USMLE® Step 1 style questions USMLE
A 3-year-old boy is brought to the emergency department to evaluate a cough. The mother states, “he’s been coughing all week, and I’m so worried he has pneumonia. We saw our pediatrician earlier today who said everything was fine, but he must be missing something!” The patient has a past medical history of NICU admission for respiratory distress in the newborn. He has since been without complications or recurrent hospitalizations. Chart review indicates that this is the patient's fourth emergency department visit for these symptoms over several months. Vital signs are within normal limits. Physical examination demonstrates a toddler playing with trucks on the ground with clear rhinorrhea from the nares. Cardiopulmonary auscultation is within normal limits. A chest radiograph is unremarkable. Which of the following is the most likely diagnosis?
Content Reviewers:Rishi Desai, MD, MPH
Contributors:Tanner Marshall, MS, Yifan Xiao, MD
Factitious disorder, which is sometimes called Munchausen syndrome, is where an individual fabricates or exaggerates physical or psychological symptoms because they enjoy being in the “sick role”.
These symptoms are sometimes faked but may also be induced; for example, a person with factitious disorder might purposefully ingest something to induce vomiting.
Factitious disorder is listed in the DSM-5 as a somatic symptom disorder.
But unlike other disorders in that group, individuals don’t experience any symptoms, nor are they concerned that they will develop any symptoms.
Factitious disorder can happen as a single episode, but generally individuals have recurrent hospitalizations and are very knowledgeable about the symptoms they are trying to pass off as real.
Individuals with factitious disorder are generally motivated by the attention and sympathy that they receive when pretending to be sick.
These motivations are often subconscious, which is to say that individuals often don’t even realize why they fabricate their symptoms.
Importantly, individuals with this disorder are usually not faking their symptoms for money, time off of work, access to medications, or any other obvious external reward; if this were the case, it’d be a psychological condition known as malingering.
A related diagnosis is “factitious disorder imposed on another” which is also called factitious disorder by proxy or Munchausen syndrome by proxy.
In this form of the disorder, one person deliberately makes a second person ill without that person’s knowledge.