History and exam
Key diagnostic factors
common
history of unexplained complaints or inconsistency over time
A long and complicated medical history may be described by the patient or revealed through gathering records from other providers.
May relate to the patient or to a person in their care (factitious disorder imposed on another [previously factitious disorder by proxy]).
unusual presentation relative to demographics
Suspicion may be increased when, for example, a patient with an intact immune system develops unusual infection, or a patient develops symptoms outside the expected age of onset, such as dementia in young adulthood.
May relate to the patient or to a person in his or her care (factitious disorder imposed on another [previously factitious disorder by proxy]).
Other diagnostic factors
common
symptoms more exaggerated while aware of being observed
Commonly seen in the emergency department or psychiatric unit.[18]
presentation for care at many different hospitals
May support a diagnosis of factitious disorder.
May relate to the patient or to a person in his or her care (factitious disorder imposed on another [previously factitious disorder by proxy]).
eyewitness evidence of the patient manipulating findings
May confirm the diagnosis.
Manipulation may be of the patient's own findings or of findings relating to a person in his or her care (factitious disorder imposed on another [previously factitious disorder by proxy]).
uncommon
dramatic history of travel and acute illness (Munchausen subtype)
People with Munchausen syndrome (an extreme form of factitious disorder) may present this way, often attracting significant attention from hospital staff.
May relate to the patient or to a person in his or her care (factitious disorder imposed on another [previously factitious disorder by proxy]).
multiple abdominal scars (Munchausen subtype)
Patients, particularly those with Munchausen subtype, may have multiple scars from unnecessary laparotomies, perhaps even inducing unintentional complications, such as bowel obstructions.
May relate to the patient or to a person in his or her care (factitious disorder imposed on another [previously factitious disorder by proxy]).
medications or medical paraphernalia found in an unusual location in a patient's room
May be the first clue that a factitious disorder exists.
This would generally be an accidental discovery. In the scenario where the medical team suspected the diagnosis and wished to make a formal search of the patient's room, then legal counsel should be sought.
Risk factors
strong
female sex (factitious disorder)
medically related employment (factitious disorder)
cluster B personality characteristics (factitious disorder)
Include borderline personality disorder, antisocial personality disorder, narcissistic personality disorder, and histrionic personality disorder.[1][10]
Characteristics that seem to be more common in presentations of factitious disorder include dramatic presentation or symptoms, over- or undervaluating medical providers, and tumultuous interpersonal relationships.
male sex (Munchausen subtype)
More likely in people presenting with the Munchausen subtype of factitious disorder.[3]
single marital status (Munchausen subtype)
More likely in people presenting with the Munchausen subtype of factitious disorder.[3]
age 40 to 50 years (Munchausen subtype)
More likely in people presenting with the Munchausen subtype of factitious disorder.[3]
antisocial personality traits (Munchausen subtype)
More likely in people presenting with the Munchausen subtype of factitious disorder.[3]
Use of this content is subject to our disclaimer