Summary

Factitious Disorder is a psychiatric condition in which an individual intentionally produces, feigns, or exaggerates physical or psychological symptoms in order to assume the "sick role". The motivation is internal (psychological) gain – Seeking attention, nurturance, care, and identity as a patient. This is distinct from Malingering, where symptoms are fabricated for external gain (Financial compensation, Avoiding legal consequences, Obtaining drugs). When a caregiver (Usually a parent) fabricates or induces illness in another person (Usually a child), it is termed Factitious Disorder Imposed on Another (FDIA – Formerly Munchausen by Proxy), and this is a form of child abuse requiring immediate safeguarding intervention. Common presentations include feigned infections, self-harm (Self-injection, Self-contamination), inconsistent histories, "Textbook" symptoms, and "Gridiron abdomen" (Multiple surgical scars from unnecessary operations). Management is challenging; direct confrontation often leads to discharge against medical advice (DAMA/AMA).

Key Facts

• Motivation: Internal/Psychological gain (Sick role, Attention, Nurturance).
• Malingering Difference: External gain (Money, Drugs, Avoiding consequences). NOT a mental disorder.
• Factitious Disorder Imposed on Another (FDIA): Illness induced in child/vulnerable person by caregiver. Child abuse. Safeguarding.
• Signs: Gridiron abdomen, Inconsistent history, Multiple hospitals ("Hospital shopping"), Leaves AMA when challenged.
• Management: MDT. Non-punitive confrontation. Psychiatric referral. Often declined.

Clinical Pearls

"Gridiron Abdomen = Multiple Unnecessary Surgeries": Extensive surgical scarring should raise suspicion.

"Factitious vs Malingering = Internal vs External Gain": Factitious = Psychological need. Malingering = Tangible benefit.

"By Proxy = Safeguarding Emergency": A carer inducing illness in a child is physical abuse.

"Patients Often Leave When Confronted": Expect patients to discharge themselves or move to another hospital.

Why This Matters Clinically

Factitious disorder wastes medical resources and can cause significant patient harm (Unnecessary investigations/surgery). FDIA is a serious form of child abuse.

Definition

• A carer (Usually mother) fabricates or induces illness in a dependent (Usually a child).
• Previously called Munchausen Syndrome by Proxy.

Mechanisms

Presentation

SAFEGUARDING

Key References

Scenario 1:

• Stem: A patient with multiple hospital admissions has recurrent abscesses that grow unusual organisms. She has extensive medical knowledge and a "gridiron abdomen". What is the diagnosis?
• Answer: Factitious Disorder (Recurrent self-induced infections. Multiple surgeries).

Scenario 2:

• Stem: What is the key difference between Factitious Disorder and Malingering?
• Answer: Motivation. Factitious = Internal psychological gain (Sick role). Malingering = External tangible gain (Money, Drugs, Avoiding work).

Scenario 3:

• Stem: A child presents with recurrent apnoeas that always occur when with the mother. What should be considered?
• Answer: Factitious Disorder Imposed on Another (FDIA / Munchausen by Proxy). Safeguarding referral required.

What is Factitious Disorder?

Factitious Disorder is a mental health condition where a person pretends to be ill, or makes themselves ill, in order to receive care and attention from doctors. The person is not trying to get money or avoid work – they have a psychological need to be seen as a patient.

What is "By Proxy"?

This is when someone (Usually a parent) makes a child appear sick by lying about symptoms or actually making the child ill. This is a form of child abuse and is taken very seriously.

• Richard Asher (1951): First described "Munchausen Syndrome" – Named after Baron Munchausen, famous for exaggerated stories.
• Roy Meadow (1977): Described "Munchausen Syndrome by Proxy".