blood thinners, chemotherapy medicines, and diabetes drugs.
- Stopping the healing process by reopening cuts and wounds.
- Tampering with tests. Examples include heating up thermometers when their temperature is taken, tampering with laboratory tests, or contaminating urine and blood samples.
Conditions that the person may pretend to have include heart problems, cancer, skin conditions, infections, bleeding disorders, metabolic disorders, chronic diarrhea, hypoglycemia, anaphylaxis, and others.
Causes and risk factors
It is unclear exactly what causes FDIS, but some factors may increase the risk.
- Having a close relative with a serious condition or disease
- A poor sense of identity
- Serious illness during childhood
- Childhood trauma, including physical, sexual, or emotional abuse
- Inadequate coping skills
- Losing a loved one early on in life due, for example, to death, illness or abandonment
- Low self-esteem
- Personality disorders
- Wanting to and failing to become a health care professional
- Working in health care
Evidence about what causes FDIS is limited, because patients are often unwilling to cooperate with psychiatric treatment or psychological profiling.
FDIS appears to be a kind of personality disorder, a condition in which the patient has a distorted pattern of thoughts and beliefs about themselves and other people. This can make them behave in unexpected ways.
It has been argued that the patient may have an antisocial personality disorder that makes them enjoy manipulating and duping health care professionals. They see a doctor as a figure of authority and derive a sense of power and control by deceiving them.
FDIS may also be an attempt to form relationships and to become more socially acceptable.
A person with FDIS may live a solitary lifestyle, with little or no contact with their family.
Adopting the role of patient gives comfort. Being nurtured by doctors and other health care workers provides human contact and emotional warmth.
People with FDIS can be very good at pretending, so it is difficult to diagnose the condition. They may have real symptoms and life-threatening conditions, but these are self-inflicted.
A person with FDIS may have low self-esteem and limited social contact.
If doctors suspect FDIS, they may review the patient's medical records and search for possible inconsistencies between what is documented and what the patient has told them.
They may also try to contact the person's family or friends to find out whether claims about their medical history are true.
They can also check blood and urine samples for traces of substances that the person may have deliberately ingested or injected.
The patient's hospital room may contain injected materials or hidden medications or substances. However, ethical considerations can make it hard to confirm this.
The doctor may consider a diagnosis of FDIS if there is compelling evidence that the patient:
- is faking symptoms
- has induced symptoms deliberately
- wishes to be seen as sick
- does not have another motivation, such as financial gain, drugs, or early retirement
The doctor may start by reassuring the patient that it can be stressful not to have a clear explanation for medical signs and symptoms. They may suggest that the problem could be caused or made worse by stress.
They may try to steer the patient towards care with a mental health provider.
There is no standard treatment for FDIS. Most people with the condition will deny that they have it, making it hard to implement a treatment plan.
Using a non-confrontational approach, the health care provider may inform the patient that they have multi-faceted health requirements, and that treatment with a psychiatrist or psychologist may help. Accepting treatment is the first step towards healing.
A combination of psychoanalysis and cognitive behavioral therapy (CBT) is most likely to have the best results.
CBT can help a person identify any unrealistic behavioral patterns and find new ways to approach a situation.
A patient with FDIS who does not receive treatment for this condition is at greater risk of self harm, substance abuse, or suicide in the longer term. They are also at risk of adverse effects from the treatment they receive for illnesses that do not exist.
One of the challenges for a doctor who suspects FDIS is to avoid encouraging the patient's psychological problem, if there is one, but to make sure they treat any illness that the patient may really have.