Foreign body insertion causing obstruction or infection
Neurobiology
No established neurobiological mechanism unique to factitious disorder
Overlap with impulse control and compulsive behavior disorders proposed
Comorbid depression alters reward processing and reinforcement of illness behavior
Therapeutic Considerations
Evidence base for treatment
No randomized controlled trials for specific factitious disorder treatments
Systematic review by Eastwood and Bisson found insufficient evidence to recommend specific intervention
Multidisciplinary team approach associated with improved outcomes in case series
Confrontation approaches
Supportive confrontation preferred over direct confrontation
Non-punitive; face-saving; continued care assured
Non-confrontational approach: address psychological needs without formal accusation
Useful when evidence is insufficient for direct confrontation
Direct confrontation: reserved for cases with definitive evidence
Risk of immediate AMA departure; approximately 75% confronted but only 17% acknowledge self-induced illness
Prognosis and outcomes
Recovery from chronic factitious disorder is rare without sustained psychiatric engagement
Approximately 12% of confronted patients agree to psychiatric treatment
Many patients leave AMA or seek care elsewhere after diagnosis is raised
Suicide risk is real and should not be dismissed even when behavior appears manipulative
Long-term medical harm from invasive procedures and unnecessary treatments
Care coordination principles
Single primary care coordinator reduces fragmentation and hospital-shopping
Electronic health record flagging for pattern recognition across encounters
Pharmacy database review to identify medication-seeking across providers
Regular multidisciplinary case conferences to align management approach
Patient Discharge Instructions
copy discharge instructions
Discharge instructions for Factitious Disorder
You were treated for a medical condition that required attention to your health and safety
Your care team has arranged follow-up appointments to support your wellbeing
Primary care provider follow-up within 1 to 2 weeks of discharge
Psychiatry or mental health follow-up within 1 to 2 weeks if arranged
Medications after discharge
Take all prescribed medications exactly as directed
Do not take medications that were not prescribed to you
Bring a complete medication list to all follow-up appointments
Warning signs requiring return to emergency department
Fever above 38.5 degrees C or chills suggesting infection
Dizziness, sweating, shaking, or confusion suggesting low blood sugar
Unusual or excessive bleeding or bruising
Severe abdominal pain or vomiting
Altered mental status or loss of consciousness
Any thoughts of harming yourself or others
New wounds, skin changes, or symptoms that were not present at discharge
Mental health support resources
Contact your psychiatry outpatient team if distress increases before appointment
Crisis line available 24 hours: local crisis resources as applicable
Emergency department is available at any time for urgent medical or mental health needs
General wellness guidance
Regular meals and hydration to maintain stable blood sugar
Avoid alcohol and non-prescribed substances
Maintain all scheduled follow-up appointments
References
Guidelines and key sources
DSM-5-TR Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Text Revision
American Psychiatric Association 2022
Diagnostic criteria for Factitious Disorder Imposed on Self F68.10 and Factitious Disorder Imposed on Another F68.A
Yates GP, Feldman MD. Factitious Disorder: A Systematic Review of 455 Cases in the Professional Literature
General Hospital Psychiatry 2016
PMID 27302720
Largest systematic review; diagnostic clues, ICU admission rates, confrontation outcomes
Hausteiner-Wiehle C, Hungerer S. Factitious Disorders in Everyday Clinical Practice
Deutsches Arzteblatt International 2020
PMID 32897184
Clinical detection, laboratory clues, and management framework
Bass C, Halligan P. Factitious Disorders and Malingering: Challenges for Clinical Assessment and Management
Lancet 2014
PMID 24612861
Malingering versus factitious disorder distinction; assessment strategies
Eastwood S, Bisson JI. Management of Factitious Disorders: A Systematic Review
Psychotherapy and Psychosomatics 2008
PMID 18418027
Evidence base for psychiatric treatment; no RCT evidence for specific intervention
Jimenez XF, Nkanginieme N, Dhand N, Karafa M, Salerno K. Clinical, Demographic, Psychological, and Behavioral Features of Factitious Disorder
General Hospital Psychiatry 2019
PMID 30777298
Kinns H, Housley D, Freedman DB. Munchausen Syndrome and Factitious Disorder: The Role of the Laboratory
Annals of Clinical Biochemistry 2013
PMID 23592802
Laboratory detection of specimen tampering and surreptitious substance ingestion
Punko D, Onyeaka H, O'Sullivan I, et al. Factitious Disorder and Malingering in General Hospitals in the United States
Journal of Psychosomatic Research 2026
PMID 42096736
National Inpatient Sample 2017 to 2021; demographic and utilization analysis
Margolis M, Wong TL, Shmuts R, Taylor JB. Consultation-Liaison Case Conference: Factitious Disorder Imposed on Self
Journal of the Academy of Consultation-Liaison Psychiatry 2023
PMID 37499871
Beran A, Bouzille G, Jego P, Allain JS. Descriptive Retrospective Case Series of Patients With Factitious Disorder Imposed on Self
BMC Psychiatry 2021
PMID 34814866
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