Munchausen Syndrome · What Is It, Causes, Diagnosis, and More

Published: Oct 16, 2025

Author: Nikol Natalia Armata, MD•

Editor: Alyssa Haag, MD•

Editor: Emily Miao, PharmD, MD•

Editor: Kelsey LaFayette, DNP, ARNP, FNP-C

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What is Munchausen syndrome?

Munchausen syndrome, now known as factitious disorder imposed on self (FDIS) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), refers to a psychiatric condition in which an individual intentionally presents with a physical or mental illness or injury without actually having a health problem. In most cases, individuals with FDIS are seeking the attention of being a “patient.” Initially, their medical diagnosis may be characterized as medical mysteries as their clinical presentation and diagnostic workup can be inconsistent.

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What is Munchausen syndrome by proxy?

Munchausen syndrome by proxy, also now called factitious disorder imposed on another (FDIA), is another psychiatric condition in which caregivers act as if the individual they are taking care of—usually a child or an elderly adult—has a physical or mental health condition when the individual is actually healthy. FDIA is considered a form of abuse, as it often involves repetitive medical tests and/or unnecessary treatments inflicted on the patient by their caregiver. Notably, it has been observed that victims of individuals with FDIA may later on develop FDIS themselves.

What causes factitious disorder imposed on self?

The exact cause of FDIS is currently unknown, yet several common factors have been identified in the affected individuals. People with FDIS often experience traumatic childhood experiences, like abuse from family members, loss of a loved one at a young age, and abandonment. In such cases, it has been postulated that individuals pretend to have medical problems in order to receive the attention they never received.

What are the signs and symptoms of factitious disorder imposed on self?

Signs and symptoms of FDIS vary in presentation but mainly consist of multiple health care provider or hospital visits and admissions, due to frequent somatic complaints, such as chest and abdominal pain, vomiting and diarrhea, or weakness. Other common presentations include hypoglycemia, infections, seizures, headaches, vision loss, skin wounds, and arthralgias. Symptoms may even be intentionally generated by harming themselves, overdosing on medication, or performing another action that would then require the intervention of a health care provider. However, test results and clinical presentation typically differ, thereby creating a puzzling case for the health care professionals.

How is factitious disorder imposed on self diagnosed?

Diagnosing FDIS can often be challenging as the clinical presentation of individuals may be misleading, therefore, it’s frequently underdiagnosed. Individuals with FDIS usually have a long history of hospitalizations in many different hospitals and visits to multiple healthcare facilities, however, many refuse to share their medical records and the results of their medical tests.

The diagnosis is generally based on an individual’s medical history, as well as clinical presentation. The DSM-5 lists the four criteria required to confirm the diagnosis. Firstly, the individual must intentionally present to others as sick, harmed, or injured, fabricating physical or psychological signs and symptoms, or self-inducing injury or illness. Secondly, their deceptive behavior should be evident even in the absence of obvious external rewards. Thirdly, the presenting symptoms must not be better explained by another mental disorder, such as a delusional or depressive disorder. Underlying psychiatric conditions, like schizophrenia, should always be excluded. Finally, there must be evidence that the suspected individual is intentionally falsifying various medical conditions.

How is factitious disorder imposed on self treated?

The only effective treatment for individuals with suspected FDIS is psychotherapy. If individuals become aggressive and deny needing help when first approached with the diagnosis, it’s necessary to provide them with such support. It’s not necessary for the individual to admit their condition and notably, most of them never do.

However, cognitive-behavioral therapy (i.e., a form of psychotherapy that helps individuals modify dysfunctional thinking and behavior, as a way of solving current problems), targeted toward their childhood trauma, has shown to be effective in treating the condition. There isn’t robust evidence to support medications, like antidepressants or antipsychotics, are beneficial for FDIS.

What are the most important facts to know about factitious disorder imposed on self?

Munchausen syndrome, now known as factitious disorder imposed on self (FDIS), refers to a psychiatric condition in which an individual consciously fakes symptoms of illness without actually being sick or injured. The exact cause of FDIS is currently unknown, yet several factors, like traumatic childhood experiences, are common factors in individuals with this syndrome. The diagnosis is mainly based on four criteria according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Treatment mainly relies on psychotherapy and requires a supportive approach by health care professionals.

Key Takeaways

Definition	Munchausen syndrome, now known as factitious disorder imposed on self (FDIS), is a psychiatric condition in which an individual intentionally presents with a physical or mental illness or injury without actually having a health problem.
By Proxy	- Munchausen syndrome by proxy - Now called factitious disorder imposed on another (FDIA) - Psychiatric condition - Caregiver acts like person in their care (child, elderly adult) is ill when they’re actually healthy - Considered a form of abuse due to: - Repetitive medical tests - Unnecessary treatments inflicted on the patient by their caregiver - Victims of people with FDIA have higher risk of developing FDIS later
Causes	- Currently unknown - Many with FDIS have history of traumatic childhood experiences - May be seeking attention associated with being a patient to receive the attention they never received
Signs and Symptoms	- Multiple health care providers, hospital visits and admissions - Frequent somatic complaints - Chest and abdominal pain - Vomiting - Diarrhea - Weakness - Common presentations, either fabricated or self-induced - Hypoglycemia - Infections - Seizures - Headaches - Vision loss - Skin wounds - Arthralgias - Medication overdoses - Test results and clinical presentation are inconsistent, puzzling
Diagnosis	- Challenging - Misleading clinical presentation - History of many visits and hospitalizations in several facilities - Patient refusal to share medical records test results - Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria: - Intentionally present to others as sick, harmed, or injured (fabricated or self-induced) - Deceptive behavior is evident in absence of external rewards - Symptoms not explained by another mental disorder (delusional or depressive disorder, schizophrenia) - Evidence of intentionally falsifying medical conditions
Treatment	- Psychotherapy - Cognitive behavioral therapy (CBT)

References

Abeln B, Love R. An overview of Munchausen syndrome and Munchausen syndrome by proxy. Nurs Clin North Am. 2018;53(3):375-384. doi:10.1016/j.cnur.2018.04.005

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

Cardona L, Asnes AG. Disclosure of caregiver-fabricated illness to a child: A team-based approach to communicating with pediatric patients. Clin Child Psychol Psychiatry. 2019;24(3):494-502. doi:10.1177/1359104518816122

Faedda N, Baglioni V, Natalucci G, et al. Don't judge a book by its cover: Factitious disorder imposed on children-Report on 2 cases. Front Pediatr. 2018;6:110. Published 2018 Apr 18. doi:10.3389/fped.2018.00110

Melton L. Brief introduction to cognitive behavioral therapy for the advanced practitioner in oncology. J Adv Pract Oncol. 2017;8(2):188-193. doi:10.6004/jadpro.2017.8.2.6

Sirka CS, Pradhan S, Mohapatra D, Mishra BR. Cutaneous Munchausen syndrome by proxy: A diagnostic challenge for dermatologist. Indian Dermatol Online J. 2018;9(6):435-437. doi:10.4103/idoj.IDOJ_28_18