Factitious disorder imposed on self

Factitious disorder imposed on self (FDIS), commonly called Munchausen syndrome, is a complex mental disorder in which an individual imitates symptoms of illness in order to elicit attention, sympathy, or physical care. Patients with FDIS intentionally falsify or induce signs and symptoms of illness, trauma, or abuse to assume this role. These actions are performed consciously, though the patient may be unaware of their motivations. There are several risk factors and signs associated with this illness and treatment is usually in the form of psychotherapy but may depend on the specific situation, which is further discussed below. Diagnosis is usually determined by meeting specific DSM-5 criteria after ruling out true illness as described below.

Factitious disorder imposed on self is related to factitious disorder imposed on another, the abuse of another person in order to seek attention or sympathy for the abuser. This is "Munchausen by proxy", and the drive to create symptoms for the victim can result in unnecessary and costly diagnostic or corrective procedures. Other similar and often confused syndromes and diagnoses are discussed in the "Related Diagnoses" section.

That patients can exaggerate or inflict symptoms on themselves has been recognized since antiquity, with the second century manuscript attributed to Galen titled On Feigned Diseases and the Detection of Them. In 1843, the Scots physician Hector Gavin invented the term "factitious disease" to describe persons who faked medical symptoms for sympathy, attention or "some inexplicable cause". In the 1930s, the psychiatrist Karl Menninger noted some patients compulsively insisted on medically unnecessary surgeries, often seeking out a physician with a powerful or dynamic personality.

In 1951, Richard Asher coined "Munchausen syndrome" for a pattern of self-harm where individuals fabricated histories, signs, and symptoms of illness. The name alludes to Baron Munchausen, a fictional character who tells many fantastic and impossible stories about himself. Asher's article was published in The Lancet in February 1951. The name sparked some controversy, with medical authorities debating the appropriateness of the name for about fifty years. While Asher was praised for bringing cases of factitious disorder to light, participants in the debate objected variously that a literary allusion was inappropriate given the seriousness of the disease; and that the name's connection to works of humor and fantasy, and to the essentially ridiculous character of the fictional Baron Munchausen, was disrespectful to patients with the disorder. Some healthcare providers avoid this term because it downplays the complexity of the illness and devalues the patient experience.

The term "factitious disorder imposed on self" provides a more neutral description of the mental disorder; however, both terms may still be used interchangeably in practice.

The exact cause of this illness is unknown due to limited research but is likely the result of multiple psychosocial factors. Specific risk factors have been associated with developing FDIS, specifically a history of childhood trauma, abandonment, having a serious childhood illness, and certain personality disorders. Patients are more likely to be female, middle aged, and work in the healthcare industry. Individuals with this disorder may also have a history of recurrent hospitalizations and frequent visits to multiple different physicians (i.e. doctor shopping). They are also more likely to have underlying depression, though it is unclear if it is a cause or symptom of this illness. Some researchers suggest other various psychiatric disorders may coincide, namely Borderline Personality Disorder. The comorbidity of these psychiatric disorders with FDIS can be termed a Tripolar Syndrome.

In factitious disorder imposed on self, the affected person exaggerates or creates physical or psychological symptoms of illnesses in themselves to gain examination, treatment, attention, sympathy or comfort from medical personnel. Because these symptoms can vary depending on how patients induce these symptoms, there is no consistent symptom specific for this illness. However, there are several common themes that may raise suspicion for FDIS. Some of these common themes include:

Common examples of commonly induced physical symptoms include intentionally infecting a wound with debris or unsanitary material, taking laxatives to induce diarrhea, or ingesting thyroid hormone replacement medication to simulate a hyperactive thyroid or hyperthyroidism.