Psychiatry
AKT · Psychiatry/Personality & otherlow yield
Factitious disorder
Overview
Intentional falsification or induction of physical/psychological symptoms in oneself (Munchausen syndrome) or another (fabricated/induced illness, "by proxy") to assume the SICK ROLE — with NO external incentive (which separates it from malingering).
Recognise
- Symptoms/signs deliberately produced or feigned (injecting insulin, contaminating samples, self-inflicted wounds)
- Motivation is the sick role/attention — NOT money or avoiding duties
- By proxy: a carer fabricates/induces illness in a child → safeguarding emergency
Red flags
- Fabricated or induced illness in a child = safeguarding emergency; self-harm/induced-illness risk
Differentials & how to tell them apart
Malingeringalso conscious, but for EXTERNAL gain (money, benefits, avoiding work/prison)
Conversion (functional neurological) disordersymptoms genuine and UNCONSCIOUS, not deliberately produced
Somatic symptom disordergenuine distress about real/perceived symptoms, not deliberate fabrication
Investigations
Often suspected from inconsistent/incongruent findings; careful documentation; safeguarding assessment if by proxy.
Management
- 1Avoid unnecessary investigations/procedures; non-confrontational psychiatric involvement; treat comorbid disorders.Gate: Factitious is for the SICK ROLE (no external gain); if there is external gain it is malingering — and fabricated illness in a child is safeguarding
- 2By proxy → child safeguarding pathway; MDT and legal involvement.
No specific drug — psychiatric engagement (often difficult); manage comorbidity
Key points
Conscious production for the sick role (vs malingering = conscious for external gain; conversion = unconscious). "By proxy" is a form of child abuse.
Monitor & prognosis
Engagement; safeguarding (by proxy); comorbidity.
Often chronic and difficult to treat.
Source: StatPearls; safeguarding guidance (fabricated or induced illness)