Factitious disorder imposed on self and factitious disorder imposed on another (Munchausen syndrome and Munchausen syndrome by proxy)

• DATE: 1951 forward
• TYPE OF PSYCHOLOGY: Psychopathology

Factitious disorder imposed on self, also known as Munchausen syndrome, is one of the most severe forms of factitious disorder, in which people simulate or produce mental or physical symptoms to benefit from playing the role of the ill person. Factitious disorder imposed on another, also known as Munchausen syndrome by proxy, describes a condition in which individuals deliberately produce physical or mental symptoms in another person under their care.

Introduction

In 1951, physician Richard Asher identified a pattern of patients who were fabricating medical histories and symptoms. He termed it Munchausen syndrome after Baron Münchausen, a fictional eighteenth-century Prussian cavalry officer who created fantastical stories about his exploits (and was, in turn, inspired by a real historical figure). The term factitious disorder imposed on self later became the preferred term by many medical professionals, as this is the term used in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).

Factitious disorder is a severe mental health disorder in which individuals complain of serious physical symptoms, although they are aware that they are fabrications. It differs from malingering, in which patients deliberately report nonexisting symptoms, in its motivation. Malingerers seek specific rewards, such as time off from work or monetary benefits; people with factitious disorder are motivated by internal needs, such as a desire for approval or attention.

The serious symptoms reported by those with factitious disorder often result in multiple hospitalizations, and individuals may travel between hospitals or engage in “doctor shopping” to earn a desired diagnosis. Patients usually describe their symptoms in dramatic detail; they can be highly knowledgeable about symptoms, terminology, and procedures. However, they may become vague when questioned. They often eagerly accept recommendations for invasive procedures and may display multiple surgical scars. In extreme cases, individuals may sabotage their laboratory samples or aggravate existing symptoms. If they are hospitalized, few friends visit, and patients are reluctant to have medical professionals query prior medical providers. Tests often reveal no medical causes for the reported symptoms.

After initial tests are negative, patients with factitious disorder often will report that their previous symptoms are gone, but new ones have appeared. After medical professionals have failed to substantiate reported symptoms, patients are either released or diagnosed with factitious disorder. If confronted, patients may deny the diagnosis of factitious disorder or suddenly discharge themselves, only to seek another opinion. Some experts recognize a subform of the disorder in which the patient uses various online channels, such as social media, message boards, and chat rooms, to draw attention and sympathy for their feigned symptoms or experiences.

Munchausen Syndrome by Proxy

In 1977, pediatrician Roy Meadow reported that one mother poisoned her child with salt, and another injected her own blood into her baby’s urine. He termed this behavior Munchausen syndrome by proxy. Later, many medical professionals adopted the more technical term, factitious disorder imposed on another. Factitious disorder imposed on another describes a condition in which caregivers create symptoms or actual illness in a person under their care. The caregiver is usually the mother, and the victim is typically a child under the age of six; however, cases have occurred in which adults create or lie about illnesses in their older parents. The caregiver ensures that the child experiences afflictions that warrant medical attention and presents the child to medical authorities while claiming not to know how the symptoms began. Rarely, those with factitious disorder imposed on another may be medical professionals who create symptoms in their patients.

Individuals with factitious disorder imposed on another may use their child’s illness as a way to gain sympathy. Their hospitalized child gets them attention from medical professionals, and they may use this as a way to earn praise for their devotion to the child’s care, often developing friendships with medical personnel. These caregivers may have previously experienced factitious disorder themselves, but when they make their child ill, they learn that they can receive psychological rewards for playing the “hero” role.

Individuals with factitious disorder imposed on another may exacerbate a child’s actual existing condition by lying about symptoms, altering samples, feeding the child contaminated or poisoned food, or injecting the child with bacteria, causing symptoms such as gastrointestinal upset or infection. The child may improve while hospitalized but become ill again after discharge.

When confronted, individuals with factitious disorder imposed on another may become depressed and suicidal. Some respond with anger and hastily remove the child from medical care. Since factitious disorder imposed on another has a victim, it is considered a form of abuse and is a criminal offense. It is estimated that approximately 10 percent of victims of factitious disorder imposed on another die. In some cases, the child learns that sickness gains attention and manifests factitious disorder in adulthood. It has been recognized that children and adolescents may falsify their own illnesses and have factitious disorder rather than be victims of factitious disorder imposed on another.

Possible Causes and Treatments

There are no reliable statistics on the prevalence of the disorders because of the inherent dishonesty involved. Individuals with these disorders may visit various hospitals, making any statistics suspect. The causes of both are also not known, but theories center on existing mental or personality disorders or a major life stress as possible origins. In some instances, the impulse to cause illness stems from rage, jealousy, or the desire to control others. Individuals with factitious disorder may have had childhood illnesses that required extensive hospitalization or may have experienced family disturbances or abuse. Factitious disorder is associated with low self-esteem and severe emotional disturbances. It is very difficult to treat and often requires years of therapy. The patients’ first goal is to acknowledge that they are lying. Psychotherapy aids in working through underlying psychological issues. Family therapy might be indicated to teach family members not to reward “sick” behavior on the part of the patient. In factitious disorder imposed on another, the first concern is the victim’s safety. Psychotherapists, law enforcement, foster care organizations, and social workers all may be involved in treatment. A multidisciplinary approach may be the best method of treatment, as well as early diagnosis and intervention. Both factitious disorder and factitious disorder imposed on another have high relapse rates and poor low-term outcomes.

Bibliography

Comacchio, C., et al. "Prevalence and Risk Factors for Depression in Factitious Disorder: A Systematic Review." Frontiers in Psychiatry, vol. 15, Apr. 2024, doi:10.3389/fpsyt.2024.1355243. Accessed 10 Apr. 2025.

Doyle, Celia, and Charles Timms. Child Neglect and Emotional Abuse. Sage, 2014.

Feldman, Marc. Playing Sick? Untangling the Web of Munchausen Syndrome, Münchhausen Syndrome by Proxy, Malingering, and Factitious Disorder. Routledge, 2004.

Gregory, Julie. Sickened: The True Story of a Lost Childhood. Bantam Books, 2004.

Kamm, F. M. Bioethical Prescriptions: To Treat, End, Choose, and Improve Lives. Oxford University Press, 2014.

Lasher, Louisa J., and Mary S. Sheridan. Munchausen by Proxy: Identification, Intervention, and Case Management. Haworth Maltreatment and Trauma Press, 2004.

Olsen, Gregg. Cruel Deception: A Mother’s Deadly Game, a Prosecutor’s Crusade for Justice. St. Martin’s True Crime, 2005.

Shaw, R., et al. "Factitious Disorder by Proxy: Pediatric Condition Falsification." Harvard Review of Psychiatry, vol. 16, no. 4, 2008, pp. 215-224.