Munchausen syndrome: signs, causes, treatment

We all had those days as kids when we pretended to be sick to get out of going to school. For some people, though, pretending to be ill is part of who they are—due to a mental health condition called Munchausen syndrome. 

In some cases, people have Munchausen syndrome for a nefarious reason, like insurance fraud. In other cases, though, the story is much more complex. Keep reading to learn about Munchausen syndrome, now called factitious disorder. 

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Munchausen syndrome is a serious mental disorder where people purposely act like they have a physical or mental illness when they don’t have one. They will invent or exaggerate symptoms of a disease they don’t have or even harm themselves so they can get medical care (Carnahan, 2021).

In 1951, Richard Asher published an article in the Lancet describing people with self-created illness as having “Munchausen syndrome,” named after a character in German tales. Baron von Munchausen reported fantastic adventures, but they were all self-created, dramatic, and patently untrue. It seemed an apt name for a syndrome that features a person’s need to fabricate a false physical or mental health illness (Yates, 2016).

The American Psychiatric Association renamed Munchausen syndrome and listed it as "factitious disorder" in the Diagnostic and Statistical Manual on Mental Disorders, fifth edition (DSM-5) (Jafferany, 2018).  

Factitious means artificially created. There are two types of factitious disorders (Hausteiner-Wiehle, 2020): 

• The first is factitious disorder imposed on self (FDIS), formerly known as Munchausen syndrome. A person deliberately deceives others by falsely claiming they are sick or making themselves sick. 

• The second is factitious disorder imposed on another (FDIA), formerly known as Munchausen syndrome by proxy. A parent, another family member, or caregiver deliberately presents another person—usually a child—as being very ill.

Factitious disorder is not when someone fakes illness to claim workman’s compensation, or they don’t want to go to school or work. Factitious disorder is a mental health condition whereby people may not even know why they falsely claim or make themselves sick (Carnahan, 2021).

With factitious disorder imposed on self (FDIS), the symptoms surround fooling others into thinking the person is very ill. Those with FDIS will deliberately and convincingly try to cover up their fabrication or exaggeration of their illness. They will continue lying and deceiving even if they've been shown that they don't have the condition they claim to. It is a severe mental health disorder. The main symptoms of deceptiveness and lying can cause significant physical injury and even death (Hausteiner-Wiehle, 2020).

Physical symptoms 

People with FDIS may fabricate vague symptoms that are difficult to determine. These symptoms may include dizziness, fainting, or stomachaches (Hausteiner-Wiehle, 2020).  

They may claim health problems that seem to get worse despite treatment. They may also exaggerate by saying that an existing injury is much worse and requires additional intervention or hospitalization. Some people with FDIS have existing medical conditions that don’t seem to respond to usual treatment. They may stop taking prescribed medications or take too many to remain sick. (Hausteiner-Wiehle, 2020)

Psychological symptoms

People with FDIS are often eager to have medical testing or procedures.

They continually seek treatments from different healthcare professionals or hospitals, potentially traveling to other states or provinces to receive treatment. Some people with FDIS behave oddly with medical staff by arguing with them or acting as if they have a strange closeness with healthcare providers (Hausteiner-Wiehle, 2020).

If you suspect someone in your life has a factitious disorder, you can watch out for these clear signs.

Factitious disorder imposed on self

People with FDIS are very deceptive and may end up with a serious injury in an attempt to make themselves ill. In some cases, their extreme self-harm actions can lead to death. These are warning signs of FDIS (Hausteiner-Wiehle, 2020):

• Unwillingness to allow healthcare providers to share their medical information with a family member or other medical providers

• Deliberate self-harm to get sick—This includes eating something poisonous or purposefully injuring themselves. Some may take too much medication (their own or someone else's) to make themselves very sick. Others may even inject themselves with dangerous substances to become ill.

• Tampering with thermometers to make it seem like they keep having fevers

• Modifying medical records to enter fake symptoms

• Purposely adding substances to medical tests to skew the test results

• Using fake names when interacting with medical personnel

Factitious disorder imposed on another

This mental health disorder was known as Munchausen syndrome by proxy. FDIA is when one person deliberately manipulates others by saying their child (or another dependent) has a severe illness—physical or psychological. Often, the caregiver knowingly hurts their child to show others how sick or disabled their child is. The unnecessary medical care and attention they get to treat their fake "illness" can seriously injure the child. Factitious disorder imposed on another with a child is considered a form of child abuse (Sousa Filho, 2017).

There are severe risks for people with FDIS, resulting in permanent injury and death. They may also have other mental health conditions, including personality disorders. Some people with FDIS use alcohol or abuse substances in an attempt to appear sicker, which comes with its own health consequences. Some lose limbs or internal organs from unnecessary procedures, surgeries, or non-accidental trauma (Sousa Filho, 2017). 

It isn't easy to calculate how common this condition is. People with this mental condition often go to multiple medical professionals and cleverly hide their deceptive behavior. Many healthcare providers don't recognize some of the symptoms of Munchausen syndrome. They may feel obliged to rule out other medical conditions first, or they may not be able to diagnose this complex psychiatric disorder (Jafferany, 2018).

While men and women both develop Munchausen syndrome, it's more common for younger women with some medical training to develop this condition. In contrast, men over the age of 40 are more likely to develop it. Some people begin to show symptoms after being hospitalized (Yates, 2016).

There may be multiple factors leading to the development of FDIS, including childhood experiences and psychological factors. More research is needed to understand this complex mental health condition (Sousa Filho, 2017).

Childhood experiences 

Having a serious illness or frequent hospitalizations as a child can cause FDIS in some cases. Some people with FDIS may have felt cared for while under treatment and seek to get the same feelings of support and comfort in adulthood by faking illness (Carnahan, 2021).

Others may have suffered traumatic experiences including neglect, abandonment, physical, emotional, or sexual abuse, or losing a loved one during their formative years. These experiences can cause significant attachment issues. Some people may fake illness to get attention or revert to childhood when someone else was in charge of them (Carnahan, 2021). 

Psychological causes 

Emotional or psychological causes include personality disorders and depression. In particular, histrionic personality disorder and borderline personality disorder often happen alongside FDIS. Some people with factitious disorder may feel shame, guilt, or in need of punishment. They may feel they deserve to be disabled or ill. These people are more likely to self-injure and self-harm (Carnahan, 2021). 

People who are sick get special attention, so people with FDIS create the identity of a sick person to get reassurance, comfort, and support from others (Carnahan, 2021). 

If your loved one shows symptoms of deliberately lying about their health or injuring themselves repeatedly, you may want to speak to a healthcare professional for evaluation.

A healthcare provider will request previous medical records, do a thorough physical exam, and only order lab tests for specific problems if needed. They will ask questions of the person and their family members. 

Several other disorders mimic the physical symptoms of factitious disorder imposed on self. These include anxiety disorders, conversion disorder, malingering disorder, and somatic symptom disorder. While all of these disorders result in a person presenting as sick, only FDIS involves the person having an unconscious desire and motivation to make themselves deliberately ill (Hausteiner-Wiehle, 2020).

The Diagnostic and Statistical Manual on Mental Disorders, fifth edition (DSM-5) states that a factitious disorder diagnosis is when these four symptoms are present (Carnahan, 2021): 

• Falsifying symptoms

• Presenting as injured or sick

• Evidence of lying and deceptive behavior

• Symptoms that can’t be attributed to another psychiatric diagnosis 

There is no standard treatment or cure for FDIS, and it is often challenging to convince a person with FDIS to get treatment for their condition (Hausteiner-Wiehle, 2020). 

If your loved one requires treatment for FDIS, you may have to coax them gently to go for help. Some FDIS patients may have already been accused of lying, manipulating, or fabricating illness and injuries. They may be defensive and resist psychological help. It is essential to approach them in a non-judgmental and non-threatening manner. 

Treatment includes: 

• A healthcare professional to manage their medical care. Having one provider monitoring all needed medical care reduces the involvement of other specialists and surgeons, often reducing the number of unnecessary tests and procedures (Carnahan, 2021).

• A psychotherapist and psychiatrist to help manage the emotional and psychological aspects of this complex disorder. This includes both short-term cognitive-behavioral therapy and long-term therapy, such as psychoanalysis or psycho-education. Psychotherapy helps identify thoughts and feelings that trigger distressing behaviors and provides tools to redirect actions, reduce stress, and acquire coping skills (Jafferany, 2018). 

There are no medications to treat FDIS. Medications may be prescribed to treat the symptoms that can occur from depression or anxiety that may occur alongside or because of FDIS. These medications may include antidepressants, antipsychotics, mood stabilizers, and anti-anxiety medicines (Carnahan, 2021).

If a person is suicidal or is in a severe emotional state, they may need to be hospitalized for treatment (Sousa Filho, 2017).

If you think your loved one has these symptoms, you may want to speak to them about what you’ve noticed. FDIS is a psychiatric disorder, and it is difficult for a person with this disorder to control their behavior. They may actively deny that there is anything mentally wrong with them and insist it is a physical illness. They may require enormous reassurance and support from you when they are “sick.” 

You will need to approach them gently with facts in a caring manner. You may want to offer to go with them to their healthcare provider to assess them and get treatment.

People with FDIS can harm, injure, or even kill themselves with their actions. If your loved one is in danger, call 911 or go to the nearest emergency room. 

You may benefit from family therapy to teach you specific skills to deal appropriately with their behavior. Both you and your loved one can benefit from psychological support so you can live a healthy and satisfying life.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

July 06, 2021

Written by

Tobi Ash, MBA, RN, BSN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.