Factitious Disorder Imposed on Self (Munchausen Syndrome): Clinical Features and Management

Factitious disorder imposed on self (formerly Munchausen syndrome) is a mental disorder where individuals deliberately falsify or induce physical/psychological symptoms to assume the sick role, without external incentives (e.g., financial gain, legal avoidance).

Clinical Features

• Extensive medical knowledge; convincing symptom simulation.
• Multiple hospitalizations, surgeries, procedures ("hospital addiction").
• Peregrination (doctor shopping, traveling for care).
• Symptoms inconsistent, atypical, unresponsive to treatment.
• Willingness for invasive tests/surgeries.
• Reluctance to allow contact with prior providers/family.

Methods of Induction

• Self-inflicted injury, toxin ingestion.
• Contaminating specimens (blood in urine, stool).
• Tampering with devices (IV lines, monitors).
• Ingesting drugs to mimic disease (insulin, warfarin).

Differential

• Malingering: External incentive (disability, drugs, legal).
• Conversion disorder: Unconscious neurological symptoms.
• Somatic symptom disorder: Excessive distress about genuine symptoms.
• Borderline PD: Self-harm for emotional regulation.

Management

• Confrontation rarely helps; maintain therapeutic alliance.
• Primary care gatekeeper; limit unnecessary tests/procedures.
• Psychiatric referral (often refused).
• CBT, DBT, psychodynamic therapy if engaged.
• Treat comorbidities (depression, personality disorders).

Factitious Disorder Imposed on Another (Proxy)

Caregiver induces illness in dependent (child, elder) – form of abuse; mandatory reporting.