16th November 2023

Factitious Disorder

Under ICD-11, factitious disorder (Munchausen’s syndrome) is now in a category of its own and covers factitious disorder posed on self and posed on others. In this condition, patients, unmotivated by potential gains, feign psychiatric or physical conditions or impose them on others (factitious disorder by proxy). They may falsify signs and symptoms to seek out treatment for themselves or keep others dependent on their care. It is often seen in paramedical professionals and is closely linked with antisocial and borderline PDs. It is very similar to malingering, the crucial difference being that in malingering, there is some obvious gain for the individual, for example, compensation. Treatment is extremely difficult, as the patient will often be resistant to psychiatric assessment. However, iatrogenic harm due to over investigation must be minimised by either directly or indirectly challenging the patient about their intent to feign illness or passing on information to surrounding regions to prevent ‘hospital hopping’.

References

• Semple D; Smyth R. (2019). Oxford Handbook of Psychiatry, fourth edition.
• International Statistical Classification of Diseases, tenth revision (ICD-10), Version:2016, https://icd.who.int/browse10/2016/en#/F60-F69
• International Statistical Classification of Diseases, eleventh revision (ICD-11), Version 01/2023, https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f430567349