An individual keeps visiting the hospital with genuine symptoms, goes through testing, and is clearly desperate for answers. But on some occasions, the disease is actually self-induced or even completely fake. Factitious disorders are more than just “pretending to be sick.” They are rather complicated psychological conditions where an individual tries to appear sick or hurt without any apparent benefit (Dickerman & Jiménez, 2023). This article discusses the types, psychological background, diagnosis, treatment issues, and consequences of factitious disorders.
What Is Factitious Disorder?
Factitious Disorder refers to behaviour whereby the individual makes up, exaggerates or creates symptoms in oneself to claim illness, injury or incapacity. Deception is seen as an intentional action involving deception, but which is not motivated primarily by external reward, for instance, monetary reward (American Psychiatric Association, 2022). It is different from other situations in which the symptoms are observed without any deliberate act of deception. It is also difficult to identify due to the element of deception that may continue to be concealed in the diagnostic process (Bérar, 2024).
The Different Forms of Factitious Disorder
A factitious disorder is self-induced or inflicted on others. In the former, a person fabricates or induces sickness on oneself and acts as a patient. In the latter, a caregiver intentionally fabricates or induces sickness in another person and acts as a sick individual (American Psychiatric Association, 2022). The factitious disorder imposed on another is especially problematic because the victim could be subjected to undue tests and treatments. The literature review of 455 people who have engaged in the mentioned behaviours and 469 people victimised by such actions has revealed that there were numerous consequences for both groups (Wang et al., 2026).
What Can It Look Like?
There is no single presentation. The individual may show symptoms that are hard to confirm, have a changing medical history, or continue seeking medical care from various practitioners. Occasionally, the patient may have medical knowledge regarding how the symptoms are tested (Yates & Feldman, 2016). The deception can lead to unwarranted tests, medications, admissions to hospitals, or other medical interventions. A study involving 49 patients with factitious disorder imposed on self found that the diagnosis of such a condition was based on indirect indicators, including incomplete testing, unusual presentation of the symptoms, conflicting history, and significant utilisation of health care facilities (Bérar et al., 2021).
Why Would Someone Deliberately Create Illness?
The hardest aspect of this disease to explain would be its causes. One does not find a single psychological theory; one should not assume that all people who suffer from factitious disorder are driven by the same desire. According to some theories in psychology, such factors as early traumas, troubled relationships, identity issues, and attention seeking may contribute to criminal behaviour. Playing the role of a sick person may offer social support or a feeling of care, but this is only a theoretical explanation and not a universal cause (Dickerman & Jiménez, 2023).
Furthermore, the connection between psychological problems and factitious disorder could also become more complicated because of the presence of comorbid mental disorders. According to a systematic review conducted in 2024, about 30% of patients presented with depression, and the authors cited childhood/adult trauma and psychosocial problems as risk factors for factitious disorder (Comacchio et al., 2024).
Factitious Disorder vs. Malingering
Although both factitious disorder and malingering entail a deliberate fabrication of symptoms, the reasons behind each are different. For instance, in the case of factitious disorder, an individual behaves as if he is ill without any obvious motive from outside. If there is malingering, the motivation for the act comes from some external incentive such as money, laziness, drugs, etc. (American Psychiatric Association, 2022). The distinction is vital since the presence of unexplained symptoms does not necessarily indicate deception on the part of the patient. Some individuals indeed suffer from certain health problems that are hard to diagnose, and there can be cases where factitious disorder coexists with an actual disease (Margolis et al., 2023).
How Is It Diagnosed?
Diagnosing such a condition is not always easy, and it is important for health care providers to differentiate between malingered symptoms and genuine problems and other disorders. The DSM-5-TR places emphasis on identifying evidence regarding false or induced signs or symptoms, the presentation of oneself as ill or injured and the fact that the deception takes place without any apparent external gain (American Psychiatric Association, 2022).
If there is a trend towards conflicting medical histories, unnecessary tests that do not have explanations, peculiar presentations of symptoms, reluctance to provide previous medical history, and increased use of the healthcare system, health care practitioners will have some suspicions about factitious disorders. However, none of these signs serves as proof on their own (Bérar et al., 2021).
Why Is Treatment So Difficult?
The reason why it could make treating such an issue hard is that the individual themselves may not understand or recognise the issue, and there may even be people who would cease their treatment once they realise the issue. The evidence base is still poor. According to a 2025 scoping review, the treatment literature on factitious disorder imposed on oneself mainly comprised case studies and case series, low-quality evidence, and insufficient evidence to establish any consistently effective treatment strategy (Liu et al., 2025).
Therapy might include psychotherapy, treatment of comorbid disorders, and proper coordination of medical care. This is because the patient may be suffering from depression and other psychological problems along with the factitious disorder. Taking a non-critical stance may also help maintain therapy, as opposed to pushing the patient from one doctor to another (Comacchio et al., 2024).
The Physical and Psychological Impact
Even though the signs might have been fabricated intentionally, their effects can be very serious. Investigations, drugs, treatments, and hospitalisation could put a person’s life at risk. In some cases, self-mutilation might result in surgical intervention and treatment in an ICU (Bérar et al., 2021).
This condition can also affect interactions with family and health care personnel. The act of constantly lying will result in frustration and mistrust, while the medical staff will have the challenge of trying to balance the safety of the patient and maintaining the therapeutic alliance. This is one of the reasons why health care professionals need to manage this condition through a multidisciplinary approach (Dickerman & Jiménez, 2023).
Understanding Without Stigma
Factitious disorder is a difficult disorder to diagnose, considering the significant amount of money invested in the study of undiagnosed diseases. Factitious disorder is more complex than being simply “attention seeking” or “lying” (Yates & Feldman, 2016). It is deliberate behaviour; however, the psychological elements associated with it might not be easy to comprehend and can cause a great deal of suffering. Sensitivity does not mean that you do not address deception or its implications; rather, it refers to maintaining healthy boundaries and minimising unnecessary physical and psychological harm (Liu et al., 2025). It is equally important to employ an empathic clinical method since a direct, aggressive approach can affect the therapeutic relationship negatively (Bérar, 2024).
Conclusion
Factitious disorder exists at an intriguing crossroads of physical well-being, psychological disturbance, deceit and care. Factitious disorder refers to when an individual consciously creates the disease he or she has, but there can be various reasons for doing so that are not easy to prove (Dickerman & Jiménez, 2023). It is necessary to diagnose the disease through a professional evaluation rather than presumptions. Increased awareness would help health care professionals identify the signs of this condition, protect patients from inappropriate treatment, and provide appropriate distance, empathy, and psychological support (Liu et al., 2025).
References +
- American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787
- Bérar, A. (2024). Factitious disorder imposed on self and Munchausen syndrome: An update. La Revue de Médecine Interne, S0248-8663. https://doi.org/10.1016/j.revmed.2024.04.001
- Bérar, A., Bouzillé, G., Jego, P. et al. A descriptive, retrospective case series of patients with factitious disorder imposed on self. BMC Psychiatry 21, 588 (2021). https://doi.org/10.1186/s12888-021-03582-8
- Comacchio, C., Misca, D. M., Bortoletto, R., Palese, A., Balestrieri, M., & Colizzi, M. (2024). Prevalence and risk factors for depression in factitious disorder: A systematic review. Frontiers in Psychiatry, 15, Article 1355243. https://doi.org/10.3389/fpsyt.2024.1355243
- Dickerman, A. L., & Jiménez, X. F. (2023). Psychosocial and psychodynamic considerations informing factitious disorder. Psychodynamic Psychiatry, 51(1), 98–113. https://doi.org/10.1521/pdps.2023.51.1.98
- Liu, R. K., Green, J., & Newton, R. (2025). A scoping review of treatment for factitious disorder (imposed on self). Psychiatry Research Communications, 5(2), Article 100216. https://doi.org/10.1016/j.psycom.2025.100216
- Margolis, M., Wong, T. L., Shmuts, R., & Taylor, J. B. (2023). Consultation-liaison case conference: A case of factitious disorder imposed on self. Journal of the Academy of Consultation-Liaison Psychiatry, 64(6), 562–570. https://doi.org/10.1016/j.jaclp.2023.07.001
- Wang, D., Zhao, M., Yin, J., & La, Y. (2026). Characteristics, interventions, and outcomes of factitious disorder imposed on another (FDIA): A systematic review of 455 perpetrators and 469 victims. Frontiers in Public Health, 13, Article 1723415. https://doi.org/10.3389/fpubh.2025.1723415
- Yates, G. P., & Feldman, M. D. (2016). Factitious disorder: A systematic review of 455 cases in the professional literature. General Hospital Psychiatry, 41, 20–28. https://doi.org/10.1016/j.genhosppsych.2016.05.002