Factitious Disorder: Signs, Causes, and Why Treatment Is So Hard
Updated: 20 hours ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Source currency note: This guide reflects medical information reviewed in February 2026. Always confirm current guidance with your healthcare professional.
Quick Answer
Factitious disorder is a serious mental health condition, previously called Munchausen syndrome, in which people pretend to be sick, fake symptoms, make themselves sick or hurt themselves with no outside reward. When imposed on another person, usually a child, it is a form of abuse. There are no standard therapies; care involves a non-judgmental approach and talk therapy. [3] [4]
What the research says
Depression is common in factitious disorder. A systematic review found depression in around 30% of people with factitious disorder, linked to childhood and adulthood traumatic experiences and a history of psychosocial problems, and recommended screening for depression once factitious disorder is diagnosed (Comacchio et al., Frontiers in Psychiatry, 2024 [1]).
Imposed-on-another cases mostly involve caregivers and children. A systematic review of 314 studies covering 455 perpetrators and 469 victims found that about 93% of perpetrators were female, that victims were most often children and adolescents, and that among the outcomes reported, 14.5% of victims were raised in foster care or by social authorities and 29.7% of perpetrators were accused of a crime (Wang et al., Frontiers in Public Health, 2026 [2]).
Many people with the condition work in healthcare. A systematic review of 455 published cases found that 66.2% of patients were women, the mean age at presentation was 34.2 years, a healthcare or laboratory profession was the most often reported occupation, and more patients induced their illness or injury (58.7%) than simulated or falsely reported it (Yates & Feldman, General Hospital Psychiatry, 2016 [5]).
No single management approach is proven. A systematic review of 32 case reports and 13 case series found no significant difference in outcomes between confrontational and non-confrontational approaches, or with psychotherapy or psychiatric medicine, and many people were not engaged in treatment and were lost to follow-up (Eastwood & Bisson, Psychotherapy and Psychosomatics, 2008 [6]).
What is factitious disorder?
Factitious disorder, previously called Munchausen syndrome, is a serious mental health condition in which people deceive others by pretending to be sick. They do this by faking symptoms, getting sick on purpose, or hurting themselves. The condition can also occur when family members or caregivers falsely present others, such as children, as ill, hurt, or struggling to function [3].
Symptoms can range from mild to severe. People may make up symptoms or even tamper with medical tests to convince others that they need treatment, including high-risk surgery [3].
Factitious disorder is not the same as faking illness for a benefit or reward, such as getting out of work or winning a lawsuit. Although people with factitious disorder know they are causing their symptoms, they may not know why they do it, and they may not see themselves as having a mental health condition. The condition is rare and hard to diagnose and treat, and help from medical and mental health professionals is critical to prevent serious injury and even death when people hurt themselves [3].
Symptoms and warning signs
Factitious disorder involves trying to look ill, making oneself ill, or self-harm. People may fake symptoms, make symptoms seem worse than they are, or pretend they cannot do certain things. They work hard to hide the deception, and they keep it up even without any benefit or reward, or when faced with evidence that does not support their claims [3].
Warning sign | What it looks like |
Clever, convincing problems | Presents medical or mental health problems that seem believable |
Deep medical knowledge | Unusually strong knowledge of medical terms and diseases |
Vague or inconsistent symptoms | Symptoms do not add up or change from one visit to the next |
Unexplained worsening | Conditions get worse for no clear reason |
Poor treatment response | Conditions do not respond as expected to standard treatments |
Doctor-hopping | Seeks treatment from many professionals or hospitals, sometimes under a fake name |
Guarded about information | Does not want professionals to talk to family, friends, or other providers |
Frequent hospitalizations | Stays in the hospital a lot and has few visitors |
Seeking risky procedures | Wants frequent testing or risky surgeries and procedures |
Evidence of procedures | Many surgical scars or other signs of many procedures |
Conflict with staff | Argues with healthcare professionals and staff |
Factitious 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 mental symptoms of illness, or causes injury or disease in another person, to deceive others. The person is presented as sick, hurt, or struggling and in need of medical help. This usually involves a parent harming a child, and it is a form of abuse that can put a child in danger of being hurt or receiving medical care that is not needed [3]. Read our full guide to factitious disorder imposed on another (FDIA).
How people with factitious disorder fake illness
Because people with factitious disorder can become expert at faking symptoms or hurting themselves, it may be hard for healthcare professionals and loved ones to know whether symptoms are real [3]:
Method | How it is done |
Exaggeration | Makes symptoms seem worse than they are, even when a real condition exists, to look sicker or less able to function |
False histories | Gives loved ones, professionals, or support groups false medical histories, such as claiming to have had cancer, or creates false health records |
Faking symptoms | Fakes symptoms such as stomach pain, seizures, or passing out |
Self-harm | Makes themselves sick by causing injury, using harmful substances, or taking medicines to mimic disease, or delays wound healing |
Tampering | Heats up thermometers or spoils urine samples to skew test results |
What causes factitious disorder?
The cause is not known, but a mix of mental health issues and stressful life experiences may play a role [3].
Risk factors
Risk factor | Details |
Childhood trauma | Emotional, physical, or sexual abuse |
Serious childhood illness | A serious illness during childhood |
Loss and abandonment | Losing a loved one through death or illness, or feeling abandoned |
Illness-related attention | Past experiences of being sick and the attention it brought |
Identity and self-esteem | A poor sense of identity or low self-esteem |
Other mental health conditions | Personality disorders and depression |
Ties to healthcare | A desire to be linked with healthcare professionals or medical centers, or working in healthcare |
Factitious disorder is thought to be rare, but no one knows exactly how many people have it. Some use fake names, some visit many hospitals, and some are never identified, which makes a reliable estimate impossible [3].
Complications
People with factitious disorder are willing to risk their lives to be seen as sick, and they often have other mental health conditions as well. Possible complications include injury or death from conditions they cause themselves, severe infections or problems from unneeded surgeries, loss of organs or limbs, misuse of alcohol or other substances, major problems getting along with others and at work, and abuse of another person when the behavior is imposed on them [3].
Prevention
Because the cause is not known, there is no way to prevent factitious disorder. Recognizing and treating it may help avoid dangerous tests and treatments that are not needed [3].
Diagnosis: how doctors approach it
Diagnosing factitious disorder is often very hard. People with the condition are experts at faking many diseases, and while they often appear to have real, even life-threatening conditions, they may have brought those conditions on themselves. Using many professionals and hospitals, using fake names, and privacy and confidentiality laws can make it hard or even impossible to gather information about previous medical care [4].
Diagnosis is based on objectively identifying symptoms that are made up, rather than on the person’s intent or motivation. A professional may suspect factitious disorder when the medical history does not make sense, there is no believable reason for an illness or injury, the illness does not follow its usual course, there is no clear reason for not improving despite the right treatment, symptoms or lab results are contradictory, the person will not share past records or allow contact with other professionals and family, or they are caught lying or harming themselves [4].
To work through the picture, professionals conduct a detailed interview, require past health records, work with family members if the person gives permission, and run only the tests needed to check for possible physical problems [4].
Treatment: why it is hard and what helps
Treatment is often hard, and there are no standard therapies. Because people with the condition want to be in the sick role, they often are not willing to seek or accept treatment for it. But if approached without judgment, they may agree to be assessed and treated by a mental health professional [4].
A non-judgmental approach
Directly accusing someone of having factitious disorder usually makes them angry and defensive, and they may suddenly end the relationship with a professional or hospital and seek care elsewhere. Instead, professionals often create an “out” that spares the person the humiliation of admitting to faking. They may reassure the person that having no explanation for symptoms is stressful and suggest that stress may cause some physical complaints, ask them to agree to explore a possible mental health reason together if the next treatment does not work, or suggest focusing treatment on improving function and quality of life rather than treating symptoms. Professionals and loved ones can also reinforce healthy, productive behaviors and avoid giving too much attention to symptoms [4].
Treatment options
Treatment often focuses on managing the condition and helping people function better rather than trying to cure it [4]:
Option | What it involves |
One primary healthcare professional | A single professional oversees care, which can reduce or stop unneeded visits to many professionals |
Talk therapy | Psychotherapy and behavior therapy help control stress and build coping skills; family therapy may be suggested, and other conditions such as depression are addressed |
Medicine | May treat other mental health conditions, such as depression or anxiety |
In-hospital treatment | A short stay in a mental health hospital if symptoms are severe, for safety and to create a treatment plan |
Treatment may not be accepted or may not help, especially in severe cases. In those situations the goal may be to stop further invasive or risky treatments. When factitious disorder is imposed on another person, professionals assess for abuse and must report it to authorities [4].
What loved ones can do
Alongside professional treatment, these steps can help people with factitious disorder [4]:
Follow through with the treatment plan. Attend therapy and take medicines as directed. When the urge to hurt themselves or cause illness comes up, talk honestly with the therapist or primary professional about better ways to cope.
Have a medical gatekeeper. Use one trusted primary professional to manage medical care instead of visiting many professionals, specialists, and surgeons.
Remember the risks. Risky tests or surgeries that are not needed can cause lifelong injury or even death.
Stay rather than run. Resist the urge to find a new professional or move to a new town where providers do not know the background. An experienced therapist can help overcome these urges.
Connect with someone. Many people with factitious disorder have no close relationships. Finding someone to confide in and share good times with matters.
When to get immediate help
If you think a loved one may be exaggerating or faking health problems, talking about your concerns may help. Try not to be angry, judgmental, or confrontational, reinforce healthier and more productive activities, offer support and care, and help find treatment if you can [3].
If your loved one causes self-harm or attempts suicide, contact a crisis line right away. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week, including a Spanish line at 1-888-628-9454. Outside the U.S., contact your local emergency number or crisis service [3]. If you suspect a child is being harmed as part of factitious disorder imposed on another, contact the Childhelp National Child Abuse Hotline at 1-800-422-4453 (toll-free, 24 hours a day, seven days a week), or your local child protective services agency [3].
Preparing for an appointment
People with factitious disorder are likely to first get care for it when healthcare professionals raise concerns that mental health issues may play a part in an illness. Professionals may ask permission to contact family members in advance to discuss the health history [4].
What loved ones can bring
A detailed health history, including complaints, diagnoses, treatments, and procedures, with names and contact details of previous providers and signed releases so records can be shared.
Notes on current behaviors that raise concern, and anything the person has been avoiding because of symptoms.
Key points from the personal history, such as childhood abuse or trauma and recent major losses.
A list of all medicines, including over-the-counter medicines and supplements, with doses, and any alcohol or substance misuse.
Your questions for the professional.
Questions worth asking
What is likely causing my loved one’s symptoms? Are there other possible causes? How will you make the diagnosis? Is this likely to be short term or long term? What treatments do you recommend? How much improvement can we expect? How will you monitor well-being over time? Would family therapy help? What are the next steps?
What the professional may ask
Expect questions about recent injuries or illnesses and past treatments, previous diagnoses, medicines and surgery, how often providers or hospitals have been changed, whether anyone has had concerns about self-caused illness or illness caused in another person, how symptoms affect work, school, and relationships, any self-harm, harm to others, or suicide attempts, childhood trauma, and whether you have talked with your loved one about your concerns [4].
Conclusion: a condition that needs compassion and a plan
Factitious disorder is one of the hardest conditions in medicine, not because it cannot be helped, but because the person at its center often does not understand why they behave this way and may not accept help. The approach that works best is a single coordinating professional, non-judgmental engagement, therapy that focuses on function rather than symptoms, and treatment for coexisting conditions such as depression [4].
If you suspect a loved one is living with factitious disorder, offer support without confrontation and gently connect them with a trusted primary care professional. If a child is being harmed through factitious disorder imposed on another, calling a hotline is not an overreaction; it is protection.
Frequently Asked Questions
What is factitious disorder?
Factitious disorder is a serious mental health condition, previously called Munchausen syndrome, in which people deceive others by pretending to be sick. They fake symptoms, get sick on purpose, or hurt themselves, and they do it without an outside reward like money or time off work.
How is factitious disorder different from faking illness for a benefit?
Faking illness for a clear outside benefit, such as getting out of work or winning a lawsuit, is a different thing. In factitious disorder there is no outside reward, and the person’s goal appears to be to take on the sick role.
What is factitious disorder imposed on another?
Previously called Munchausen syndrome by proxy, it is when someone falsely claims another person, usually a child, is ill, or causes illness or injury in them, to deceive others. It is a form of abuse, and professionals must report it to authorities.
How do people fake illness with factitious disorder?
People with factitious disorder exaggerate real symptoms, invent false medical histories, fake symptoms such as seizures or fainting, cause themselves harm or take medicines to mimic disease, and tamper with tests, for example by heating thermometers or spoiling urine samples.
What are the warning signs?
Vague or inconsistent symptoms, conditions that worsen without reason or do not respond to treatment, deep medical knowledge, doctor-hopping, reluctance to let professionals contact family, frequent hospitalizations, a desire for risky procedures, many surgical scars, few hospital visitors, and arguments with staff.
What causes factitious disorder?
The exact cause is not known. A mix of mental health issues and stressful life experiences may contribute. Risk factors include childhood trauma, serious childhood illness, loss or abandonment, past illness-related attention, low self-esteem, personality disorders, depression, and ties to the healthcare field.
Is factitious disorder curable?
There are no standard therapies, and treatment focuses on managing the condition and improving function rather than curing it. Talk therapy, one coordinating professional, medicines for coexisting conditions, and sometimes a short hospital stay are used.
How do doctors diagnose it?
Diagnosis is based on objectively identifying symptoms that are made up, not on the person’s motivation. Professionals use detailed interviews, past health records, family input with permission, and only the tests needed to rule out physical problems.
What can family members do?
Offer support without anger, judgment, or confrontation, reinforce healthy activities, help the person keep one trusted primary professional, and seek immediate help from a crisis or child abuse hotline if self-harm or harm to a child is suspected.
Is factitious disorder the same as illness anxiety disorder?
No. A person with illness anxiety disorder truly fears they are sick and is not faking. A person with factitious disorder knowingly fakes or causes symptoms to be seen as sick.
Related Reading
Factitious Disorder Imposed on Another (FDIA): Signs, Causes, Diagnosis, Treatment and When to Get Help — What You Need to Know explains the form where a caregiver fakes or causes illness in another.
Factitious Disorder Imposed on Self (FDIS): The Complete Guide to Signs, Causes, Diagnosis and Treatment explains the self-imposed form in more depth.
Illness Anxiety Disorder: When Fear of Getting Sick Takes Over, and What Actually Helps explains real health worry and how it differs from faking illness.
Conversion Disorder (Functional Neurological Disorder): Real Symptoms, Diagnosis & Recovery explains real nerve symptoms with no structural cause, which are not faked.
References
Comacchio C, Misca DM, Bortoletto R, et al. Prevalence and risk factors for depression in factitious disorder: a systematic review. Frontiers in Psychiatry. 2024;15:1355243. PMID 38736625. https://doi.org/10.3389/fpsyt.2024.1355243
Wang D, Zhao M, Yin J, et al. Characteristics, interventions, and outcomes of factitious disorder imposed on another (FDIA): a systematic review of 455 perpetrators and 469 victims. Frontiers in Public Health. 2026;13:1723415. PMID 41641042. https://doi.org/10.3389/fpubh.2025.1723415
Mayo Clinic Staff. Factitious disorder: symptoms and causes. Mayo Clinic. February 11, 2026. https://www.mayoclinic.org/diseases-conditions/factitious-disorder/symptoms-causes/syc-20356028
Mayo Clinic Staff. Factitious disorder: diagnosis and treatment. Mayo Clinic. February 11, 2026. https://www.mayoclinic.org/diseases-conditions/factitious-disorder/diagnosis-treatment/drc-20356034
Yates GP, Feldman MD. Factitious disorder: a systematic review of 455 cases in the professional literature. General Hospital Psychiatry. 2016;41:20-28. PMID 27302720. https://doi.org/10.1016/j.genhosppsych.2016.05.002
Eastwood S, Bisson JI. Management of factitious disorders: a systematic review. Psychotherapy and Psychosomatics. 2008;77(4):209-218. PMID 18418027. https://doi.org/10.1159/000126072
Medical disclaimer
This article was prepared for general information only and is not a substitute for professional medical advice.
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