Imagine purposefully trying to act sick in front of others even when you do not have a clear financial, legal, or other gain from doing so. This strange behaviour is a phenomenon of Factitious Disorder Imposed on Self (FDIS), where a person fakes physical or psychological symptoms or deliberately induces them, pretending to be ill or injured. This disorder is different from malingering in that the motivation for it is not linked specifically to external factors (Bérar et al., 2021). Therefore, FDIS is not just a form of “lying about being sick”; it is a complex set of behaviours that shows a convoluted pattern of the person’s emotional or psychological needs and their desire to occupy the role of a sick person.
Understanding Factitious Disorder Imposed on Self
FDIS belongs to the category of Somatic Symptom and Related Disorders and has three key features according to the DSM-5-TR. First, individuals fake or induce symptoms characteristic of deception. Second, they act sick or report to others that they are ill or injured. Third, people continue to pretend to be sick even in the absence of an apparent external incentive (Chen et al., 2026). No other mental disorders must not better explains the behaviour.
The term “Munchausen syndrome” is an older term historically used to describe a severe form of factitious disorder, particularly involving dramatic and recurrent presentations for medical care. Although the term is still sometimes used informally, FDIS is the terminology used in current diagnostic classifications. (Sousa Filho et al., 2017).
Notably, there is no proposed period of time before a person has to begin displaying symptoms of FDIS. An individual does not need to act in a certain way for a certain number of weeks or months. Diagnosis depends on identifying typical deceptive behaviour and ruling out other causes of the condition. A disorder may take the form of an isolated episode or persist as recurrent or chronic (Sousa Filho et al., 2017).
Aetiology: What Might Lead Someone To Do This?
The aetiology of FDIS is unknown, and there is no psychosocial history that is invariably associated with the disorder. Nevertheless, there are several general hypotheses about possible psychosocial influences. Histories of abuse, neglect, loss, and unstable relationships have been reported among some individuals (Kaur et al., 2025). These may often compromise their ability to develop normal methods of coping with stress and obtaining emotional support.
A common hypothesis about the development of FDIS focuses on the idea that illness provides an opportunity to gain love and attention from caregivers. In addition, patients may experience a sense of worth derived from receiving attention from others as well as the feeling of being dependent on them. Moreover, for some patients, the possibility of creating and controlling the disease is a chance to have power and dominance in their lives. These hypotheses should not be considered exclusively but are presented as potential factors that may contribute to the emergence of the disorder (Kaur et al., 2025).
In addition to the previously mentioned causes, a psychiatric condition can also exist alongside FDIS. According to the results of a systematic review including 455 cases, depression was diagnosed more often than personality disorder among cases with comorbid psychiatric problems (Yates & Feldman, 2016). Nevertheless, in most cases, the information was based on reports and clinical samples, which makes proving causality difficult.
Symptomatology and Behaviour
FDIS can manifest itself in several ways, both psychologically and physically. People may exaggerate, make up symptoms, or act as though they are ill or injured. There have been reports of pain, infections, convulsions, bleeding, anaemia, dermatological lesions, gastrointestinal issues, and other conditions (Kaur et al., 2025; Yates & Feldman, 2016).
Some behaviours that may arouse suspicions include repeated admissions, protracted investigations with contradictory results, inconsistent history gathering, frequent provider changes, overly familiar medical language, or a strong desire to be probed or treated (Hausteiner-Wiehle & Hungerer, 2020). However, none of the features taken individually can prove FDIS. One of us could also be suffering from a chronic disease or a difficult-to-identify ailment that also causes multiple visits and inconclusive tests. This is an important difference because mislabeling can cause damage to the patient.
Why Is The Diagnosis Difficult?
The central challenge to FDIS lies in the fact that it involves establishing intention of deception, which cannot be objectively identified via laboratory tests or scans. Indeed, in a 49-patient case series, direct evidence of patient falsification was discovered in only 20.4% of cases; more often, diagnosis was based on indirect evidence, such as atypical case presentation, high levels of healthcare utilisation, largely unrevealing investigation outcomes, inconsistent history, and treatment failure (Bérar et al., 2021).
In turn, FDIS has to be distinguished from malingering and somatic symptom disorder; in malingering, symptoms are intentionally fabricated to gain an external reward or to avoid an undesirable circumstance, e.g., a military assignment or paying taxes, whereas patients with a somatic symptom disorder do not aim to feign a symptom, and their suffering is not intentional. At the same time, patients with FDIS intentionally create false symptoms, but an external reward is rarely involved (Hausteiner-Wiehle & Hungerer, 2020).
Treatment and Ethical Challenges
Treatment becomes challenging as the patients may deny deception, reject the idea of a psychiatric disorder, and abandon treatment when confronted. Moreover, there is currently no established treatment known to have been positively proven effective against FDIS. The scoping review conducted in 2025 revealed that treatment literature was overwhelmingly comprised of treatment reports or series, and the quality of the body of studies was generally low (Liu et al., 2025).
However, psychotherapy may help patients in dealing with underlying feelings and emotions, as well as developing improved coping mechanisms, interpersonal relationships, and less dependence on the sick role, among other outcomes. Additionally, the management of comorbid psychiatric problems may play an important role in the treatment process (Eastwood & Bisson, 2008).
Ethically, clinicians should understand the need to stay committed to the patient while avoiding the tendency to cause him/her unnecessary medical harm. Unnecessary investigations, medication, and procedures may expose an individual to significant medical risks. Likewise, accusing an individual of “faking” can undermine the trust that has been built with a patient. This can potentially drive them away, which could lead to the person receiving treatment elsewhere. As such, a balanced approach that remains focused on facts is important. It should also avoid pressuring the patient to admit fault (Hausteiner-Wiehle & Hungerer, 2020).
Conclusion
Saying that someone only “wants attention” is not enough to explain FDIS. Although the behaviour is deliberate, it may be motivated by psychological demands. These may include identity, control, belonging, caring, or unresolved emotional issues. Knowing this difference becomes important since providing successful care should involve more than just exposing deception. Additionally, it should treat underlying psychological issues, minimise medical harm, and offer better options for the person to get assistance.
References +
- Bérar, A., Bouzillé, G., Jego, P., & Allain, J. S. (2021). A descriptive, retrospective case series of patients with factitious disorder imposed on self. BMC psychiatry, 21(1), 588. https://doi.org/10.1186/s12888-021-03582-8
- Chen, A., Levitt, T., Shadan, J., Akhavan, M., Siegel, R., & Defillo-Lopez, C. (2026). Factitious disorder imposed on self: Diagnostic challenges and clinical lessons. Cureus, 18(1), Article e102639. doi.org
- Eastwood, S., & Bisson, J. I. (2008). Management of factitious disorders: a systematic review. Psychotherapy and psychosomatics, 77(4), 209–218. https://doi.org/10.1159/000126072
- Hausteiner-Wiehle, C., & Hungerer, S. (2020). Factitious Disorders in Everyday Clinical Practice. Deutsches Arzteblatt International, 117(26), 452–459. https://doi.org/10.3238/arztebl.2020.0452
- Kaur, J., Gokarakonda, S. B., & Aslam, S. P. (2025, July 7). Factitious disorder overview. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK518999/
- Liu, R., Green, J., & Newton, R. (2025). A scoping review of treatment for Factitious disorder (imposed on self). Psychiatry Research Communications, 5(1), Article 100216. doi.org
- Sousa Filho, D., Kanomata, E., Feldman, R., & Maluf Neto, A. (2017). Munchausen syndrome and Munchausen syndrome by proxy: A narrative review. Einstein (São Paulo), 15(4), 516–521. doi.org
- Yates, G. P., & Feldman, M. D. (2016). Factitious disorder: A systematic review of 455 cases in the professional literature. General Hospital Psychiatry, 41, 20–28.
