Factitious disorder (Munchausen syndrome): signs, causes and treatment

On its pages the NHS uses the name Munchausen syndrome for this condition, named after Baron Munchausen, a German aristocrat famous for telling wild tales. Clinicians more often use the term factitious disorder. In either case the central feature is the same: a person pretends to be ill, or deliberately produces symptoms of illness in themselves, because they want to be seen as sick.

The NHS says the person's main intention is to assume the sick role so that other people care for them and they become the centre of attention. This separates the condition from malingering, in which someone fakes illness for a practical benefit, such as claiming incapacity benefit or obtaining strong painkillers. Doctors will want to rule these other motivations out when assessing someone.

Some people with the syndrome may spend years travelling from hospital to hospital, faking a wide range of illnesses. When they are found to be lying they may suddenly leave hospital and move to another area. In the most serious cases the NHS says people may undergo painful and sometimes life-threatening surgery even though they know it is unnecessary.

The NHS describes several ways people can behave, including pretending to have psychological symptoms, such as claiming to hear voices, pretending to have physical symptoms, such as chest pain or a stomach ache, and actively trying to get ill. It lists four main ways in which illness is faked or induced.

• Clues the NHS lists include frequent visits to hospitals in different areas, a history of complex and serious conditions with little supporting evidence, symptoms that get worse for no apparent reason, very good medical knowledge, and receiving few or no hospital visitors.

• Others are a willingness to undergo painful or dangerous tests, vague and inconsistent symptoms or "textbook" symptom patterns, and telling unbelievable and elaborate stories about their past.

• No single clue proves the condition. They are signs that clinicians weigh up alongside records and test results.

The NHS describes Munchausen by internet as a newer form, in which a person joins an internet support group for people with a serious health condition, such as cystic fibrosis or leukaemia, and then claims to have the illness themselves. These actions may only be confined to the internet, but the NHS says they can have a significant negative effect on support groups and online communities; people with genuine health conditions have reported feeling angry and betrayed on discovering they had been lied to.

Signs that online posts may not be genuine include text that looks copied from health websites, symptoms reported as much more severe than most people experience, claims of near-fatal illness followed by a miraculous recovery, and fantastic claims that later contradict or turn out to be false, such as attending a hospital that does not exist.

The NHS says the syndrome is complex and poorly understood, and several factors have been identified as possible causes: emotional trauma or illness during childhood that often resulted in extensive medical attention, a personality disorder, and a grudge against authority figures or healthcare professionals.

It describes childhood trauma, including parental neglect and abandonment, as one possible route. As a result, a person might have unresolved issues that lead them to fake illness because they have a compulsion to punish themselves, a need to feel important and be the centre of attention, or a need to pass responsibility for their care on to other people. There is also some evidence that people who had extensive medical procedures or prolonged medical attention in childhood or their teenage years may associate illness with being cared for.

Different personality disorders are thought to be linked, including antisocial personality disorder, borderline personality disorder and narcissistic personality disorder. The NHS says there appear to be two separate groups most affected: women aged 20 to 40, often with a background in healthcare, and unmarried white men aged 30 to 50, though it is unclear why.

The NHS says diagnosis can be challenging because people with the syndrome are often very convincing and skilled at manipulating and exploiting doctors. A healthcare professional who suspects it will look through health records to check for inconsistencies between the claimed and actual medical history, and can run tests to look for evidence of self-inflicted illness or tampering with tests, for example checking blood for traces of medicine the person should not be taking.

The condition can usually be diagnosed if there is clear evidence of fabricating or inducing symptoms, the person's prime motivation is to be seen as sick, and there is no other likely explanation for the behaviour.

The NHS says treatment can be difficult because most people with the syndrome refuse to admit that they have a problem and do not co-operate with treatment plans. Some experts recommend a gentle, non-confrontational approach that suggests referral to a psychiatrist, while others argue the person should be asked directly why they have lied and whether they have stress and anxiety.

If a person admits to their behaviour, they can be referred to a psychiatrist. If they do not, the NHS says most experts agree the doctor in charge should minimise medical contact, because the doctor-patient relationship is based on trust. There is no standard treatment, but a combination of psychoanalysis and cognitive behavioural therapy (CBT) has shown some success in controlling symptoms where the person admits the problem and co-operates. Family therapy may also help, including teaching relatives how to avoid reinforcing the behaviour.

Anyone worried that they may be doing this, or who recognises it in a family member, can raise it with a GP. The condition is a genuine mental health problem, and help is available for people who feel able to seek it.

The NHS treats fabricated or induced illness (FII), formerly called Munchausen syndrome by proxy, as a separate issue. It describes FII as a rare form of child abuse in which a parent or carer exaggerates or deliberately causes symptoms of illness in a child. The parent or carer does not necessarily intend to deceive doctors, but their behaviour is likely to harm the child, who may have unnecessary treatment or tests, be made to believe they are ill, or have their education disrupted.

Anyone who is concerned about a child should speak to their GP, health visitor or another professional involved in the child's care.

Suspected factitious disorder is usually identified within general hospital or primary care services, with liaison psychiatry involved where it is recognised. NHS mental health services provide assessment and therapy at no charge to the person, and the NHS notes that psychiatric referral depends on the person admitting the behaviour.

Private psychiatrists and psychologists can offer assessment and talking therapies such as CBT. Because trust and consistency matter so much, it helps for one clinician to coordinate care and communicate with the GP and any hospital teams involved.