ICD-116D50	FACTITIOUS DISORDER IMPOSED ON SELF Factitious disorder imposed on self
ICD-10F68.1	Intentional production or feigning of symptoms or disabilities, either physical or psychological [factitious disorder]
DSM-5-TRF68.10	Factitious Disorder Imposed on Self

1. Definition and nosology

Self-applied factitious disorder (ICD-11: 6D50; DSM-5-TR: F68.10 Factitious Disorder Imposed on Self) — intentional production of physical or psychological symptoms or injury in oneself, presentation of these symptoms to others; no obvious external incentive (distinguishing it from malingering). The patient's primary motivation is to assume the sick role or be perceived as a patient.

2. History

• Asher R. (1951) — term “Munchausen syndrome” (from Baron Munchausen's fantastic stories).
• DSM-III (1980) — Formalization of Factitious Disorder.
• DSM-5 (2013) — “Imposed on Self” and “Imposed on Another” subtypes.
• Eisendrath S.J. reviews — diagnosis and clinical approach.

3. Epidemiology

• Rare in clinical populations (1–2% of hospital admissions); under-detection in clinical approach.
• Sex: relatively higher in females (in the context of medical profession).
• Comorbidity: BPD, depressive disorders, history of trauma.

4. Aetiology and pathogenesis

• Psychological — deep emotional need in medical role; childhood trauma, neglect.
• Medical system proximity (being a healthcare professional).
• BPD is frequently comorbid.

5. Clinical features

• Multiple medical consultations and examinations; numerous clinic visits (“hospital shopping”).
• Multiple surgical procedures.
• Intentional creation of symptom or injury (bleeding, creating infection, poisoning with medication, fabricating somatic complaint).
• Clinical presentation “impossible” or atypical; laboratory results contradict the patient's account.
• The patient may lie during the interview; the medical history is unreliable.
• No overt material gain (insurance, legal, work).

6. Diagnosis

6.1 Unified diagnostic criteria

A. Deliberate induction or feigning of physical or psychological symptoms or injury.

B. The patient presents themselves as ill or injured.

C. Deceptive behavior with no apparent material gain.

D. The behavior is not better explained by another mental disorder (delusional disorder, other psychotic).

6.2 Source-specific clarifications

• DSM-5-TR / ICD-11 — same.
• Diagnosis is difficult — requires evidence (insurance documents, information from other clinics, video).

6.3 Diagnostic algorithm

1. Clinical suspicion — atypical clinical presentations, multiple clinics, “impossible” symptom.
2. Obtain medical history from other clinics (with patient consent).
3. Insurance and pharmacy records.
4. Observation — method of creating laboratory samples.
5. Comorbid BPD, MDD, trauma history.
6. Legal and ethical coordination.

6.4 Differential diagnosis

7. Examination and assessment

• Medical history (from other clinics).
• Insurance records.
• Psychiatric interview for comorbid disorders.

8. Treatment

1. Non-confrontational approach (Eisendrath) — the diagnosis is explained to the patient within a framework of care rather than punishment; “your distress is real, we can help in another way”.
2. Single physician model — all complaints are managed through that physician.
3. Limitation of invasive procedures and unnecessary examinations.
4. Psychotherapy — supportive, CBT; long-term follow-up.
5. Comorbid BPD, MDD, trauma treatment.
6. Confrontation abruptly ‘burns’ the patient; better in a gentle and caring context.

Source-specific specifications

• Eisendrath S.J. — non-confrontational approach and therapeutic alliance.
• APA Textbook of Consultation-Liaison Psychiatry (Levenson).

Treatment methods

1. Soft confrontation (Eisendrath) — Explanation of diagnosis within a care framework instead of punishment.
2. Single Physician Model — All complaints through the same physician.
3. Supportive Psychotherapy — Attention to patient's emotional needs.
4. Multidisciplinary approach — Medical and psychiatric combined.

9. Prognosis

• Chronic course; “hospital shopping” continues.
• Long-term therapeutic alliance and treatment of comorbidities improve prognosis.

10. Myths and misconceptions

Myth 1: “The patient is a ‘liar’, legal punishment is required”

Evidence: Factitious disorder is a psychiatric disorder — response to emotional need; a non-confrontational approach and psychotherapy are recommended.

Myth 2: “Directly saying ‘you are lying’ will ‘correct’ the patient”

Evidence: a harsh confrontation causes the patient to “flee” and transfer to another clinic; a gentle approach builds a therapeutic alliance.

Myth 3: “Factitious disorder = somatic symptom disorder”

Evidence: Factitious deliberate lying; somatic symptom — patient's genuine feeling.

Myth 4: “Invasive procedures that have been started must be carried through”

Evidence: Unnecessary invasive procedures are harmful and should be limited after a diagnosis is made.

Myth 5: “Factitious disorder cannot be treated”

Evidence: Evidence base is limited, but improvement is possible with long-term therapeutic alliance and multidisciplinary care.

11. Sources

1. WHO. ICD-11. 6D50 Factitious disorder imposed on self. 2024.
2. APA. DSM-5-TR. 2022.
3. Eisendrath S.J. Factitious physical disorders: treatment without confrontation. Psychosomatics 1989;30(4):383–387.
4. Levenson J.L. (ed.). APA Publishing Textbook of Psychosomatic Medicine and Consultation-Liaison Psychiatry. 3rd ed. 2018.
5. Asher R. Munchausen's syndrome. Lancet 1951;1(6650):339–341.