Curriculum · Mental Health / Psychiatry
Factitious disorder (Munchausen syndrome) and malingering
What it is
In factitious disorder patients injure themselves or fabricate symptoms for primary gain, meaning the sympathy and attention given to the sick. Munchausen's syndrome is a form of factitious disorder in which patients fabricate physical symptoms, not those of a mental illness. Malingering is similar to factitious disorder in that patients intentionally create or feign their symptoms; the motivation in malingering, however, is secondary gain, such as financial benefits.
Causes and risk
Munchausen's syndrome is more common among health care workers.
How it presents
The pattern to watch for is repeated episodes for which an extensive workup has been done without a diagnosis, reluctance to give the names of former providers, and a physical examination that is within normal limits. Symptoms may be due to surreptitious injection of insulin, resulting in hypoglycemia. A described example is a nursing student who presents to the emergency department after a syncopal episode: light-headedness, diaphoretic, then slumped over unresponsive, with a fingerstick blood glucose of 24 mg/dL on the way in, revived with glucose.