What are the other Names for this Condition? (Also known as/Synonyms)

• Factitious Disorder Imposed on Another (FDIOA)
• Factitious Disorder Imposed on Self (FDIOS)
• FDIOS (Factitious Disorder Imposed on Self)

What is Factitious Disorder, NOS? (Definition/Background Information)

• Factitious Disorder is a mental illness. An individual is said to have a mental illness when abnormalities in emotional, judgment, memory, reasoning or perception processes affect
  • One’s thoughts, feelings and actions
  • How he or she relates one’s self with the outside world
• Factitious in Latin means “artificial”
• Individuals with Factitious Disorder voluntarily makes (acts or deceives) symptoms and signs to assume a sick role:
  • These individuals are themselves disturbed by this behavior or urges. At the same time, they are not aware why they are getting these urges
  • They may fake both physical and psychological signs and or symptoms
  • In simple terms they want to appear sick+
• As per the latest DSM5 (APA standard reference book for mental diseases) it is classified under Somatic Symptom and Related disorders; DSM5 classifies Factitious Disorder into
  • Factitious Disorder Imposed on Self (FDIOS) (formerly Factitious Disorder): Severe FDIOS was previously called Munchausen syndrome
  • Factitious Disorder Imposed on Another (FDIOA) (formerly Munchausen syndrome by proxy or Factitious Disorder by proxy)
• Factitious Disorder Imposed on Another (FDIOA) is a disorder in which, a caregiver makes (or acts, or deceives) symptoms and signs in an individual whom they care for, in order to obtain attention while accompanying the sick. The word 'proxy' means 'substitute'. For example a mother intentionally makes her child sick in order to get attention. The diagnosis is for the caregiver and not the individual who are sick (victim)
• The main motive of these individuals is to assume a sick role and not for any other potential gain such escaping law, financial reason, etc.
• The exact cause and mechanism of Factitious Disorder is unknown. It is very difficult to treat these individuals, as they are dishonest. Nevertheless healthcare providers and family should support and help them in recovering from this disorder; medications do not help
• The prognosis of Factitious Disorder varies from fair to poor depending on the severity and chronicity (prolonged period). The overall outlook becomes better as they age and mature

Who gets Factitious Disorder, NOS? (Age and Sex Distribution)

• Factitious Disorder Imposed on Self (FDIOS) usually occurs in adults in their 20s to 40s, although it may occur in adolescents
  • FDIOS is more common in young women than men. Although, more chronic and severe FDIOS is more common in men, especially who are unmarried
  • It is more common in individuals working in the healthcare field           
• Factitious Disorder Imposed on Another (FDIOA) is more common in middle-aged mothers than fathers. Although, FDIOA can be noticed in any individuals (e.g. stepmother) caring for someone. The victims are usually children aged 4 years and younger. But elderly, spouse, disabled, pets, etc. can also be a victim of FDIOA
• Although, the exact prevalence is not known precisely due to under-diagnosis due to dishonesty in these individuals, researchers have made the following observations:
  • The condition is seen worldwide
  • Can affect individuals of any religion, race, ethnicity, etc.
  • Up to 1% of hospital admissions may have a diagnosis of FDIOS, or are victims of FDIOA

What are the Risk Factors for Factitious Disorder, NOS? (Predisposing Factors)

The risk factors of Factitious Disorder Imposed on Self (FDIOS) / Factitious Disorder Imposed on Another (FDIOA) include:

• Since the exact cause and mechanism of FDIOS is unknown, the risk factors of this condition are not yet defined. However, scientists believe the following risk factors may increase one’s risk to get FDIOS
  • History of any mental disorders or medical conditions in childhood that resulted in significant medical attention
  • History of caring for individuals who had illness
  • Dislike against the medical profession
  • History of an important (unhealthy) relationship with physician(s) in the past       
  • Failed attempts to get into health-related profession
  • History of any personality disorders, such as borderline personality disorder, etc.
  • History of hospitalization for medical and mental conditions
  • Low self-esteem
• Since the exact cause and mechanism of FDIOA is unknown, the risk factors of this condition are not yet defined. However, scientists believe the following risk factors may increase one’s risk to get FDIOA
  • Family history of abuse/neglect/rejection as a child
  • History of any personality disorders, such as borderline, narcissistic personality disorder, etc.
  • Abnormal relationship with the child           

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Factitious Disorder, NOS? (Etiology)

The causes of Factitious Disorder Imposed on Self (FDIOS) / Factitious Disorder Imposed on Another (FDIOA) include:

• The exact cause and mechanism of FDIOS and FDIOA is currently unknown. However the following mechanisms have been proposed for the development of FDIOS/FDIOA:
• Both physical and or psychological issues may play a role in its development:
  • Affected individuals may want to be cared for, if they lack support from family and friends
  • They want sympathy and have a desire for significant care
  • History of any kind of child abuse or neglect in their childhood
  • History of presence of any personality disorders
  • History of frequent illness and hospitalizations in childhood
  • History of caring for sick relatives with long-term illnesses           
  • History of hospitalization for medical and mental conditions
  • History of unresolved childhood issues/conflicts with their parents
  • There may be significant life stressors in the family

What are the Signs and Symptoms of Factitious Disorder, NOS?

The signs and symptoms of Factitious Disorder Imposed on Self (FDIOS) include:

• History of multiple admissions, long hospitalizations, and frequent emergency room visits in different hospitals, frequent surgical procedures and frequent tests, contributing to a long medical record
• If an individual is really sick they may exaggerate their symptoms
• Inconsistent or conflicting details (history, symptoms) about their illness
• Portraying exact signs and symptoms present in medical textbooks
• The individual may have extensive knowledge in health-related areas or be employed in a medical environment
• They may create symptoms even if they know it would harm them
• They may demand tests, and be willing to undergo risky diagnostic tests or surgeries. But, most often they really do not want to be treated
• Their health may deteriorate for no obvious reason
• Their symptoms are more common when nobody is around. They may have few visitors if they are hospitalized
• They may get angry with medical staff if confronted
• They may fabricate medical charts
• If any tests come out negative they may complain of new symptoms
• They may be hesitant in allowing their family or friends to talk with the healthcare provider
• They may expect same level of care what a really sick individual gets
• They may do anything to avoid being caught while acting / deceiving
• The may have associated mental illness, such as personality disorder, depression, substance or alcohol abuse, etc.
• History of relationships failure, difficulty with work or school, etc.

The signs and symptoms specific to Factitious Disorder Imposed on Another (FDIOA) include:

• The victim is a child usually less than 4 years of age; this is a form of child abuse
• The child’s siblings may have history of failure to thrive and frequent hospitalizations or death in early childhood from an unexplained illness
• Sometimes, the individual actually injures the child to ensure that the child and themselves are taken care of
• Individuals may exhibit unusual lying in describing the day-to-day activities of the victim and circumstances in which the child or victim became sick or injured
• The mother may have  history of personality disorder or other mental illnesses

Examples of how FDIOS/FDIOA affected individuals assume a sick role:

• Mixing blood or sugar with urine
• Mixing of bacteria with urine
• Having or giving sleep medications to simulate unconsciousness
• Tampering with medical devices such as heating up thermometers

How is Factitious Disorder, NOS Diagnosed?

The following tools may be used to diagnose Factitious Disorder Imposed on Self (FDIOS) / Factitious Disorder Imposed on Another (FDIOA):

• Thorough evaluation of the individual’s medical history and a thorough physical examination including organs where the symptoms originate from
• During history-taking the physicians may want to know the following:
  • When the symptoms began and whether they are becoming worse
  • List of prescription and over-the-counter medications that are currently being taken
  • About one’s personal and family history of mental illnesses, medical illnesses, alcohol and substance use, etc.             
• Your healthcare provide may request a psychiatrist (or psychologist consultation) if he or she suspects a diagnosis of FDIOS / FDIOA, as they are the experts in dealing with mental disorders
• The diagnosis is based on DSM5 criteria
• Exclusion of medical illness that may cause this kind of behavior
• Exclusion of other mental illnesses or substance abuse that may cause this kind of behavior
• The individual is intentionally faking to have physical or psychological signs or symptoms of a mental or medical illness
• The individual’s motivation is to assume the sick role
• They do not fake for personal gain such as money or sick leave that explains for this behavior
• Other basic diagnostic tests to rule out real diseases and conditions

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Factitious Disorder, NOS?

The complications of Factitious Disorder Imposed on Self (FDIOS) / Factitious Disorder Imposed on Another (FDIOA) include:

• The artificial production of illness can lead to emotional distress in the individual (or victim) and their family members
• Multiple workups done to exclude, diagnose and treat the faked condition can lead to high health care costs on the individual
• Frequent and or risky procedures can also result in real deterioration of their (or victim’s) health and may even cause death

How is Factitious Disorder, NOS Treated?

The treatment options of Factitious Disorder Imposed on Self (FDIOS) / Factitious Disorder Imposed on Another (FDIOA) include:

• The main goal of treatment is to change their behavior of affected individuals and protect them from harming themselves further with risky procedures, etc.
• Reminding about the complications that could arise from frequent testing/surgeries
• Try to limit the misuse of health resources except for ruling-out life-threatening conditions
• Explanation to the individual about their illness in a gentle confrontational way and pursue them to get treated for their condition
• Suggest to the affected individual about having only one trusted healthcare provider (including psychologist/psychiatrist) who could treat them
• Medications: There are no medications to treat FDIOS/FDIOA. Medications like selective serotonin reuptake inhibitors (SSRI) are used to treat the personality disorders, anxiety disorder, and depression associated with FDIOS/FDIOA
• Family therapy: Family therapy is useful in helping the family members understand the individual's behavior (mental illness) and help them in being supportive to recover from their illness. It is also important for the family to not to reinforce their abnormal behavior
• For psychological issues the mainstay of treatment is cognitive-behavioral therapy. In this therapy, the goal is to alter their thinking, help them to control their urges and modify their behavior to a favorable one
• In individuals diagnosed with FDIOA, the following may be performed for the victim and the caregiver:
  • Notification of the authorities for the immediate protection of the child
  • Removal of the child (victim) from the home and also evaluation of the child's siblings and long-term monitoring of the family
  • Psychotherapy should be offered to the mother (caregiver), the affected children (victim), and the family. The major goal of this therapy is to establish a stable relationship between the perpetrator, victim, and family, and thereby the individual’s behavior and thinking is modified 

Your healthcare provider will recommend the best treatment options based upon your individual circumstances.

How can Factitious Disorder, NOS be Prevented?

• There is no effective way to prevent Factitious Disorder Imposed on Self (FDIOS) / Factitious Disorder Imposed on Another (FDIOA) from occurring
• However, it is important to protect the victim from the FDIOA-affected individual

What is the Prognosis of Factitious Disorder, NOS? (Outcomes/Resolutions)

• Factitious Disorder is a long-term condition that is difficult to cure primarily due to dishonesty. However, every effort should be taken to protect them from doing further damage to themselves (or victims)
• The prognosis varies from fair to poor depending on the severity and chronicity (prolonged period). The overall outlook becomes better as they age and mature, and with constant monitoring and treatment
• In cases of FDIOA, the affected victim should be rescued at the earliest available opportunity in order to prevent complications and even death

Additional and Relevant Useful Information for Factitious Disorder, NOS:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/emotional-well-being/