Factitious disorder imposed on self

File:Tales From Munchausen.jpg

The name "Munchausen syndrome" derives from Baron Munchausen, a literary character loosely based on the German nobleman Hieronymus Karl Friedrich Freiherr von Münchhausen (1720–1797).{{Cite journal |last1=Tatu |first1=Laurent |last2=Aybek |first2=Selma |last3=Bogousslavsky |first3=Julien |date=2018 |title=Munchausen Syndrome and the Wide Spectrum of Factitious Disorders |journal=Frontiers of Neurology and Neuroscience |volume=42 |pages=81–86 |doi=10.1159/000475682 |issn=1662-2804 |pmid=29151093|isbn=978-3-318-06088-1 }} The historical baron became a well-known storyteller in the late 18th century for entertaining dinner guests with tales about his adventures during the Russo-Turkish War. In 1785, German-born writer and con artist Rudolf Erich Raspe anonymously published an English-language book in which a heavily fictionalized version of "Baron Munchausen" tells many fantastic and impossible stories about himself. Raspe's Munchausen became a sensation, establishing a literary exemplar of a bombastic liar or exaggerator.{{cite book |last1=McCoy |first1=Monica L. |url=https://books.google.com/books?id=ZCkVAgAAQBAJ&pg=PA210 |title=Child Abuse and Neglect |edition=2nd |last2=Keen |first2=Stefanie M. |publisher=Psychology Press |year=2013 |isbn=978-1-136-32287-7 |page=210}}{{cite journal |last=Olry |first=Regis |date=June 2002 |title=Baron Munchhausen and the Syndrome Which Bears His Name: History of an Endearing Personage and of a Strange Mental Disorder |url=http://www.biusante.parisdescartes.fr/ishm/vesalius/VESx2002x08x01.pdf#page=54 |journal=Vesalius |volume=8 |issue=1 |pages=53–7 |pmid=12422889}}

That patients can exaggerate or inflict symptoms on themselves has been recognized since antiquity, with the second century manuscript attributed to Galen titled On Feigned Diseases and the Detection of Them.{{cite journal |vauthors=Savino AC, Fordtran JS |title=Factitious disease: clinical lessons from case studies at Baylor University Medical Center |journal=Proc (Bayl Univ Med Cent) |volume=19 |issue=3 |pages=195–208 |date=July 2006 |pmid=17252033 |pmc=1484524 |doi=10.1080/08998280.2006.11928162 }} In 1843, Scots physician Hector Gavin invented the term "factitious disease" to describe persons who faked medical symptoms for sympathy, attention or "some inexplicable cause”. In the 1930s, psychiatrist Karl Menninger noted some patients compulsively insisted on medically unnecessary surgeries, often seeking out a physician with a powerful or dynamic personality.

In 1951, Richard Asher coined the term "Munchausen syndrome" to describe a pattern of self-harm, wherein individuals fabricated histories, signs, and symptoms of illness. Remembering Baron Munchausen, Asher's article was published in The Lancet in February 1951. Asher's nomenclature sparked some controversy, with medical authorities debating the appropriateness of the name for about fifty years. While Asher was praised for bringing cases of factitious disorder to light, participants in the debate objected variously that a literary allusion was inappropriate given the seriousness of the disease; and that the name's connection to works of humor and fantasy, and to the essentially ridiculous character of the fictional Baron Munchausen, was disrespectful to patients with the disorder.{{cite journal |last1=Fisher |first1=Jill A. |year=2006 |title=Investigating the Barons: Narrative and nomenclature in Munchausen syndrome |journal=Perspectives in Biology and Medicine |volume=49 |issue=2 |pages=250–62 |doi=10.1353/pbm.2006.0024 |pmid=16702708 |s2cid=12418075}} Some healthcare providers avoid this term because it downplays the complexity of the illness and devalues the patient experience. The term "factitious disorder imposed on self" provides a more accurate and encompassing description of this mental disorder; however, both terms may still be used interchangeably in practice.{{Cite journal |last1=Yates |first1=Gregory P. |last2=Feldman |first2=Marc D. |date=2016-07-01 |title=Factitious disorder: a systematic review of 455 cases in the professional literature |url=https://www.sciencedirect.com/science/article/pii/S016383431630072X |journal=General Hospital Psychiatry |volume=41 |pages=20–28 |doi=10.1016/j.genhosppsych.2016.05.002 |pmid=27302720 |issn=0163-8343}}

The exact cause of this illness is unknown due to limited research but is likely the result of multiple psychosocial factors. Specific risk factors have been associated with developing FDIS, specifically a history of childhood trauma, abandonment, having a serious childhood illness, and certain personality disorders.{{Cite journal |last1=Jafferany |first1=Mohammad |last2=Khalid |first2=Zaira |last3=McDonald |first3=Katherine A. |last4=Shelley |first4=Amanda J. |date=2018-02-22 |title=Psychological Aspects of Factitious Disorder |journal=The Primary Care Companion for CNS Disorders |volume=20 |issue=1 |pages=17nr02229 |doi=10.4088/PCC.17nr02229 |issn=2155-7780 |pmid=29489075}}{{Cite journal |last=Repper |first=Julie |date=1995 |title=Munchausen Syndrome by Proxy in health care workers |url=https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.1995.tb02526.x |journal=Journal of Advanced Nursing |volume=21 |issue=2 |pages=299–304 |doi=10.1111/j.1365-2648.1995.tb02526.x |pmid=7714287 |issn=1365-2648}} Patients are more likely to be female, middle aged, and work in the healthcare industry.{{Citation |last1=Weber |first1=Brennan |title=Munchausen Syndrome |date=2025 |work=StatPearls |id=NBK518999 |url=https://www.ncbi.nlm.nih.gov/books/NBK518999/ |access-date=2025-01-14 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30085541 |last2=Gokarakonda |first2=Srinivasa B. |last3=Doyle |first3=Michael Q.}} Individuals with this disorder may also have a history of recurrent hospitalizations and frequent visits to multiple different physicians (i.e. doctor shopping). They are also more likely to have underlying depression, though it is unclear if it is a cause or symptom of this illness. Some researchers suggest other various psychiatric disorders may coincide, namely Borderline Personality Disorder. The comorbidity of these psychiatric disorders with FDIS can be termed a Tripolar Syndrome. {{cite journal |last1=Lazzari |first1=Carlo |last2=Shoka |first2=Ahmed |last3=Papanna |first3=Basavaraja |last4=Rabottini |first4=Marco |title=The hypothesis of a tripolar syndrome in liaison psychiatry and medicine: Depression comorbid with factitious disorders and borderline personality disorder |journal=Indian Journal of Medical Research and Pharmaceutical Sciences |date=April 2018 |volume=5 |issue=4 |pages=61–68 |doi=10.5281/zenodo.1220047}}

In factitious disorder imposed on self, the affected person exaggerates or creates physical or psychological symptoms of illnesses in themselves to gain examination, treatment, attention, sympathy or comfort from medical personnel. Because these symptoms can vary depending on how patients induce these symptoms, there is no consistent symptom specific for this illness. However, there are several common themes that may raise suspicion for FDIS. Some of these common themes include:

• Prolonged, repeated hospital stays{{Cite journal |last1=Sousa Filho |first1=Daniel de |last2=Kanomata |first2=Elton Yoji |last3=Feldman |first3=Ricardo Jonathan |last4=Maluf Neto |first4=Alfredo |date=2017 |title=Munchausen syndrome and Munchausen syndrome by proxy: a narrative review |journal=Einstein (Sao Paulo, Brazil) |volume=15 |issue=4 |pages=516–521 |doi=10.1590/S1679-45082017MD3746 |pmc=5875173 |pmid=29364370}}
• Frequent visits to multiple different physicians{{Cite web |date=2021-02-16 |title=Overview — Munchausen syndrome |url=https://www.nhs.uk/mental-health/conditions/munchausen-syndrome/overview/ |access-date=2025-01-17 |website=nhs.uk }}
• Opting for unnecessary operations or procedures where the results are generally normal or inconclusive
• Inconsistencies in past medical history, where illness/procedural history stated by patient is different than their documented history
• Vague, nonspecific pain unresponsive to normal treatment options

Common examples of commonly induced physical symptoms include intentionally infecting a wound with debris or unsanitary material, taking laxatives to induce diarrhea.

Due to the behaviors involved, diagnosing factitious disorder is very difficult. Because induced symptoms may mimic those of a real disease or disorder, physicians must first rule out genuine disease. Therefore, FDIS is usually a diagnosis of exclusion.{{Cite journal |last1=Caselli |first1=Ivano |last2=Poloni |first2=Nicola |last3=Ielmini |first3=Marta |last4=Diurni |first4=Marcello |last5=Callegari |first5=Camilla |date=2017 |title=Epidemiology and evolution of the diagnostic classification of factitious disorders in DSM-5 |journal=Psychology Research and Behavior Management |volume=10 |pages=387–394 |doi=10.2147/PRBM.S153377 |doi-access=free |issn=1179-1578 |pmc=5729833 |pmid=29270035}} To rule out genuine illness, lab tests may be required, including complete blood count (CBC), urine toxicology, drug tests, blood cultures to rule out infection, coagulation tests, assays for thyroid function, or DNA typing, depending on the mimicked disease. In some cases CT scan, magnetic resonance imaging, psychological testing, electroencephalography, or electrocardiography may be required. A more extensive list of how organic illness is differentiated from FDIS is provided below.{{Cite journal |last1=Kinns |first1=H |last2=Housley |first2=D |last3=Freedman |first3=DB |date=2013-05-01 |title=Munchausen syndrome and factitious disorder: the role of the laboratory in its detection and diagnosis |url=https://journals.sagepub.com/doi/10.1177/0004563212473280 |journal=Annals of Clinical Biochemistry |volume=50 |issue=3 |pages=194–203 |doi=10.1177/0004563212473280 |pmid=23592802 |issn=0004-5632}}

If the healthcare provider finds no physical reason for the symptoms, they may refer the person to a psychiatrist or psychologist (mental health professionals who are specially trained to diagnose and treat mental illnesses). Psychiatrists and psychologists use thorough history, physical examinations, laboratory tests, imagery, and psychological testing to evaluate a person for physical and mental conditions and to distinguish between feigned versus real illness. Once the person's history has been thoroughly evaluated, diagnosing factitious disorder imposed on self requires a clinical assessment, typically performed by a psychiatrist.{{Cite web |title=Factitious Disorder Imposed on Self (Munchausen's Syndrome) Workup: Approach Considerations, Laboratory Studies, Diagnostic Imaging |url=https://emedicine.medscape.com/article/291304-workup#c1 |access-date=2025-01-17 |website=emedicine.medscape.com}}

For a person to be diagnosed with factitious disorder imposed on self, they must meet the following criteria:{{Cite book |url=https://doi.org/10.1176/appi.books.9780890420249.dsm-iv-tr |title=DSM-IV-TR |date=January 2000 |publisher=American Psychiatric Association |isbn=0-89042-024-6 |doi=10.1176/appi.books.9780890420249.dsm-iv-tr }}

1. The patient presents as sick or injured motivated by a primary gain, or internal reward of validation/attention as opposed to a secondary gain, which usually involves external benefits.
2. There is evidence that the patient is inducing or falsifying their symptoms
3. There is no alternative explanation, mental disorder, or illness to explain the patient's symptoms

There are common methods for inducing certain symptoms and mimicking specific diseases. As mentioned earlier, it is important to first rule out true disease. Oftentimes this requires multiple lab tests as a form of differential diagnosis, especially when the disease is mimicked closely in patients with existing medical knowledge. Physicians usually must have a high suspicion for FDIS to pursue it as a likely diagnosis based on abnormal patient behaviors and medical history. Some examples of these are listed in the table below, along with how to differentiate them from real versus mimicked disease using medical laboratory tests or imaging.{{Cite journal |last1=Kinns |first1=H. |last2=Housley |first2=D. |last3=Freedman |first3=D. B. |date=May 2013 |title=Munchausen syndrome and factitious disorder: the role of the laboratory in its detection and diagnosis |journal=Annals of Clinical Biochemistry |volume=50 |issue=Pt 3 |pages=194–203 |doi=10.1177/0004563212473280 |issn=1758-1001 |pmid=23592802}}

Munchausen by internet is a term describing the pattern of behavior in factitious disorder imposed on self, wherein those affected feign illnesses in online venues to gain sympathy from online supporters. It has been described in medical literature as a manifestation of factitious disorder imposed on self.{{cite journal |author=Feldman MD |date=July 2000 |title=Munchausen by Internet: detecting factitious illness and crisis on the Internet |journal=South. Med. J. |volume=93 |issue=7 |pages=669–72 |doi=10.1097/00007611-200093070-00006 |pmid=10923952}} Reports of users who deceive internet forum participants by portraying themselves as gravely ill or as victims of violence first appeared in the 1990s due to the relative newness of Internet communications. The specific internet pattern was named "Münchausen by internet" in 1998 by psychiatrist Marc Feldman. New Zealand PC World Magazine called Munchausen by Internet "cybermunch", and those who posed online "cybermunchers".Todd, Belinda (October 21, 2002).[http://pcworld.co.nz/pcworld/pcw.nsf/ht/00547454259E27A3CC256C520079F1F9 "Faking It"] {{webarchive|url=https://web.archive.org/web/20110717133932/http://pcworld.co.nz/pcworld/pcw.nsf/ht/00547454259E27A3CC256C520079F1F9|date=2011-07-17}}, New Zealand PC World Magazine. Retrieved on July 29, 2009. More recently, online forums such as snark subreddits have labelled these individuals as "illness fakers", or "munchies".{{Cite web |title=r/illnessfakers: Discussion of Munchausen By Internet, Medical Deception and toxic "Chronic Illness Influencers" |url=https://www.reddit.com/r/illnessfakers/?rdt=57066 |access-date=2025-02-07 |website=www.reddit.com/r/illnessfakers}}

During the COVID-19 pandemic, an increasing amount of TikTok users, primarily teenage girls,{{Cite journal |last=Richmond |first=Linda M. |date=2024 |title=Teen 'Social Media-Induced Illness' Requires Careful Workups |url=https://psychiatryonline.org/doi/10.1176/appi.pn.2024.01.1.28 |journal=Psychiatric News |volume=59 |issue=1 |doi=10.1176/appi.pn.2024.01.1.28 |issn=0033-2704}} began to present with tics and vocalizations similar to those associated with Tourette syndrome.{{Cite web |first=Robert H. |last=Shmerling |date=2022-01-18 |title=Tics and TikTok: Can social media trigger illness? |url=https://www.health.harvard.edu/blog/tics-and-tiktok-can-social-media-trigger-illness-202201182670 |access-date=2025-02-07 |website=Harvard Health }} However, lack of congruent family history and other diagnostic criteria led some experts to interpret this phenomenon as mass psychogenic illness facilitated by social media.{{Cite journal |last1=Hull |first1=Mariam |last2=Parnes |first2=Mered |date=2021 |title=Tics and TikTok: Functional Tics Spread Through Social Media |journal=Movement Disorders Clinical Practice |volume=8 |issue=8 |pages=1248–52 |doi=10.1002/mdc3.13267 |issn=2330-1619 |pmc=8564820 |pmid=34765689}} Mass psychogenic illness is described as requiring physical proximity to spread, hence technologically-facilitated conversion is differentiated under the label "Mass Social Media-Induced Illness" (MSMI).{{Cite journal |last=Giedinghagen |first=Andrea |date=2023 |title=The tic in TikTok and (where) all systems go: Mass social media induced illness and Munchausen's by internet as explanatory models for social media associated abnormal illness behavior |journal=Clinical Child Psychology and Psychiatry |volume=28 |issue=1 |pages=270–8 |doi=10.1177/13591045221098522 |issn=1461-7021 |pmid=35473358}} Other conditions feigned as a result of MSMI include autism spectrum disorders, attention deficit hyperactivity disorders, dissociative identity disorder, and bipolar disorders.

When confronted with this diagnosis, patients often refuse to accept it and will continue their behaviors seeking healthcare at different institutions or physicians. Those who accept the diagnosis benefit most from psychotherapy delivered by a skilled therapist or psychiatrist. In doing so, patients can learn the underlying subconscious motivations that drive their conscious behaviors in order to develop a sense of awareness the prevents them from continuing these harmful behaviors.{{Cite journal |last1=Bass |first1=Christopher |last2=Halligan |first2=Peter |date=2014-04-19 |title=Factitious disorders and malingering: challenges for clinical assessment and management |journal=Lancet |volume=383 |issue=9926 |pages=1422–32 |doi=10.1016/S0140-6736(13)62186-8 |issn=1474-547X |pmid=24612861}} If a person is considered to be at risk of harming themself or others, psychiatric hospitalization may be initiated.{{cite journal |pmid=10774844 |url=http://www.jaapl.org/content/28/1/74.short |year=2000 |last1=Johnson |first1=BR |title=Suspected Munchausen's syndrome and civil commitment |journal=The Journal of the American Academy of Psychiatry and the Law |volume=28 |issue=1 |pages=74–6 |last2=Harrison |first2=JA}}

Specific forms of therapy may be tailored to underlying personality disorders contributing to their behaviors. For example, dialectical behavior therapy (DBT) can be used to treat borderline personality disorder.{{Cite journal |last1=Storebø |first1=Ole Jakob |last2=Stoffers-Winterling |first2=Jutta M. |last3=Völlm |first3=Birgit A. |last4=Kongerslev |first4=Mickey T. |last5=Mattivi |first5=Jessica T. |last6=Jørgensen |first6=Mie S. |last7=Faltinsen |first7=Erlend |last8=Todorovac |first8=Adnan |last9=Sales |first9=Christian P. |last10=Callesen |first10=Henriette E. |last11=Lieb |first11=Klaus |last12=Simonsen |first12=Erik |date=2020-05-04 |title=Psychological therapies for people with borderline personality disorder |journal=The Cochrane Database of Systematic Reviews |volume=5 |issue=5 |pages=CD012955 |doi=10.1002/14651858.CD012955.pub2 |issn=1469-493X |pmc=7199382 |pmid=32368793}} Medications may be necessary to treat an underlying mood disorder or anxiety disorder, as many patients with this disorder may have underlying depression.{{Cite journal |last1=Comacchio |first1=Carla |last2=Misca |first2=Delia Manuela |last3=Bortoletto |first3=Riccardo |last4=Palese |first4=Alvisa |last5=Balestrieri |first5=Matteo |last6=Colizzi |first6=Marco |date=2024 |title=Prevalence and risk factors for depression in factitious disorder: a systematic review |journal=Frontiers in Psychiatry |volume=15 |pages=1355243 |doi=10.3389/fpsyt.2024.1355243 |doi-access=free |issn=1664-0640 |pmc=11082576 |pmid=38736625}} Patients with underlying depression and/or anxiety are typically responsive to antidepressants with or without cognitive behavioral therapy, a form of psychotherapy.{{Cite journal |last1=Karyotaki |first1=Eirini |last2=Efthimiou |first2=Orestis |last3=Miguel |first3=Clara |last4=Bermpohl |first4=Frederic Maas Genannt |last5=Furukawa |first5=Toshi A. |last6=Cuijpers |first6=Pim |last7=Individual Patient Data Meta-Analyses for Depression (IPDMA-DE) Collaboration |last8=Riper |first8=Heleen |last9=Patel |first9=Vikram |last10=Mira |first10=Adriana |last11=Gemmil |first11=Alan W. |last12=Yeung |first12=Albert S. |last13=Lange |first13=Alfred |last14=Williams |first14=Alishia D. |last15=Mackinnon |first15=Andrew |date=2021-04-01 |title=Internet-Based Cognitive Behavioral Therapy for Depression: A Systematic Review and Individual Patient Data Network Meta-analysis |journal=JAMA Psychiatry |volume=78 |issue=4 |pages=361–371 |doi=10.1001/jamapsychiatry.2020.4364 |issn=2168-6238 |pmc=8027916 |pmid=33471111}}{{Citation |title=Guideline Watch: Practice Guideline for the Treatment of Patients With Major Depressive Disorder, 2nd Edition |work=APA Practice Guidelines for the Treatment of Psychiatric Disorders: Comprehensive Guidelines and Guideline Watches |date=2006 |volume=1 |url=https://doi.org/10.1176/appi.books.9780890423363.148217 |access-date=2025-01-22 |place=Arlington, VA |publisher=American Psychiatric Association |doi=10.1176/appi.books.9780890423363.148217 |isbn=0-89042-336-9}}{{Cite web |title=Depression Treatments for Adults |work=Clinical Practice Guideline for the Treatment of Depression |url=https://www.apa.org/depression-guideline/adults |access-date=2025-01-22 |publisher=American Psychiatric Association }}

This disorder can sometimes be difficult to distinguish from several related diagnoses, but they differ in their motivational gains and control over symptoms.{{cite book |title=Kaplan & Sadock's Comprehensive Textbook of Psychiatry |date=15 January 2000 |publisher=Lippincott Williams & Wilkins |isbn=978-0-683-30128-1 |editor1-last=Sadock |editor1-first=Benjamin J. |edition=7th |location=Philadelphia, Pennsylvania |pages=3172 |editor2-last=Sadock |editor2-first=Virginia A.}} "Gain" is a Freudian psychoanalytic term that is used to describe the psychological benefits that drive certain illnesses and their behaviors.{{Cite journal |last=Freud |first=Sigmund |date=1971 |title=Introductory lectures on psychoanalysis (1916–17). Part III. General theory of the neuroses (1917). Lecture XXVIII: Analytic therapy |url=https://doi.org/10.1037/e417472005-391 |access-date=2025-01-23 |website=PsycEXTRA Dataset|doi=10.1037/e417472005-391 }} A primary gain refers to internal benefits from a symptom or illness, like feeling a decrease in emotional or psychological stress. A secondary gain refers to the external benefits from a symptom or illness, like receiving financial benefits or avoiding a stressful activity.{{Cite book |title=Diagnostic and statistical manual of mental disorders: DSM-IV-TR |date=2009 |publisher=American Psychiatric Association |isbn=978-0-89042-025-6 |edition=4th ed., text rev., 13. print }}

Factitious disorder is distinct from malingering in that people with factitious disorder do not fabricate symptoms for material gain such as financial compensation, absence from work, or access to drugs.{{Cite journal |last1=Cassano |first1=A. |last2=Grattagliano |first2=I. |date=2019 |title=Lying in the medicolegal field: Malingering and psychodiagnostic assessment |journal=La Clinica Terapeutica |volume=170 |issue=2 |pages=e134–e141 |doi=10.7417/CT.2019.2123 |issn=1972-6007 |pmid=30993310}} Somatiform disorders include a range of illnesses where physical symptoms result from psychological stressors.{{Cite web |title=Somatic Symptom Disorder — Psychiatric Disorders |url=https://www.merckmanuals.com/en-ca/professional/psychiatric-disorders/somatic-symptom-and-related-disorders/somatic-symptom-disorder |access-date=2025-01-23 |website=Merck Manual Professional Edition }} Perhaps the most common subtype, Functional Neurologic Disorder is characterized by psychological distress resulting from neurologic symptoms (e.g. paralysis, seizures, loss of vision) that typically coincide with periods of psychological stress and are not due to an underlying neurologic condition.{{Cite journal |last=Feinstein |first=Anthony |date=2011-05-17 |title=Conversion disorder: advances in our understanding |journal=CMAJ: Canadian Medical Association |volume=183 |issue=8 |pages=915–920 |doi=10.1503/cmaj.110490 |issn=1488-2329 |pmc=3091899 |pmid=21502352}} Below is a table outlining the differences between these related diagnoses.{{Cite journal |last=Fishbain |first=David A. |date=December 1994 |title=Secondary gain concept |url=https://doi.org/10.1016/s1058-9139(05)80274-8 |journal=APS Journal |volume=3 |issue=4 |pages=264–273 |doi=10.1016/s1058-9139(05)80274-8 |issn=1058-9139}}{{Cite journal |last1=Galli |first1=Silvio |last2=Tatu |first2=Laurent |last3=Bogousslavsky |first3=Julien |last4=Aybek |first4=Selma |date=2018 |title=Conversion, Factitious Disorder and Malingering: A Distinct Pattern or a Continuum? |journal=Frontiers of Neurology and Neuroscience |volume=42 |pages=72–80 |doi=10.1159/000475699 |issn=1662-2804 |pmid=29151092|isbn=978-3-318-06088-1 }}

Factitious disorder imposed on another, also referred to as Munchausen's by proxy, occurs when an individual induces symptoms or feigns illness in someone else to receive some form of psychological satisfaction for themselves.{{Cite journal |last1=Tozzo |first1=P. |last2=Picozzi |first2=M. |last3=Caenazzo |first3=L. |date=2018 |title=Munchausen Syndrome by Proxy: balancing ethical and clinical challenges for healthcare professionals Ethical consideration in factitious disorders |journal=La Clinica Terapeutica |volume=169 |issue=3 |pages=e129–e134 |doi=10.7417/T.2018.2067 |issn=1972-6007 |pmid=29938745}} This has been documented in the parent or guardian of a child or the owner of a pet animal.{{cite journal |vauthors=Munro HM, Thrusfield MV |title='Battered pets': Munchausen syndrome by proxy (factitious illness by proxy) |journal=J Small Anim Pract |volume=42 |issue=8 |pages=385–9 |date=August 2001 |pmid=11518417 |doi=10.1111/j.1748-5827.2001.tb02486.x }} The adult ensures that their child will experience some medical condition, therefore compelling the child to suffer through treatments and spend a significant portion during youth in hospitals. Furthermore, a disease may actually be initiated in the child by the parent or guardian. This condition is considered distinct from Munchausen syndrome. There is growing consensus in the pediatric community that this disorder should be renamed "medical abuse" to highlight the harm caused by the deception and to make it less likely that the sufferer can use a psychiatric defense when harm is done.{{cite journal |vauthors=Stirling J |year=2007 |title=Beyond Munchausen syndrome by proxy: identification and treatment of child abuse in a medical setting |journal=Pediatrics |volume=119 |issue=5 |pages=1026–30 |doi=10.1542/peds.2007-0563 |pmid=17473106 |doi-access=free}}

{{Portal|Psychiatry}}

• List of Munchausen by proxy cases
• Hypochondriasis
• Psychosomatic illness

{{Reflist}}

{{refbegin}}

• {{Cite book |last=Feldman |first=Marc |title=Playing sick?: untangling the web of Munchausen syndrome, Munchausen by proxy, malingering & factitious disorder |publisher=Brunner-Routledge |location=Philadelphia |year=2004 |isbn=978-0-415-94934-7 |url=https://archive.org/details/playingsickuntan00feld }}
• {{Cite journal|author=Fisher JA |title=Playing patient, playing doctor: Munchausen syndrome, clinical S/M, and ruptures of medical power |journal=The Journal of Medical Humanities |volume=27 |issue=3 |pages=135–49 |year=2006 |pmid=16817003 |doi=10.1007/s10912-006-9014-9|s2cid=40739963 }}
• {{Cite journal|author=Fisher JA |title=Investigating the Barons: narrative and nomenclature in Munchausen syndrome |journal=Perspect. Biol. Med. |volume=49 |issue=2 |pages=250–62 |year=2006 |pmid=16702708 |doi=10.1353/pbm.2006.0024|s2cid=12418075 }}
• {{cite book|last=Friedel |first=Robert O. |title=Borderline Personality Disorder Demystified|pages=[https://archive.org/details/borderlineperson00frie/page/9 9–10]|isbn=978-1-56924-456-2|url=https://archive.org/details/borderlineperson00frie/page/9|date=4 August 2004|publisher=Hachette Books }}
• {{Cite book |last=Davidson |first=G.|title=Abnormal Psychology |edition=3rd Canadian |publisher=Wiley |year=2008 |pages=412 |isbn=978-0-470-84072-6 }}
• {{cite journal |last1=Prasad |first1=A. |last2=Oswald |first2=A. G. |title=Munchausen's syndrome: an annotation |journal=Acta Psychiatrica Scandinavica |volume=72 |issue=4 |pages=319–22 |year=1985 |pmid=4072733 |doi=10.1111/j.1600-0447.1985.tb02615.x |s2cid=40707 }}
• {{cite book|author-link1=Leila Schneps |first1=Leila |last1=Schneps |author2-link=Coralie Colmez |first2=Coralie |last2=Colmez |title=Math on trial. How numbers get used and abused in the courtroom|publisher=Basic Books|year=2013|isbn=978-0-465-03292-1|chapter=1. Math error number 1: multiplying non-independent probabilities. The case of Sally Clark: motherhood under attack|title-link=Math on Trial}}
• {{cite web|title=Munchausen syndrome|publisher=Mayo Foundation for Medical Education and Research|date=13 May 2011|access-date=11 April 2013|url=https://members.mhn.com/web/public/default/Mayo/DS00965}}
• {{cite news |first=Abigail |last=Zuger |title=The Baron Strikes Again |newspaper=Discover magazine |date=July 1993 |url=https://www.discovermagazine.com/health/the-baron-strikes-again}}

{{refend}}

{{Wiktionary}}

{{Medical resources

| DiseasesDB = 8459

| diseasesDB_mult = {{DiseasesDB2|33167}}

| ICD10 = {{ICD10|F|68|1}}

| ICD9 = {{ICD9|301.51}}

| ICDO =

| OMIM =

| MedlinePlus =

| eMedicineSubj = med

| eMedicineTopic = 3543

| eMedicine_mult = {{EMedicine2|emerg|322}} {{EMedicine2|emerg|830}}

| MeshID = D009110

}}

{{Mental and behavioural disorders|selected = adult}}

{{Baron Munchausen}}

{{Authority control}}

Category:Forensic psychology

Category:Factitious disorders

Category:Psychopathological syndromes

Category:Baron Munchausen