Faking illnesses for attention

Overview - Munchausen syndrome - NHS

Munchausen syndrome is a psychological condition where someone pretends to be ill or deliberately produces symptoms of illness in themselves.

Their main intention is to assume the "sick role" so that people care for them and they are the centre of attention.

Any practical benefit in pretending to be sick – for example, claiming incapacity benefit – is not the reason for their behaviour.

Munchausen syndrome is named after a German aristocrat, Baron Munchausen, who became famous for telling wild, unbelievable tales about his exploits.

Types of behaviour

People with Munchausen syndrome can behave in a number of different ways, including:

pretending to have psychological symptoms – for example, claiming to hear voices or claiming to see things that are not really there
pretending to have physical symptoms – for example, claiming to have chest pain or a stomach ache
actively trying to get ill – such as deliberately infecting a wound by rubbing dirt into it

Some people with Munchausen syndrome may spend years travelling from hospital to hospital faking a wide range of illnesses. When it's discovered they're lying, they may suddenly leave hospital and move to another area.

People with Munchausen syndrome can be very manipulative and, in the most serious cases, may undergo painful and sometimes life-threatening surgery, even though they know it's unnecessary.

Read more about the signs and symptoms of Munchausen syndrome

What causes Munchausen syndrome?

Munchausen syndrome is complex and poorly understood. Many people refuse psychiatric treatment or psychological profiling, and it's unclear why people with the syndrome behave the way they do.

Several factors have been identified as possible causes of Munchausen syndrome. These include:

emotional trauma or illness during childhood – this often resulted in extensive medical attention
a personality disorder – a mental health condition that causes patterns of abnormal thinking and behaviour
a grudge against authority figures or healthcare professionals

Childhood trauma

Munchausen syndrome may be caused by parental neglect and abandonment, or other childhood trauma.

As a result of this trauma, a person may have unresolved issues with their parents that cause them to fake illness. They may do this because they:

have a compulsion to punish themselves by making themselves ill because they feel unworthy
need to feel important and be the centre of attention

need to pass responsibility for their wellbeing and care on to other people

There's also some evidence to suggest people who have had extensive medical procedures, or received prolonged medical attention during childhood or their teenage years, are more likely to develop Munchausen syndrome when they're older.

This may be because they associate their childhood memories with a sense of being cared for. As they get older, they try to obtain the same feelings of reassurance by pretending to be ill.

Personality disorders

Different personality disorders thought to be linked with Munchausen syndrome include:

antisocial personality disorder – where a person may take pleasure in manipulating and deceiving doctors, giving them a sense of power and control
borderline personality disorder – where a person struggles to control their feelings and often swings between positive and negative views of others
narcissistic personality disorder – where a person often swings between seeing themselves as special and fearing they're worthless

It could be that the person has an unstable sense of their own identity and also has difficulty forming meaningful relationships with others.

Playing the "sick role" allows them to adopt an identity that brings support and acceptance from others with it. Admission to hospital also gives the person a clearly defined place in a social network.

Diagnosing Munchausen syndrome

Diagnosing Munchausen syndrome can be challenging for medical professionals.

People with the syndrome are often very convincing and skilled at manipulating and exploiting doctors.

Investigating claims

If a healthcare professional suspects a person may have Munchausen syndrome, they'll look at the person's health records to check for inconsistencies between their claimed and actual medical history.

Healthcare professionals can also run tests to check for evidence of self-inflicted illness or tampering with clinical tests. For example, the person's blood can be checked for traces of medicine they should not be taking but which could explain their symptoms.

Doctors will also want to rule out other possible motivations for their behaviour, such as faking illness for financial gain or because they want access to strong painkillers.

Munchausen syndrome can usually be diagnosed if:

there's clear evidence of fabricating or inducing symptoms
the person's prime motivation is to be seen as sick
there's no other likely reason or explanation for their behaviour

Treating Munchausen syndrome

Treating Munchausen syndrome can be difficult because most people with it refuse to admit they have a problem and refuse to co-operate with treatment plans.

Some experts recommend that healthcare professionals should adopt a gentle non-confrontational approach, suggesting the person may benefit from a referral to a psychiatrist.

Others argue that a person with Munchausen syndrome should be confronted directly and asked why they've lied and whether they have stress and anxiety.

People who have Munchausen syndrome have a genuine mental health condition, but will often only admit to having a physical illness.

If a person admits to their behaviour, they can be referred to a psychiatrist for further treatment. If they do not admit to lying, most experts agree the doctor in charge of their care should minimise medical contact with them.

This is because the doctor-patient relationship is based on trust and if there's evidence the patient can no longer be trusted, the doctor is unable to continue treating them.

Psychiatric treatment and CBT

It may be possible to help control the symptoms of Munchausen syndrome if the person admits they have a problem and co-operates with treatment.

There's no standard treatment for Munchausen syndrome, but a combination of psychoanalysis and cognitive behavioural therapy (CBT) has shown some success controlling symptoms.

Psychoanalysis is a type of psychotherapy that attempts to uncover and resolve unconscious beliefs and motivations.

CBT helps a person identify unhelpful and unrealistic beliefs and behavioural patterns. A specially trained therapist teaches the person ways of replacing unrealistic beliefs with more realistic and balanced ones.

Family therapy

People with Munchausen syndrome still in close contact with their family may also benefit from having family therapy.

The person with the syndrome and their close family members discuss how it's affected the family and the positive changes that can be made.

It can also teach family members how to avoid reinforcing the person's abnormal behaviour. For example, this could involve recognising when the person is playing the "sick role" and avoiding showing them concern or offering support.

Who's affected by Munchausen syndrome?

There appear to be 2 separate groups of people affected by Munchausen syndrome. They are:

women who are 20 to 40 years of age, often with a background in healthcare
unmarried white men who are 30 to 50 years of age

It's unclear why these 2 groups tend to be affected by Munchausen syndrome.

Some experts believe Munchausen syndrome is underdiagnosed because many people succeed in deceiving medical staff. It's also possible cases may be overdiagnosed as the same person could use different identities.

Fabricated or induced illness

Fabricated or induced illness, which used to be known as Munchausen syndrome by proxy, is a related condition.

This is where a person fakes or induces illness in a person under their care, such as their child.

Video: Munchausen syndrome

In this video, an expert discusses Munchausen syndrome and Munchausen by proxy (fabricated or induced illness).

Media last reviewed: 7 December 2021
Media review due: 7 December 2024

Factitious disorder - Symptoms and causes

Overview

Factitious disorder is a serious mental disorder in which someone deceives others by appearing sick, by purposely getting sick or by self-injury. Factitious disorder also can happen when family members or caregivers falsely present others, such as children, as being ill, injured or impaired.

Factitious disorder symptoms can range from mild (slight exaggeration of symptoms) to severe (previously called Munchausen syndrome). The person may make up symptoms or even tamper with medical tests to convince others that treatment, such as high-risk surgery, is needed.

Factitious disorder is not the same as inventing medical problems for practical benefit, such as getting out of work or winning a lawsuit. Although people with factitious disorder know they are causing their symptoms or illnesses, they may not understand the reasons for their behaviors or recognize themselves as having a problem.

Factitious disorder is challenging to identify and hard to treat. However, medical and psychiatric help are critical for preventing serious injury and even death caused by the self-harm typical of this disorder.

Products & Services

Book: Mayo Clinic Family Health Book, 5th Edition
Newsletter: Mayo Clinic Health Letter — Digital Edition

Symptoms

Factitious disorder symptoms involve mimicking or producing illness or injury or exaggerating symptoms or impairment to deceive others. People with the disorder go to great lengths to hide their deception, so it may be difficult to realize that their symptoms are actually part of a serious mental health disorder. They continue with the deception, even without receiving any visible benefit or reward or when faced with objective evidence that doesn't support their claims.

Factitious disorder signs and symptoms may include:

Clever and convincing medical or psychological problems

Extensive knowledge of medical terms and diseases
Vague or inconsistent symptoms
Conditions that get worse for no apparent reason
Conditions that don't respond as expected to standard therapies
Seeking treatment from many different doctors or hospitals, which may include using a fake name
Reluctance to allow doctors to talk to family or friends or to other health care professionals
Frequent stays in the hospital
Eagerness to have frequent testing or risky operations
Many surgical scars or evidence of numerous procedures
Having few visitors when hospitalized
Arguing with doctors and staff

Factious disorder imposed on another

Factitious disorder imposed on another (previously called Munchausen syndrome by proxy) is when someone falsely claims that another person has physical or psychological signs or symptoms of illness, or causes injury or disease in another person with the intention of deceiving others.

People with this disorder present another person as sick, injured or having problems functioning, claiming that medical attention is needed. Usually this involves a parent harming a child. This form of abuse can put a child in serious danger of injury or unnecessary medical care.

How those with factitious disorder fake illness

Because people with factitious disorder become experts at faking symptoms and diseases or inflicting real injuries upon themselves, it may be hard for health care professionals and loved ones to know if illnesses are real or not.

People with factitious disorder make up symptoms or cause illnesses in several ways, such as:

Exaggerating existing symptoms. Even when an actual medical or psychological condition exists, they may exaggerate symptoms to appear sicker or more impaired than is true.
Making up histories. They may give loved ones, health care professionals or support groups a false medical history, such as claiming to have had cancer or AIDS. Or they may falsify medical records to indicate an illness.
Faking symptoms. They may fake symptoms, such as stomach pain, seizures or passing out.
Causing self-harm. They may make themselves sick, for example, by injecting themselves with bacteria, milk, gasoline or feces. They may injure, cut or burn themselves. They may take medications, such as blood thinners or drugs for diabetes, to mimic diseases. They may also interfere with wound healing, such as reopening or infecting cuts.
Tampering. They may manipulate medical instruments to skew results, such as heating up thermometers. Or they may tamper with lab tests, such as contaminating their urine samples with blood or other substances.

When to see a doctor

People with factitious disorder may be well aware of the risk of injury or even death as a result of self-harm or the treatment they seek, but they can't control their behaviors and they're unlikely to seek help. Even when confronted with objective proof — such as a videotape — that they're causing their illness, they often deny it and refuse psychiatric help.

If you think a loved one may be exaggerating or faking health problems, it may help to attempt a gentle conversation about your concerns. Try to avoid anger, judgment or confrontation. Also try to reinforce and encourage more healthy, productive activities rather than focusing on dysfunctional beliefs and behaviors. Offer support and caring and, if possible, help in finding treatment.

If your loved one causes self-inflicted injury or attempts suicide, call 911 or emergency medical help or, if you can safely do so, take him or her to an emergency room immediately.

Request an Appointment at Mayo Clinic

Causes

The cause of factitious disorder is unknown. However, the disorder may be caused by a combination of psychological factors and stressful life experiences.

Risk factors

Several factors may increase the risk of developing factitious disorder, including:

Childhood trauma, such as emotional, physical or sexual abuse
A serious illness during childhood
Loss of a loved one through death, illness or abandonment
Past experiences during a time of sickness and the attention it brought
A poor sense of identity or self-esteem
Personality disorders
Depression
Desire to be associated with doctors or medical centers
Work in the health care field

Factitious disorder is considered rare, but it's not known how many people have the disorder. Some people use fake names to avoid detection, some visit many different hospitals and doctors, and some are never identified — all of which make it difficult to get a reliable estimate.

Complications

People with factitious disorder are willing to risk their lives to be seen as sick. They frequently have other mental health disorders as well. As a result, they face many possible complications, including:

Injury or death from self-inflicted medical conditions
Severe health problems from infections or unnecessary surgery or other procedures
Loss of organs or limbs from unnecessary surgery
Alcohol or other substance abuse
Significant problems in daily life, relationships and work
Abuse when the behavior is inflicted on another

Prevention

Because the cause of factitious disorder is unknown, there's currently no known way to prevent it. Early recognition and treatment of factitious disorder may help avoid unnecessary and potentially dangerous tests and treatment.

By Mayo Clinic Staff